In scar-related ventricular tachycardia, what is a key management strategy?

• A. Immediate electrical cardioversion without substrate modification
• B. Catheter ablation of the VT substrate and/or ICD therapy
• C. Rate-control with beta-blockers only
• D. ICD therapy alone

Answer: (B)

Scar-related ventricular tachycardia comes from reentrant circuits that form around scar tissue after myocardial injury. The key goal is to disrupt that circuit by modifying the substrate, which is done with catheter ablation. By targeting the critical isthmus that sustains the reentry, ablation can reduce or even eliminate VT episodes and the associated hemodynamic instability and shocks. Because these patients remain at ongoing risk for life-threatening arrhythmias, an implantable cardioverter-defibrillator is usually included to provide immediate termination of VT or VF when it occurs and to offer ongoing protection. So, the strongest approach combines removing the substrate responsible for the VT with the safety net of ICD therapy. Relying on beta-blockers alone mainly controls rate and does not remove the circuit, and ICD therapy alone protects against consequences without addressing the underlying substrate. Immediate cardioversion is a rescue maneuver, not a definitive strategy for long-term VT suppression.