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VT Ablation — RACP Adult Medicine MCQ

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HardCardiologyVT AblationRACP Adult Medicine

A 62-year-old man with known alcoholic cardiomyopathy (LVEF 20%) presents with sustained monomorphic VT. He is haemodynamically stable. Amiodarone infusion is commenced but VT recurs after conversion. He has declined an ICD. What catheter-based therapy can reduce VT recurrence?

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Correct answer: C — Pulmonary vein isolation

Catheter ablation for recurrent sustained monomorphic VT in structural heart disease reduces VT recurrence and ICD shocks. It involves identifying and ablating the re-entrant circuit (scar-mediated re-entry). The VANISH trial showed VT ablation was superior to escalated antiarrhythmic therapy in patients with ischaemic cardiomyopathy and recurrent VT despite amiodarone. In patients who decline or are not candidates for ICD, VT ablation plus antiarrhythmic therapy is the primary management strategy.

Reference: eTG – 2025 – Cardiovascular; ESC – 2022 – Ventricular Arrhythmia Guidelines