Advances in VT ablation for arrhythmogenic cardiomyopathy: evidence, mapping and ablation strategies, and predictive factors.

Catheter ablation of ventricular tachycardia (VT) in arrhythmogenic cardiomyopathy (ACM) is a crucial yet challenging procedure, given the evolving disease definitions, diverse subtypes, genetic variability, complexities in risk stratification, and the intricate substrate distribution characteristic of this condition. Initially described as a right ventricular cardiomyopathy (ARVC), ACM now encompasses left-dominant (ALVC) and biventricular (ABVC) phenotypes, driven by desmosomal (e.g., DSP, PKP2) and non-desmosomal (e.g., FLNC, LMNA) mutations, with fibrosis as the primary arrhythmic substrate. Catheter ablation, particularly combined endocardial-epicardial approaches, reduces VT burden but faces high recurrence rates in younger patients and those with extensive scarring. In this review, we critically assess the role of VT ablation in ACM, current evidence, available techniques for mapping and ablation, outcomes and predictors of success of the ablation procedure in this patient group.