Ventricular Tachycardia Ablation Outcomes in Patients With Previous Implantable Cardioverter‐Defibrillator Insertion: A Multicenter Cohort Study

ABSTRACT Background Catheter ablation is increasingly used in patients with ventricular tachycardia (VT) and an implantable cardioverter‐defibrillator (ICD) device in situ, but its real‐world safety and effectiveness remain underexplored in this high‐risk population. We aim to evaluate in‐hospital outcomes associated with catheter ablation in VT patients with a history of ICD implantation using a large, nationally representative dataset. Methods We performed a retrospective cohort study using the National Inpatient Sample (2016–2021) to identify adult hospitalizations with VT and prior ICD device insertion. Patients were stratified into ablation and non‐ablation groups. Propensity score matching was used to balance baseline characteristics. Primary outcome was in‐hospital mortality; secondary outcomes included acute heart failure, ST‐elevation myocardial infarction (STEMI), sepsis, major adverse cardiac events (MACE), and procedure‐related complications. Results Among 395,290 hospitalizations with VT and prior ICD, 4.9% underwent ablation. Catheter ablation remained independently associated with reduced in‐hospital mortality (adjusted odds ratio aOR = 0.59; 95% CI: 0.48–0.74), acute heart failure (aOR = 0.59; 95% CI: 0.54–0.64), ST‐elevation MI (aOR = 0.44; 95% CI: 0.36–0.54), and sepsis (aOR = 0.34; 95% CI: 0.26–0.45) (all p < 0.001). The composite MACE outcome also showed a reduced odds ratio for ablation (aOR = 0.76; 95% CI: 0.68–0.85; p < 0.001). However, ablation was also associated with higher odds of cardiac tamponade (aOR = 8.33; 95% CI: 5.92–11.73), cardiogenic shock (aOR = 1.36; 95% CI: 1.19–1.55), need for mechanical circulatory support (aOR = 5.36; 95% CI: 4.63–6.21), and prolonged hospital stay ≥ 7 days (aOR = 1.69; 95% CI: 1.57–1.82) (all p < 0.001). Conclusion In patients with VT and prior ICD implantation, catheter ablation is associated with improved in‐hospital outcomes but higher procedural risks. These findings support its selective use in experienced centers capable of managing complications.