LAUSR

40% and a dual chamber implantable cardioverter defibrillator (ICD) or cardiac resynchronization device (AATAC trial). The ablation strategy went beyond PVI alone and included ablation of and mapping techniques for both substrates may further improve such outcomes and hopefully improve long-term success in the near future. extensive areas of the left atrium plus isolation of the superior vena cava in certain cases and redo procedures if necessary. The results showed that catheter ablation was superior to amiodarone in achieving freedom from AF during long-term follow-up. More stunning was that catheter ablation reduced unplanned hospitalizations and overall mortality, which needs to be confirmed in other trials. Another complex substrate with recent advances leading to clinical implications is ventricular tachycardia (VT) ablation in patients with underlying coronary artery disease and recurrent VT. The prospective, nonrandomized and multicenter Post-Approval THERMOCOOL VT trial has shown that VT ablation significantly reduced sustained monomorphic VT recurrences by 62% at the 6-month follow-up. Moreover, 41% of patients were free from VT after a 3-year follow-up. This outcome translated into a statistically significant decrease in hospitalizations, ICD shocks, and amiodarone use. The ablation approach to identify target sites was left to the investigators’ criteria, while recommending activation and entrainment mapping during VT to guide the ablation sites. Substrate characterization by voltage mapping, identification of split or late potentials and/or pace maps with long stimulus to QRS intervals, in which the QRS mimics the target VT, were recommended when VT was intolerable. Another step forward in VT ablation came from the VANISH trial, which was a multicenter, randomized study aiming to compare catheter ablation with continuation of baseline antiarrhythmic medications or escalated antiarrhythmic drug therapy in patients with prior myocardial infarction, ICD, and recurrent VT. Patients within the antiarrhythmic drug group were treated with amiodarone or amiodarone plus mexiletine. The primary outcome was a composite of death or VT storm or appropriate ICD shock after a 30-day treatment period, including as secondary outcomes all-cause mortality and hospital admissions for cardiac causes, among others. The ablation strategy was similar to that used in the postapproval THERMOCOOL VT trial. Catheter ablation demonstrated to be more effective than antiarrhythmic drug therapy in reducing the primary endpoint after 27.9 17.1 months of followup, although mortality did not significantly differ between groups. With respect to mortality, it is likely that this study was underpowered. Large registries indicate that VT ablation, especially in postinfarction patients, appears to reduce mortality if successfully performed (Figure). The best of catheter ablation in 2016 provides the first evidence of improved outcomes with decreased hospitalizations and possibly also mortality after AF ablation in heart failure patients, and reduced death or VT storms or appropriate ICD shocks after VT ablation in patients with an infarct-related substrate. New imaging