Key result
Catheter ablation for VT in ICD patients is linked to ~41% lower in-hospital mortality despite procedural risks.
Why the study?
Catheter ablation is increasingly used in patients with ventricular tachycardia and an implantable cardioverter-defibrillator in situ, but its real-world safety and effectiveness remain underexplored.
Does catheter ablation reduce in-hospital mortality in adult patients with ventricular tachycardia and a prior ICD?
Cohort (n=395,290)
Yes
Does catheter ablation reduce in-hospital mortality in adult patients with ventricular tachycardia and a prior ICD?
Odds Ratio: 0.59 (95% CI 0.48–0.74)
p-value: p=<0.001
In patients with VT and prior ICDs, catheter ablation is associated with reduced in-hospital mortality and MACE, but carries significantly higher procedural risks such as cardiac tamponade and cardiogenic shock.
Caution against routine adoption from observational data alone; leaves open need for RCTs to confirm net benefit.
Background Catheter ablation is increasingly used in patients with ventricular tachycardia (VT) and an implantable cardioverter‐defibrillator (ICD) device in situ, but its real‐world safety and effectiveness remain underexplored in this high‐risk population. We aim to evaluate in‐hospital outcomes associated with catheter ablation in VT patients with a history of ICD implantation using a large, nationally representative dataset. Methods We performed a retrospective cohort study using the National Inpatient Sample (2016–2021) to identify adult hospitalizations with VT and prior ICD device insertion. Patients were stratified into ablation and non‐ablation groups. Propensity score matching was used to balance baseline characteristics. Primary outcome was in‐hospital mortality; secondary outcomes included acute heart failure, ST‐elevation myocardial infarction (STEMI), sepsis, major adverse cardiac events (MACE), and procedure‐related complications. Results Among 395,290 hospitalizations with VT and prior ICD, 4.9% underwent ablation. Catheter ablation remained independently associated with reduced in‐hospital mortality (adjusted odds ratio [aOR] = 0.59; 95% CI: 0.48–0.74), acute heart failure (aOR = 0.59; 95% CI: 0.54–0.64), ST‐elevation MI (aOR = 0.44; 95% CI: 0.36–0.54), and sepsis (aOR = 0.34; 95% CI: 0.26–0.45) (all p < 0.001). The composite MACE outcome also showed a reduced odds ratio for ablation (aOR = 0.76; 95% CI: 0.68–0.85; p < 0.001). However, ablation was also associated with higher odds of cardiac tamponade (aOR = 8.33; 95% CI: 5.92–11.73), cardiogenic shock (aOR = 1.36; 95% CI: 1.19–1.55), need for mechanical circulatory support (aOR = 5.36; 95% CI: 4.63–6.21), and prolonged hospital stay ≥ 7 days (aOR = 1.69; 95% CI: 1.57–1.82) (all p < 0.001). Conclusion In patients with VT and prior ICD implantation, catheter ablation is associated with improved in‐hospital outcomes but higher procedural risks. These findings support its selective use in experienced centers capable of managing complications.
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Al‐Shammari et al. (2026) conducted a cohort in Ventricular tachycardia with prior implantable cardioverter-defibrillator (n=395,290). Catheter ablation vs. Non-ablation was evaluated on In-hospital mortality (aOR 0.59, 95% CI 0.48-0.74, p=<0.001). Catheter ablation in patients with VT and prior ICD was associated with reduced in-hospital mortality (aOR 0.59; 95% CI 0.48-0.74; p<0.001) but higher procedural risks.
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