Complications of catheter ablation for ventricular tachycardia and premature ventricular contractions: a systematic review and meta-analysis

Background Catheter ablation is widely used for ventricular tachycardia (VT) and premature ventricular complexes (PVCs) yet reported complication rates vary. Objectives To quantify procedure-related complications and formally assess between-study heterogeneity in VT and PVC ablation. Methods We systematically searched PubMed and Embase for human studies reporting complications of VT or PVC ablation. Case reports/series <10 patients and duplicate registry publications were excluded. Study-level data were extracted. Proportions were pooled using common-effect and random-effects models; heterogeneity was summarized with I². Results Thirty-two studies were included: 26 VT cohorts (58,514 patients; 59,005 procedures) and 8 PVC cohorts (1,555 patients; 2,158 procedures). VT populations were older (pooled mean 62.4±15.0 years) with structural heart disease (pooled prevalence 46.6%) and reduced LVEF (pooled mean 36.3±14.6%); PVC cohorts were younger (pooled mean 53.2±15.9 years) with predominantly structurally normal hearts (pooled prevalence of SHD 14.5%). In VT ablation, random-effects pooled proportions were: tamponade/pericardial effusion 1.99% (95% CI 1.29–3.05; I²=92.5%), major bleeding 1.23% (95% CI 0.61–2.46; I²=91.4%), cerebrovascular events 0.69% (0.53–0.89; I²=37.5%), and procedure-related death 0.76% (0.52–1.11; I²=19.7%). In PVC ablation, pooled risks were lower: tamponade/pericardial effusion 1.21% (0.41–3.53; I²=90.3%), major bleeding 0.29% (95% CI 0.011–0.78; I²=0.0%), and cerebrovascular events 0.10% (0.01–0.71; I²=0%); no procedure-related deaths were reported across included PVC cohorts. Complication rates were higher in series with a substantial rate of epicardial procedures. Conclusion In >60,000 patients, complication rates were higher in VT than PVC ablation, with substantial between-study heterogeneity driven by procedural complexity and differences in definitions of complications used across studies. Large collaborative registries and individual patient–level meta-analyses are needed to generate accurate estimates and predictors of complications in contemporary VT and PVC ablation practice.