Key result
Catheter ablation linked to ~72% lower in-hospital mortality vs. medical therapy in ICD-naive VT.
Why the study?
The role of catheter ablation in high-risk patients presenting with ventricular tachycardia without an ICD is unclear, particularly regarding short-term in-hospital outcomes.
Does catheter ablation reduce in-hospital mortality and complications in ICD-naive patients hospitalized for ventricular tachycardia?
Cohort (n=2,214,424)
Yes
Does catheter ablation reduce in-hospital mortality and complications in ICD-naive patients hospitalized for ventricular tachycardia?
Odds Ratio: 0.28 (95% CI 0.24–0.32)
Absolute Event Rate: 3.17% vs 8.98%
p-value: p=<0.001
In a large, nationwide cohort of ICD-naive patients admitted with ventricular tachycardia, catheter ablation was associated with significantly improved short-term in-hospital survival and lower rates of STEMI and sepsis, despite a higher risk of procedural complications such as cardiac tamponade.
Ablation linked to lower mortality in this cohort; leaves open confirmation by randomized trials before practice change.
Ventricular tachycardia (VT) is a fatal arrhythmia, often managed with implantable cardioverter-defibrillators (ICDs). Many patients, however, present without an ICD. The role of catheter ablation in this high-risk group is unclear, particularly for short-term in-hospital outcomes. We assessed associations between ablation and in-hospital outcomes among ICD-naive VT patients using a large national dataset. We conducted a retrospective study using the National Inpatient Sample (2016-2021), identifying adult hospitalizations with VT. Patients with prior ICDs or ICD implantation during the same admission were excluded. The cohort was divided into those who underwent catheter ablation versus those managed without ablation. Multivariable logistic regression and 1:1 propensity score matching (PSM) adjusted for demographic, clinical, and hospital factors. The primary outcome was in-hospital mortality; secondary outcomes included ST-elevation myocardial infarction (STEMI), sepsis, major adverse cardiac events (MACEs) (death, STEMI, or cardiogenic shock), cardiogenic shock, tamponade, mechanical circulatory support (MCS), acute heart failure, and prolonged hospitalization (≥7 days). Of 2,214,424 VT hospitalizations, 32,640 (1.5%) underwent catheter ablation. After PSM (n = 12,668), ablation was associated with significantly lower rates of in-hospital mortality (3.17% vs. 8.98%; P < .001), STEMI (6.82% vs. 18.83%; P < .001), sepsis (3.38% vs. 10.34%; P < .001), and MACEs (15.82% vs. 28.40%; P < .001). However, ablation was associated with higher rates of cardiac tamponade (1.78% vs. 0.43%; P < .001), cardiogenic shock (9.14% vs. 7.12%; P < .001), and MCS use (5.04% vs. 3.71%; P < .001). Rates of acute heart failure and prolonged hospitalization were comparable. In ICD-naive VT patients, catheter ablation was associated with improved in-hospital survival and fewer complications, albeit with higher procedural risks.
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Al-Shammari et al. (2026) conducted a cohort in Ventricular Tachycardia (VT) (n=2,214,424). Catheter ablation vs. No ablation (medical management alone) was evaluated on In-hospital mortality (aOR 0.28, 95% CI 0.24-0.32, p=<0.001). Catheter ablation in ICD-naive patients hospitalized with ventricular tachycardia was associated with significantly lower in-hospital mortality (3.17% vs. 8.98%, aOR 0.28) compared to medical management alone.
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