Impact of Left Ventricular Ejection Fraction on Clinical Outcomes Following Ventricular Tachycardia Ablation: A Propensity-Matched Analysis from a Large Multicenter Database

Background Ventricular tachycardia (VT) ablation is an established therapy for patients with structural heart disease and recurrent VT. However, the impact of left ventricular function on peri-procedural and long-term outcomes remains incompletely understood. We evaluated the association of left ventricular ejection fraction (LVEF) on clinical outcomes after VT ablation. Methods We conducted a retrospective cohort study using the TriNetX Research Network (2010–2021) to evaluate outcomes after VT ablation, stratifying patients by LVEF (>30% vs. ≤30%). Propensity score matching (1:1) was used to balance baseline characteristics. The primary outcome was a 30-day composite safety endpoint defined as all-cause mortality, acute kidney injury (AKI), mechanical circulatory support (MCS) use, or cardiac tamponade. Secondary outcomes included 3-year all-cause mortality, ventricular arrhythmia recurrence, and rehospitalization. The individual components of the 30-day composite were evaluated in exploratory analyses. Results Among 2,549 patients who underwent VT ablation, 623 were matched in each subgroup. The 30-day composite safety endpoint was significantly lower in patients with LVEF >30% (17.9% vs. 26.3%; p=0.0004). In exploratory analyses, patients with LVEF ≤30% had higher 30-day mortality, AKI, and MCS use, while tamponade rates were similar between groups. At 3-year follow-up, all-cause mortality (15.2% vs. 28.7%) and rehospitalization (31.6% vs. 44.1%) remained significantly lower (p < 0.01) in the higher LVEF group. VT recurrence rates were high in both groups (71% vs. 67%) without a significant difference. Conclusion In this large real-world study, patients with LVEF >30% undergoing VT ablation experienced significantly better peri-procedural and long-term outcomes.