Radiofrequency catheter ablation (RFA) of recurrent sustained monomorphic ventricular tachycardia (SMVT) results in fewer implantable cardioverter-defibrillator (ICD) shocks and reduced need for antiarrhythmic drug therapy, but the optimal technique is unknown. In a 2019 systematic review of 17 nonrandomized studies, patients who underwent combined epicardial/endocardial versus endocardial RFA had lower rates of recurrent VT. Subset analysis suggested the benefit was confined to those with ischemic cardiomyopathy or arrhythmogenic right ventricular cardiomyopathy. Additional data are required, ideally from randomized trials comparing the two techniques, prior to recommending combined epicardial/endocardial over endocardial RFA for all patients with recurrent sustained monomorphic ventricular tachycardia(SMVT). UpToDate 2019.06.23
