title: Ablation of ischemic ventricular tachycardia: evidence, techniques, results, and future directions.
abstract: OBJECTIVE
  This article summarizes current understanding of the arrhythmia substrate and effect of catheter ablation for infarct-related ventricular tachycardia, focusing on recent findings.
  
  
  RESULTS
  Clinical studies support the use of catheter ablation earlier in the course of ischemic disease with moderate success in reducing arrhythmia recurrence and shocks from implantable defibrillators, although mortality remains unchanged. Ablation can be lifesaving for patients presenting with electrical storm. Advanced mapping systems with image integration facilitate identification of potential substrate, and several different approaches to manage hemodynamically unstable ventricular tachycardia have emerged. Novel ablation techniques that allow deeper lesion formation are in development.
  
  
  CONCLUSIONS
  Catheter ablation is an important therapeutic option for preventing or reducing episodes of ventricular tachycardia in patients with ischemic cardiomyopathy. Present technologies allow successful ablation in the majority of patients, even when the arrhythmia is hemodynamically unstable. Failure of the procedure is often because of anatomic challenges that will hopefully be addressed with technological progress.
authors.affiliation: Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Samuel H
authors.initials: SH
authors.lastname: Baldinger
authors.forename: William G
authors.initials: WG
authors.lastname: Stevenson
authors.forename: Roy M
authors.initials: RM
authors.lastname: John
mesh_terms: D017115:Catheter Ablation / Q000379:methods* / Q000592:standards*; D004562:Electrocardiography; D006801:Humans; D017202:Myocardial Ischemia / Q000209:etiology* / Q000601:surgery; D017410:Practice Guidelines as Topic; D017180:Tachycardia, Ventricular / Q000150:complications / Q000601:surgery*