Is age still a barrier in ventricular tachycardia ablation? A study of safety, efficacy and clinical outcomes in the elderly

Background Ventricular tachycardia (VT) catheter ablation is an established therapy in patients with structural heart disease (SHD), yet its use in elderly populations remains limited due to concerns regarding procedural risk and outcomes. This study aimed to evaluate the safety, efficacy, and clinical outcomes of VT ablation across different age groups. Methods We performed a retrospective analysis of 142 consecutive patients with SHD who underwent radiofrequency catheter ablation (RFCA) for sustained monomorphic VT between 2013 and 2025. Patients were stratified into three age groups: ≤64 years ( n = 71), 65–74 years ( n = 40), and ≥75 years ( n = 31). Primary endpoints included procedural safety and acute procedural success. Secondary endpoints assessed at 24 months were arrhythmic recurrence, appropriate implantable cardioverter-defibrillator (ICD) therapies, cardiovascular hospitalizations (CVH), and all-cause mortality. Results Acute procedural success rates were similar across age groups (complete success: 76.05% vs. 72.5% vs. 77.42%, p = 0.87), with no significant differences in minor or major complication rates. At 24 months, arrhythmic recurrence (36.62% vs. 40% vs. 45.16%, p = 0.68) and appropriate ICD therapies (32.4% vs. 35% vs. 25.8%, p = 0.74) were comparable between groups. In contrast, CVH increased significantly with age (43.66% vs. 57.5% vs. 70.96%, p = 0.02), as did all-cause mortality (8.45% vs. 22.5% vs. 25.8%, p = 0.03). Conclusions VT ablation in elderly patients with SHD demonstrates comparable procedural safety and arrhythmic efficacy to younger populations. However, advanced age is associated with worse long-term outcomes, likely reflecting a higher burden of comorbidities. These findings support an individualized approach to patient selection, where age alone should not preclude consideration for VT ablation in appropriately selected patients.