A comparative analysis of the safety of ventricular arrhythmia ablation in patients undergoing procedures for ventricular tachycardia and premature ventricular contractions

Background Catheter ablation is an established therapy for ventricular tachycardia (VT) and premature ventricular complexes (PVC). Despite growing experience and improved procedural techniques, careful patient selection and continuous improvement in the performance of the procedure are essential for achieving better outcomes. Purpose This study aims to assess the incidence, types and predictors of complications following ventricular arrhythmia ablation by comparing outcomes between patients treated for VT and those undergoing PVC ablation. Methods A retrospective analysis was performed on consecutive patients undergoing catheter ablation for ventricular arrhythmias. Clinical characteristics, comorbidities, procedural features including vascular access and pharmacotherapy were evaluated in relation to complications. Patients with and without complications were compared using standard statistical tests for categorical and continuous variables. A p < 0.05 was considered statistically significant. Results A total of 404 patients (292 men, 72%) with a median age of 62 years (IQR 50–70) were included, comprising 205 patients treated for VT and 199 for PVC. Structural heart disease was present in 97% of VT and 28.1% of PVC patients, predominantly of ischaemic origin. Adverse events (AE) occurred in 31 patients (7.7%), including 23 (5.7%) with procedural complications - types and rates shown in Figure 1. Some patients experirnced more than one event. Late complications (≤30 days) occurred in 3 patients (0.7%): 1 transient ischemic attack and 2 patients with heart failure excerebration. No deaths were recorded. AE were observed more frequently in patients with heart failure NYHA IV (p=0.016), coronary artery disease (p=0.002), and in those after transseptal puncture (p<0.001). Patients with VT had higher incidence of AE (p=0.005) and in procedures performed for VT storm (p=0.037). Hyperthyroidism requiring pharmacological treatment was also more frequent among patients suffering from AEs (p< 0.001). In the PVC group complications were generally mild, although rare severe events were observed. Lower complication rate was noted in right ventricular procedures (p=0.031). Interestingly, treated anxiety-depressive reactions were observed in almost 11.6% of patients. Conclusions Ventricular arrhythmia ablation was associated with a low overall complication rate of 5.7%, and no deaths occurred. AEs occur more frequently in VT than in PVC procedures. Older patients with structural heart disease, advanced heart failure or anxiety disorder appear particularly vulnerable. Identifying these high-risk profiles may enhance preprocedural planning and improve procedural safety in clinical practice. These findings confirm the favourable safety profile of ventricular arrhythmia ablation, regardless considerable clinical burdens, while emphasising the need for careful periprocedural monitoring in patients identified as having a higher risk of AEs.