Ventricular tachycardia exit site location within myocardial reinnervation zones predicts hemodynamic stability in ischemic cardiomyopathy

Q: What are the key findings of this study?

Ventricular tachycardia with exit site in the central scar zone increased odds of hemodynamic instability by 6.8-fold compared to peri-infarct border zone exit sites in males with ischemic scar-mediated VT.

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Male patients with ischemic scar-mediated ventricular tachycardia undergoing catheter ablation (n=27). Intervention: VT exit site location classification by voltage mapping (CSZ vs PIBZ) vs. VT exit site in central scar zone (CSZ) versus peri-infarct border zone (PIBZ). Primary outcome: Hemodynamic stability during ventricular tachycardia defined as sustained VT without precipitous blood pressure drop requiring cardioversion (OR 6.8, 95% CI 1.3-35.8, p=0.02).

Q: What does this research mean for the field?

Ventricular tachycardia with an exit site in the central scar zone increases the odds of hemodynamic instability by 6.8-fold compared to peri-infarct border zone exit sites in patients with ischemic scar-mediated VT. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Jorge L. Reyes; Saurabh Mehrotra; Lucy Q. Lin; Faris Haddadin; David G. Benditt; Venkatakrishna N. Tholakanahalli

doi:10.1007/s10840-026-02255-4

February 19, 2026Journal of Interventional Cardiac ElectrophysiologyOpen Access

Ventricular tachycardia exit site location within myocardial reinnervation zones predicts hemodynamic stability in ischemic cardiomyopathy

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Key result

Central scar zone VT exits linked to ~6.8-fold higher hemodynamic instability risk vs border zones.

OR 6.8
95% CI 1.3-35.8
P=0.02
n=27

Why the study?

Hemodynamic stability during ischemic VT critically influences mapping strategies and ablation outcomes, but whether VT exit site location within distinct myocardial scar zones affects stability was unknown.

Does VT exit site location within the central scar zone predict hemodynamic instability during ventricular tachycardia in patients with ischemic cardiomyopathy?

Key Points

To determine whether the location of ventricular tachycardia exit sites within distinct post-infarction myocardial scar zones predicts hemodynamic stability during arrhythmia.
Retrospectively analyzed 51 ventricular tachycardias across 27 male patients with ischemic cardiomyopathy undergoing electroanatomic mapping and catheter ablation between 2014 and 2017.
Categorized exit sites by bipolar voltage mapping into central scar zones (< 0.5 mV) or peri-infarct border zones (0.5–1.5 mV), defining hemodynamic instability as sustained arrhythmia causing blood pressure drops that necessitated cardioversion.
Identified independent predictors of hemodynamic instability using multivariate logistic regression adjusting for cycle length and ejection fraction.
Of 51 ventricular tachycardias, 30 (58.8%) were hemodynamically unstable, whereas 81% of stable arrhythmias had peri-infarct border zone exit sites compared to 19% in central scar zones (P = 0.01).
Central scar zone exit site location independently predicted hemodynamic instability (OR 6.8, 95% CI 1.3–35.8; P = 0.02) after adjustment for cycle length and ejection fraction.
Unstable tachycardias demonstrated significantly lower left ventricular ejection fractions (28.7 ± 10.5% vs. 35.7 ± 11.4%, P = 0.03) and shorter cycle lengths (330.5 ± 78.5 ms vs. 403.2 ± 107.7 ms, P = 0.007).

Study Design

Type

Observational (n=27)

Multicenter

No

Structured PICO

Does VT exit site location within the central scar zone predict hemodynamic instability during ventricular tachycardia in patients with ischemic cardiomyopathy?

P

Population

27 male patients with ischemic scar-mediated ventricular tachycardia (VT) undergoing electroanatomic mapping and catheter ablation, contributing 51 distinct VTs for analysis.

I

Intervention

VT exit site located in the central scar zone (CSZ, bipolar voltage < 0.5 mV)

C

Comparator

VT exit site located in the peri-infarct border zone (PIBZ, bipolar voltage 0.5-1.5 mV)

O

Outcome

Hemodynamic stability (defined as sustained VT without precipitous blood pressure drop below 70 mmHg requiring emergency cardioversion)

Main Result

Effect estimate: OR 6.8 (95% CI 1.3-35.8)

Absolute Event Rate: 19% vs 53.3%

p-value: p=0.02

Ventricular tachycardia exit sites located in the central scar zone are strongly associated with hemodynamic instability during VT, which can help risk-stratify patients and guide mapping and ablation strategies.

