Catheter Ablation of Ventricular Tachycardias - Sooner Rather than Later

Background Catheter ablation of ventricular tachycardia (VT) secondary to structural heart disease is effective in the management of VT recurrence and implantable cardioverter defibrillator (ICD) therapies. Nevertheless, patients are often presented relatively late for catheter ablation in their clinical course.Objective The question relates to the optimal timing for catheter ablation, which is still today the subject of intense debate.Materials and Methods After the publication of the guidelines on the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death, three multicenter randomized controlled trials were published (PARTITA, PAUSE SCD and SURVIVE VT) trying to find the optimal timing of catheter ablation of VT.Results PARTITA, PAUSE SCD and SURVIVE VT were able to provide evidence that early VT ablation, i.e. after the first occurrence of a VT episode, not only resulted in a reduction in ICD therapies with a trend towards reduction in hospitalizations for recurrent arrhythmias and worsening heart failure but can also provide a mortality benefit.Conclusion Knowing the current study situation, the early initiation of catheter ablation in patients with structural heart disease should be considered after the first occurrence of a VT episode, in order not to miss positive effects. Larger studies are needed to determine the risk/benefit of first-line ablation and its optimal timing.