title: Recent advances in ablation of ventricular tachycardia associated with structural heart disease: overcoming the challenges of functional and fixed barriers.
abstract: OBJECTIVE
  Ablation of ventricular tachycardia in structural heart disease has evolved to include techniques to ablate the myocardial substrate in sinus rhythm for ventricular tachycardias that are noninducible or hemodynamically unstable. The intricacies of the complex functional and fixed components of the myocardial scar involved in the arrhythmic mechanisms require careful consideration in identifying targets for substrate ablation identified in sinus rhythm.
  
  
  RESULTS
  The substrate ablation approach referred to as 'scar homogenization' aims to thoroughly abolish any abnormal electrical activity inside the scar. However, this extensive approach may target bystander abnormal activity that is not necessarily related to arrhythmias. Recently, different substrate ablation strategies have been developed to more selectively target areas of the scar responsible for ventricular tachycardia. New technologies have also been introduced to provide offline analysis of the electroanatomical substrate, and to improve high-density mapping of the myocardial scar.
  
  
  CONCLUSIONS
  Recent advances have improved the ability to ablate ventricular tachycardia using techniques that allow targeting the responsible myocardial substrate while in sinus rhythm. Further research using higher-density mapping with more sophisticated online and offline analysis will aid in the assessment of the complex arrhythmogenicity of the scar and improve efficacy of ventricular tachycardia ablation.
authors.affiliation: aMcGill University Health Center bCardiology Division, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke cHôpital Sacré-Coeur de Montreál, Montreal, Quebec, Canada dCardiology Department, Luigi Sacco Hospital, Milan, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Proietti
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Roux
authors.forename: Vidal
authors.initials: V
authors.lastname: Essebag
mesh_terms: D009202:Cardiomyopathies / Q000150:complications*; D017115:Catheter Ablation / Q000379:methods*; D004562:Electrocardiography; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D017180:Tachycardia, Ventricular / Q000209:etiology / Q000503:physiopathology / Q000601:surgery