Key result
LV papillary muscle VT exit sites comprise ~33% of HF cases and are linked to higher recurrence.
Why the study?
Substrate characteristics and outcomes of VT ablation in patients with reduced LVEF are not well described.
Does the presence of a ventricular tachycardia exit site at the left ventricular papillary muscle affect VT recurrence and mortality in heart failure patients with LVEF <35% undergoing catheter ablation?
Does the presence of a ventricular tachycardia exit site at the left ventricular papillary muscle affect VT recurrence and mortality in heart failure patients with LVEF <35% undergoing catheter ablation?
In heart failure patients with LVEF <35% undergoing VT ablation, a VT exit site at the left ventricular papillary muscle is associated with significantly higher VT recurrence and a trend toward increased 1-year mortality.
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Prompts closer follow-up after VT ablation in HFrEF; leaves open whether enhanced papillary muscle ablation improves outcomes.
Background & Aims Ventricular tachycardia (VT) is common in heart failure (HF) with up to 20% of patients with HF experiencing VT. However, substrate characteristics and outcomes of VT ablation in a population with reduced left ventricular ejection fraction (LVEF) are not well described. This study aimed to: (i) evaluate the substrate characteristics in patients with HF with VT, in particular the role of papillary muscles (PM); and (ii) evaluate the outcomes of catheter ablation, including VT recurrence and mortality. Methods This is a retrospective single-centre study, including patients with LVEF <35% and sustained monomorphic VT undergoing VT ablation. Procedural characteristics, VT substrate characteristics and clinical outcomes were evaluated. Intracardiac echocardiography was used to identify abnormalities in PM. Results A total of 48 patients were included (age 68±11 years; males 93%; LVEF 27±6%; ischaemic cardiomyopathy 56%; non-ischaemic cardiomyopathy 39%; mixed cardiomyopathy 4%). The main findings were: (i) 33% of the VT exit sites were located at LV PM; (ii) 68% patients had LV PM abnormal tissue characteristics on intracardiac echocardiography; however, such characteristics were not indicative of VT exit; (iii) the presence of VT exit in the LV PM was associated with a higher rate of VT recurrence (log-rank p=0.03), and a trend towards higher mortality at 1 year (log-rank p=0.07). Conclusions In patients with LVEF <35%, VT with endocavitary structures as exit sites is not uncommon. Patients with VT exiting at the LV PM have worse clinical outcomes with higher VT recurrence and mortality.
So et al. (2026) studied this question. Ventricular tachycardia exiting at the left ventricular papillary muscle accounts for 33% of exit sites in heart failure patients and is associated with a higher rate of VT recurrence (p=0.03).
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