Ventricular Tachycardia Ablation in Structural Heart Disease With LVEF > 35%: Clinical Outcomes and Recurrence Patterns

BACKGROUND: In patients with structural heart disease (SHD) and moderately impaired left ventricular ejection fraction (LVEF > 35%), data on outcomes after ventricular tachycardia (VT) ablation remain limited. This analysis focuses on VT recurrence after ablation in patients presenting with sustained VT and LVEF > 35% within a secondary-prevention population. OBJECTIVE: To evaluate procedural outcomes and long-term VT recurrence after catheter ablation in SHD patients with LVEF > 35%. METHODS: We analyzed 219 consecutive patients with SHD and LVEF > 35% undergoing VT ablation, including 89 with ischemic cardiomyopathy (ICM) and 130 with non-ischemic cardiomyopathy (NICM). Procedural characteristics, complications, and VT recurrence during follow-up were compared between groups. RESULTS: ICM patients were older, more frequently hypertensive, and had slightly lower LVEF than NICM patients. Ablation was predominantly endocardial in ICM, whereas combined endocardial-epicardial ablation was required in 28% of NICM patients (p < 0.001). Acute VT non-inducibility was achieved more frequently in ICM than in NICM (93% vs 67%; p < 0.001). Procedural complications were infrequent and comparable between groups (6% overall; p = 0.342). During follow-up, VT recurred in 35% of patients, more frequently in NICM than ICM (42% vs 25%; p = 0.004). Cardiomyopathy type emerged as the only independent predictor of VT recurrence (HR 2.312, CI 1.3-4.0, p = 0.004), while acute non-inducibility was associated with a lower recurrence risk. CONCLUSION: VT ablation in SHD patients with LVEF > 35% was associated with acceptable safety and moderate arrhythmia control. Outcomes were more favorable in ICM than in NICM, reflecting the heterogeneity of arrhythmic risk in this secondary prevention population.