Of the numerous non-surgical therapies available to treat ventricular tachycardia (VT), catheter ablation is the least practised but has great promise for increased use in the treatment of this difficult arrhythmia. The paper by Furniss and colleagues1 in this issue of Heart describes the successful application of catheter ablation to a population of patients hitherto regarded as being virtually untreatable in this way; those whose arrhythmia leads quickly to collapse. Is their experience reproducible? If so, does it represent a new limit for the technique or does it offer a glimmer of hope that all ventricular tachyarrhythmias, including ventricular fibrillation, might be treatable by catheter ablation?

Catheter ablation has become the treatment of choice for most supraventricular tachycardias (SVTs) with the sole exception, for the moment, of atrial fibrillation. This has occurred because of the treatment's efficacy (a success rate of at least 90%) and safety. Currently, when catheter ablation is applied to treat ventricular tachycardia (VT), the aim is to improve quality of life but not prognosis. This is so whether VT arises benignly within a normal heart or in the context of structural heart disease, when the patient's prognosis is ultimately determined by the severity of the underlying disease. In the former, success rates approaching those for ablation of accessory atrioventricular pathways can be anticipated2-7so that for many, usually young patients, ablation may, as with SVT, be the treatment of choice.

In patients with VT complicating structural heart disease, the complexity of the …