Clinical outcomes of ischemic and non-ischemic cardiomyopathy following catheter ablation for ventricular tachycardia among elderly patients

BACKGROUND: Catheter ablation (CA) is an effective treatment for ventricular tachycardia (VT), but its role in elderly non-ischemic cardiomyopathy (NICM) patients remains unclear. We aim to evaluate the feasibility of VT ablation in this population by comparing outcomes with elderly ischemic cardiomyopathy (ICM) patients. METHODS: We retrospectively analyzed patients ≥ 70 years with structural heart disease who underwent VT ablation at a tertiary center from 2016 to 2024. Patients were categorized as NICM (n = 52) or ICM (n = 70), and demographic, mapping, procedural, and long-term outcomes were compared. RESULTS: The mean age was 76.5 ± 5.2 and 76.6 ± 4.6 years in the NICM and ICM groups. The baseline demographic data were not different except for a lower left ventricular (LV) ejection fraction in the ICM group. The LV substrate map showed larger overall scars in ICM, whereas NICM had a relatively larger unipolar than bipolar scar, suggesting intramural substrate. In NICM, scars commonly involved the perivalvular region, with frequent basal septal involvement. During a median follow-up of 819 days, the rates of VA recurrence after multiple procedures and cardiovascular mortality were similar between the groups. The estimated one-year VA-free survival was 64.6 ± 7.0% in NICM and 74.9 ± 5.5% in ICM (log-rank P = 0.19), while cardiovascular mortality-free survival was 84.0 ± 5.2% and 85.7 ± 4.2%, respectively (log-rank P = 0.32). Furthermore, VA recurrence was associated with a higher risk of subsequent cardiovascular mortality (hazard ratio 2.12, 95% confidence interval 1.06–4.22, P = 0.03). CONCLUSION: CA for VT in elderly patients demonstrated comparable feasibility in both ICM and NICM. Effective VT control may contribute to favorable survival outcomes.