Journal of cardiovascular electrophysiology · 2026
Ventricular Tachycardia Ablation in Structural Heart Disease With LVEF > 35%: Clinical Outcomes and Recurrence Patterns.
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Waezsada Said-Elias, Khalaph Moneeb, Braun Martin, Fink Thomas, Sciacca Vanessa, Trajkovska Nadica, Lucas Philipp, Akkaya Ersan, Didenko Maxim, Hamriti Mustapha El, Imnadze Guram, Guckel Denise, Sohns Christian, Sommer Philipp, Darma Angeliki
Аннотация
BACKGROUND: In patients with structural heart disease (SHD) and moderately impaired left ventricular ejection fraction (LVEF > 35%), data on outcomes after ventricular tachycardia (VT) ablation remain limited. This analysis focuses on VT recurrence after ablation in patients presenting with sustained VT and LVEF > 35% within a secondary-prevention population.
OBJECTIVE: To evaluate procedural outcomes and long-term VT recurrence after catheter ablation in SHD patients with LVEF > 35%.
METHODS: We analyzed 219 consecutive patients with SHD and LVEF > 35% undergoing VT ablation, including 89 with ischemic cardiomyopathy (ICM) and 130 with non-ischemic cardiomyopathy (NICM). Procedural characteristics, complications, and VT recurrence during follow-up were compared between groups.
RESULTS: ICM patients were older, more frequently hypertensive, and had slightly lower LVEF than NICM patients. Ablation was predominantly endocardial in ICM, whereas combined endocardial-epicardial ablation was required in 28% of NICM patients (p < 0.001). Acute VT non-inducibility was achieved more frequently in ICM than in NICM (93% vs 67%; p < 0.001). Procedural complications were infrequent and comparable between groups (6% overall; p = 0.342). During follow-up, VT recurred in 35% of patients, more frequently in NICM than ICM (42% vs 25%; p = 0.004). Cardiomyopathy type emerged as the only independent predictor of VT recurrence (HR 2.312, CI 1.3-4.0, p = 0.004), while acute non-inducibility was associated with a lower recurrence risk.
CONCLUSION: VT ablation in SHD patients with LVEF > 35% was associated with acceptable safety and moderate arrhythmia control. Outcomes were more favorable in ICM than in NICM, reflecting the heterogeneity of arrhythmic risk in this secondary prevention population.
OBJECTIVE: To evaluate procedural outcomes and long-term VT recurrence after catheter ablation in SHD patients with LVEF > 35%.
METHODS: We analyzed 219 consecutive patients with SHD and LVEF > 35% undergoing VT ablation, including 89 with ischemic cardiomyopathy (ICM) and 130 with non-ischemic cardiomyopathy (NICM). Procedural characteristics, complications, and VT recurrence during follow-up were compared between groups.
RESULTS: ICM patients were older, more frequently hypertensive, and had slightly lower LVEF than NICM patients. Ablation was predominantly endocardial in ICM, whereas combined endocardial-epicardial ablation was required in 28% of NICM patients (p < 0.001). Acute VT non-inducibility was achieved more frequently in ICM than in NICM (93% vs 67%; p < 0.001). Procedural complications were infrequent and comparable between groups (6% overall; p = 0.342). During follow-up, VT recurred in 35% of patients, more frequently in NICM than ICM (42% vs 25%; p = 0.004). Cardiomyopathy type emerged as the only independent predictor of VT recurrence (HR 2.312, CI 1.3-4.0, p = 0.004), while acute non-inducibility was associated with a lower recurrence risk.
CONCLUSION: VT ablation in SHD patients with LVEF > 35% was associated with acceptable safety and moderate arrhythmia control. Outcomes were more favorable in ICM than in NICM, reflecting the heterogeneity of arrhythmic risk in this secondary prevention population.