Role of transcatheter ablation in ischaemic ventricular tachycardia: should we be using it more?

Ischaemic ventricular tachycardia (VT) represents a major cause of morbidity and mortality in patients with ischaemic heart disease. Transcatheter ablation has emerged as a complementary therapeutic strategy to implantable cardioverter-defibrillators (ICDs) and antiarrhythmic drug therapy. The efficacy, safety, optimal timing, and cost-effectiveness of catheter ablation justify its current role in patients with ischaemic cardiomyopathy who undergo device-based interventions. Randomized clinical trials, including VANISH, VANISH2, and PARTITA, have demonstrated that early ablation significantly reduces VT recurrence and ICD shocks compared with antiarrhythmic drug therapy alone. First-line ablation in patients with preserved left ventricular systolic function (LVEF >35%) is associated with excellent long-term outcomes and low rates of sudden cardiac death. Recent advances in functional substrate mapping techniques have further improved procedural outcomes. Periprocedural mortality remains low (0.4-5%) and is mainly attributable to early VT recurrence rather than procedural complications. Current evidence supports a broader use of catheter ablation in ischaemic VT, which has historically been confined to high-volume centres, and particularly suggests its adoption as an early or first-line strategy in selected patients.