Evolution of ventricular tachycardia ablation in structural heart disease

The field of catheter ablation of VT has evolved conceptually and technologically over the past three decades. From the fundamental understanding of the reentrant mechanism in scar-mediated VT to the advent and routine implementation of electroanatomic mapping, catheter ablation has emerged from a palliative last-resort therapy to a more preemptive strategy for patients at risk for arrhythmia recurrence. An increasing utilization of pre-procedural imaging, high-density mapping, epicardial access, and more extensive ablation strategies have all contributed to improved clinical success. Advances in ablation technology and randomized trials are needed to build upon the progress in this growing field as sudden cardiac death from ventricular tachyarrhythmia continues to be the one of leading causes of death throughout the world. (C) 2014 Japanese Heart Rhythm Society. Published by Elsevier B.V. All rights reserved.