What does scar homogenization refer to in VT ablation?

• A. Ablating within scar tissue to eliminate channels and slow conduction that sustain VT, aiming to homogenize the scar substrate.
• B. Removing scar tissue completely to prevent any conduction.
• C. Isolating the pulmonary veins.
• D. Creating new scar tissue to slow heart rate.

Answer: (A)

Scar homogenization means delivering ablation within scarred heart tissue to eliminate the surviving conducting channels that form reentrant VT circuits, with the goal of turning the scar into a uniform nonconductive substrate. In scar-related VT, live-looking channels can thread through scar tissue and support slow conduction paths that sustain reentry. By extensively ablating throughout the scar and its channels, you remove these pathways and make the entire scar region electrically uniform, preventing the circuits from being able to reenter. This is why the approach focuses on homogenizing the substrate rather than just isolating a single channel or removing all scar. It’s not about isolating veins or creating new scar solely to slow rate; those aren’t the targets of this technique.