2025年，室性心律失常领域取得突破性进展，诊疗策略呈现三大转向：治疗策略前移、管理维度拓宽与技术持续革新。欧洲心律协会联合多学会发布首部《心外膜室性心律失常消融临床共识声明》，从解剖学特征、基质识别、穿刺路径及并发症防控等方面建立了标准化流程，推动技术规范化；欧洲心律协会联合美国心律协会首次发布《室性心动过速（室速）立体放疗的患者选择、靶区定义和数据转移》，这是业内首次对立体定向放疗治疗室速的全面技术总结性文件。三项标志性临床研究重塑实践范式：VANISH2试验证实，对于缺血性心肌病伴室速患者，导管消融作为一线治疗在降低复合终点事件方面优于抗心律失常药；POTCAST试验开创了代谢干预新维度，证明主动提升血钾水平至正常高值（4.5~5.0 mmol/L）可显著降低植入型心律转复除颤器患者室速事件与住院风险；VCAS试验验证了高压脉冲电场消融在器质性室速中的可行性，首次在人体中实现经心内膜单路径透壁消融，显著降低了室速负荷。上述进展从策略、理念到技术层面，共同构建了更立体、更主动的室性心律失常诊疗新体系，为临床决策提供了基于循证医学的清晰路径。

Significant progress has been made in the management of ventricular arrhythmias in 2025, characterized by three paradigm shifts: earlier therapeutic intervention, expanded management dimensions, and continuous technological innovation. The European Heart Rhythm Association, in collaboration with multiple societies, released the first international consensus statement on epicardial ventricular arrhythmia ablation, establishing standardized protocols encompassing anatomical considerations, substrate identification, access techniques, and complication prevention. The European Heart Rhythm Association, in collaboration with the Heart Rhythm Society, has released the first-ever consensus document on patient selection, target definition, and data transfer for stereotactic radiotherapy in ventricular tachycardia. This document represents the first comprehensive technical summary of stereotactic radiotherapy for the treatment of ventricular tachycardia in the field. Three landmark clinical trials have reshaped clinical practice, VANISH2 demonstrated that catheter ablation as first-line therapy was superior to antiarrhythmic drugs in reducing composite endpoints in ischemic cardiomyopathy patients with ventricular tachycardia. POTCAST pioneered a metabolic intervention approach by showing that actively maintaining serum potassium in the high-normal range (4.5-5.0 mmol/L) significantly reduced ventricular tachycardia events and hospitalizations in implantable cardioverter defibrillator recipients. VCAS validated the feasibility of high-voltage pulsed field ablation for structural ventricular tachycardia, achieving transmural lesions via endocardial-only approach in humans and dramatically reducing arrhythmia burden. Collectively, these advances, spanning from treatment strategies and clinical concepts, to ablation technologies, are shaping a more comprehensive and proactive paradigm for ventricular arrhythmia management, offering evidence-based guidance for clinical decision-making.