Outcomes following catheter ablation for structural ventricular tachycardia stratified by left ventricular ejection fraction: A retrospective cohort study.

BACKGROUND

Despite advances in catheter ablation for ventricular tachycardia (VT), patients with lower left ventricular ejection fractions (LVEFs) tend to have worse outcomes. However, there is limited understanding of the periprocedural factors associated with recurrence, and whether LVEF directly influences outcomes.

OBJECTIVES

The study sought to evaluate the electrophysiological characteristics and outcomes of patients undergoing VT ablation, stratified by LVEF.

METHODS

Adults (≥18 years of age) who underwent VT ablation at Mayo Clinic Rochester or Mayo Clinic Health System between January 1, 2012, and January 1, 2023, were included. Data were collected through chart review, and categorized by LVEF (<25%, 25%-49%, ≥50%). The primary outcome was VT recurrence. Logistic regression, robust linear regression, and survival analysis were utilized.

RESULTS

A total of 448 patients underwent 566 ablations. Significant differences were observed in VT recurrence at 1 year based on LVEF (<25%: 36.7%; 25%-49%: 32.3%; ≥50%: 22.2%; .014). Those with LVEF <25% had higher recurrence compared with the ≥50% group (hazard ratio 2.27, 95% confidence interval [CI] 1.46 to 3.54, .001). A significant trend toward lower VT recurrence over time was observed (-1.15% per year, 95% CI -1.72% to -0.58%, .001). Factors associated with higher recurrence included underlying atrial arrhythmia, postablation VT inducibility, and antiarrhythmic use. Hemodynamic instability at baseline was associated with lower odds of recurrence (adjusted odds ratio 0.38, 95% CI 0.17 to 0.83, .017), with differences in demographic and procedural characteristics, including higher energy delivery times.

CONCLUSION

Lower LVEF was associated with higher VT recurrence, but after adjustment, this difference appeared to be driven by other factors, such as comorbid conditions.