Is VF an Ablatable Rhythm?

OPINION STATEMENT: Ventricular fibrillation (VF) has traditionally been considered to be a disorganized arrhythmia not amenable to catheter ablation. However, a better understanding of the VF pathophysiology has allowed identification of targets for ablation. Ablation targeting the premature ventricular complexes which trigger VF was proven to be associated with high success rates and long-term freedom from VF recurrence. Recent mapping data has identified rotors, focal breakthroughs, and figure of eight re-entries as main drivers maintaining human VF. Most interestingly, the type and the spatiotemporal behavior of these drivers are reproducible between different VF episodes. In addition, drivers are usually clustered at the scar borders. This has ushered in a new era of ablation targeting the VF substrate and the drivers maintaining VF with promising results.