Ten‐Year Outcomes and Predictors of Mortality Following Catheter Ablation of Ventricular Tachycardia

BACKGROUND: Catheter ablation is the primary treatment option for idiopathic ventricular tachycardia (VT). It plays a key role in acute therapy of electrical storm, treatment of VTs in patients with structural heart disease (SHD), and can reduce VT burden. Here we report on 10-year clinical outcomes following VT ablation from patients enrolled in the prospective German Ablation Registry. METHODS AND RESULTS: Long-term follow-up was conducted on 334 patients undergoing VT ablation (118/334, 35%) with structurally normal hearts and 216 out of 334 (65%) with SHD, including 161 out of 216 (75%) with ischemic heart disease at 38 centers. Follow-up was completed in 94.8% of patients. Median observation time was 10.8 (4.3-12.3) years, with a 10-year all-cause mortality rate of 39.4%. VT ablation in patients with SHD was associated with worse outcome when compared with patients with structurally normal hearts (estimated 10-year mortality for SHD 54.8% versus structurally normal hearts 12.1%). Estimated 10-year mortality following VT ablation was highest in patients with ischemic heart disease (62.4%). Significant predictors of mortality following VT ablation included age (hazard ratio HR, 2.35 1.90-2.92 per decade), left ventricular ejection fraction ≤30% (HR, 2.11 1.44-3.10), diabetes (HR, 1.73 1.14-2.61), incessant VT (HR, 2.96 1.74-5.03), linear lesion (HR, 1.46 0.99-2.16), and acute procedural failure (HR, 2.57 1.39-4.77). Procedural failure was the only statistically significant predictor for VT recurrence during follow-up (HR, 3.76 1.59-8.91). CONCLUSIONS: Within an all-comer patient cohort, estimated 10-year all-cause mortality following VT ablation is 39.4%. Mortality after VT ablation is worse in patients with SHD and highest for patients with ischemic heart disease. Acute procedural success plays a major role in predicting VT recurrence and long-term mortality.