Limitations

Retrospective single-center study with modest sample size (27 patients, 51 VTs)
All study participants were male limiting generalizability to females
Scar zone classification based on voltage mapping without direct sympathetic innervation imaging
Potential confounding effects of antiarrhythmic drugs on VT characteristics and autonomic responses not systematically analyzed
Definition of hemodynamic instability not standardized but reflects real-world clinical practice
Lower LVEF in unstable VT group may be a confounder despite multivariate adjustment
Retrospective single-center study with a modest sample size (51 VTs in 27 patients)
Exclusively male population, limiting generalizability to female patients
No direct assessment of sympathetic innervation through 123I-MIBG imaging
Detailed autonomic function testing was not performed
Antiarrhythmic drugs were not systematically assessed for their potential confounding effects
Definition of hemodynamic instability was not standardized

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Implication

May aid intraprocedural risk stratification during ischemic VT ablation; hypothesis-generating and requires prospective validation.

Abstract

Purpose Hemodynamic stability during ischemic ventricular tachycardia (VT) critically influences mapping strategies and ablation outcomes. This study investigated whether VT exit site location within distinct myocardial scar zones affects hemodynamic stability. Methods We analyzed 51 VTs in 27 patients with ischemic scar-mediated VT who underwent electroanatomic mapping and catheter ablation (2014–2017). Exit sites were categorized by voltage mapping as adjacent to central scar zone (CSZ, bipolar voltage < 0.5 mV) or peri-infarct border zone (PIBZ, voltage 0.5–1.5 mV). Hemodynamic stability was defined as sustained VT without precipitous blood pressure drop requiring cardioversion. Multivariate logistic regression identified independent predictors of instability. Results Of 51 VTs, 30 (58.8%) were hemodynamically unstable. Among stable VTs, 81% had PIBZ exit sites versus 19% CSZ exits ( P = 0.01). CSZ exit site location independently predicted hemodynamic instability (OR 6.8, 95% CI 1.3–35.8; P = 0.02) after adjusting for cycle length and ejection fraction. Unstable VTs had lower ejection fraction (28.7 ± 10.5% vs. 35.7 ± 11.4%, P = 0.03) and shorter cycle length (330.5 ± 78.5 ms vs. 403.2 ± 107.7 ms, P = 0.007). Conclusions VT exit site location adjacent to distinct scar zones independently predicts hemodynamic stability. CSZ exits are associated with instability, while PIBZ exits maintain stability. These findings may reflect differential post-infarction reinnervation patterns and mechanical forces between scar zones, enhancing risk stratification and guiding ablation strategy selection in ischemic VT.

Cite This Study

Reyes et al. (2026) conducted an observational in Male patients with ischemic scar-mediated ventricular tachycardia undergoing catheter ablation (n=27). VT exit site location classification by voltage mapping (CSZ vs PIBZ) vs. VT exit site in central scar zone (CSZ) versus peri-infarct border zone (PIBZ) was evaluated on Hemodynamic stability during ventricular tachycardia defined as sustained VT without precipitous blood pressure drop requiring cardioversion (OR 6.8, 95% CI 1.3-35.8, p=0.02). Ventricular tachycardia with exit site in the central scar zone increased odds of hemodynamic instability by 6.8-fold compared to peri-infarct border zone exit sites in males with ischemic scar-mediated VT.

synapsesocial.com/papers/69994c14873532290d020534 https://doi.org/10.1007/s10840-026-02255-4

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Ventricular tachycardia exit site location within myocardial reinnervation zones predicts hemodynamic stability in ischemic cardiomyopathy

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Discussion

Implication

Abstract

Cite This Study

Ventricular tachycardia exit site location within myocardial reinnervation zones predicts hemodynamic stability in ischemic cardiomyopathy

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Discussion

Implication

Abstract

Cite This Study

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