Real-world characteristics and management of ventricular tachycardias in ICD patients: Data from the VIDEO registry

BACKGROUND: While VT ablation is increasingly recognized as effective, its real-world efficacy, risks, and outcomes require further investigation. This study aims to assess VT ablations in a real-world scenario using data from the German VIDEO registry. METHODS: We analyzed 801 ICD patients hospitalized with VT within the German VIDEO registry between 2018 and 2023. Among these, 145 patients (18%) underwent VT ablation. Characteristics and in-hospital outcomes were compared between patients with and without ablation. RESULTS: Patients (mean age 63 ± 14 years, 19% female) selected for VT ablation had fewer comorbidities. The ablation group had lower rates of diabetes mellitus (16.6% vs. 24.7%, p = 0.04), chronic kidney disease (11.0% vs. 25.0%, p < 0.01), and ischemic heart disease (55.9% vs. 68.1%, p < 0.01). In-hospital outcomes differed between groups, with fewer ICU admissions (39.3% vs. 55.5%, p < 0.01) and less need for mechanical ventilation (11.0% vs. 20.1%, p = 0.01) in the ablation group. Additionally, the ablation group experienced fewer serious arrhythmic events, including lower rates of ventricular fibrillation (8.3% vs. 17.2%, p < 0.01) and cardiac arrest (9.7% vs. 19.1%, p < 0.01) while in-hospital mortality did not differ significantly. CONCLUSION: In this real-world registry, about 20% of VT patients underwent catheter ablation. Patients undergoing ablation had fewer comorbidities, indicating substantial selection. Observed differences in in-hospital outcomes likely reflect the combination of patient selection for ablation and treatment effects.