Ablation of ventricular tachycardia in the setting of coronary artery disease.

Ablation of reentrant ventricular tachycardia (VT) is an accepted therapy for certain patients with VT caused by coronary artery disease (CAD). Its use is currently limited to patients with sustained, monomorphic, hemodynamically tolerated VT. The use of entrainment in mapping reentrant VT has made possible increasingly accurate localization of critical sites on the reentrant pathway that are amenable to ablation. Recent work has examined the accuracy with which various mapping criteria are able to predict successful ablation of reentrant VT in patients with CAD. Other recent studies have investigated attempted ablation of all inducible VTs in patients with multiple VT morphologies. In the future, substrate mapping may make possible ablation of VT in patients with nonsustained or fast, hemodynamically unstable VTs, thus allowing VT ablation to become a first-line therapy for many patients with VT in the setting of CAD.