Sudden cardiac death (SCD) remains a major public health problem. The prevailing underlying mechanism of SCD is still ventricular tachycardia (VT) or ventricular fibrillation (VF) that may be triggered by different causes. Among different means to prevent ventricular arrhythmias, catheter ablation (CA) has emerged as an effective therapeutic method. In patients with structural heart disease, the main challenge for CA of ventricular tachyarrhythmias is the complex arrhythmogenicity of the myocardial scar. Therefore, identifying and effectively targeting the culprit areas of the myocardial scar remains a challenging task. The clinical correlation of this complex arrhythmia substrate is the high rate of VT recurrence after ablation, especially in patients with nonischemic cardiomyopathy. The feasibility of catheter ablation of VT associated with structural heart disease has improved dramatically with the use of substrate identification using the electroanatomical 3-D mapping systems.
This session will present recent advances in new mapping methods and ablation techniques, high-density multielectrode mapping, epicardial approach, bipolar ablation, infusion-needle ablation, arterial/venous chemical ablation; these advances aim to improve the understanding and characterization of the arrhythmic substrate to more specifically target for ablation and optimize procedural outcomes.