What is the clinical evidence from this study?

Study design: Observational. Population: Ventricular tachycardia with structural heart disease (n=122). Intervention: Catheter ablation vs. Ischemic cardiomyopathy (ICM). Primary outcome: Cardiovascular mortality (HR 0.69, 95% CI 0.34-1.43, p=0.32).

What does this research mean for the field?

Catheter ablation for ventricular tachycardia in elderly patients results in comparable cardiovascular mortality and ventricular arrhythmia recurrence rates between those with non-ischemic and ischemic cardiomyopathy. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

April 3, 2026Open Access

Clinical outcomes of ischemic and non-ischemic cardiomyopathy following catheter ablation for ventricular tachycardia among elderly patients

KHKenji HashimotoWestmead Hospital STSamual TurnbullElectrophysiology MBMax BickleyThe University of Sydney

Key Result

Catheter ablation for ventricular tachycardia in elderly patients resulted in comparable cardiovascular mortality between non-ischemic and ischemic cardiomyopathy groups (HR 0.69).

Key Points

Evaluate the outcomes of catheter ablation for ventricular tachycardia in elderly patients with ischemic and non-ischemic cardiomyopathy.
Retrospective analysis of patients aged ≥70
Comparison of outcomes between NICM and ICM groups
Assessment of demographic, mapping, procedural, and long-term outcomes
No significant demographic differences between NICM and ICM groups besides left ventricular ejection fraction
Similar rates of ventricular arrhythmia recurrence and cardiovascular mortality between groups
Estimated one-year VA-free survival rates were 64.6% for NICM and 74.9% for ICM
Higher risk of cardiovascular mortality associated with VA recurrence (hazard ratio 2.12)

Study Design

Type

Observational (n=122)

Multicenter

Structured PICO

Does catheter ablation for ventricular tachycardia yield comparable outcomes in elderly patients with non-ischemic cardiomyopathy versus ischemic cardiomyopathy?

Population

122 patients ≥ 70 years with structural heart disease (52 with non-ischemic cardiomyopathy [NICM] and 70 with ischemic cardiomyopathy [ICM]) who underwent catheter ablation for ventricular tachycardia at a tertiary center in Australia. Mean age 76.5 (NICM) and 76.6 (ICM) years, predominantly male.

Intervention

Catheter ablation for ventricular tachycardia in elderly patients with non-ischemic cardiomyopathy (NICM)

Comparator

Catheter ablation for ventricular tachycardia in elderly patients with ischemic cardiomyopathy (ICM)

Outcome

Cardiovascular mortalityhard clinical

Catheter ablation for ventricular tachycardia is feasible and yields comparable long-term cardiovascular mortality and arrhythmia-free survival in elderly patients with either non-ischemic or ischemic cardiomyopathy.

Main Result

Effect estimate: HR 0.69 (95% CI 0.34-1.43)

Absolute Event Rate: 21% vs 33%

p-value: p=0.32

Limitations

Retrospective study design with potential selection bias
Data derived from a single tertiary referral center
Procedures routinely performed under general anesthesia, limiting generalizability
Electroanatomic mapping analysis was only performed in patients who underwent complete substrate mapping
Preprocedural cardiac magnetic resonance imaging was only available in four NICM patients
No medically treated comparison arm to assess efficacy versus medical therapy alone

Abstract

Catheter ablation (CA) is an effective treatment for ventricular tachycardia (VT), but its role in elderly non-ischemic cardiomyopathy (NICM) patients remains unclear. We aim to evaluate the feasibility of VT ablation in this population by comparing outcomes with elderly ischemic cardiomyopathy (ICM) patients. We retrospectively analyzed patients ≥ 70 years with structural heart disease who underwent VT ablation at a tertiary center from 2016 to 2024. Patients were categorized as NICM (n = 52) or ICM (n = 70), and demographic, mapping, procedural, and long-term outcomes were compared. The mean age was 76.5 ± 5.2 and 76.6 ± 4.6 years in the NICM and ICM groups. The baseline demographic data were not different except for a lower left ventricular (LV) ejection fraction in the ICM group. The LV substrate map showed larger overall scars in ICM, whereas NICM had a relatively larger unipolar than bipolar scar, suggesting intramural substrate. In NICM, scars commonly involved the perivalvular region, with frequent basal septal involvement. During a median follow-up of 819 days, the rates of VA recurrence after multiple procedures and cardiovascular mortality were similar between the groups. The estimated one-year VA-free survival was 64.6 ± 7.0% in NICM and 74.9 ± 5.5% in ICM (log-rank P = 0.19), while cardiovascular mortality-free survival was 84.0 ± 5.2% and 85.7 ± 4.2%, respectively (log-rank P = 0.32). Furthermore, VA recurrence was associated with a higher risk of subsequent cardiovascular mortality (hazard ratio 2.12, 95% confidence interval 1.06–4.22, P = 0.03). CA for VT in elderly patients demonstrated comparable feasibility in both ICM and NICM. Effective VT control may contribute to favorable survival outcomes.

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