Determinants of recurrence after epicardial ventricular tachycardia ablation in structural heart disease

BACKGROUND: Epicardial catheter ablation is an established treatment for ventricular tachycardia (VT) in patients with structural heart disease (SHD); however, VT recurrence remains frequent, particularly in advanced cardiomyopathy. OBJECTIVE: This study aimed to identify clinical and electrophysiological determinants of VT recurrence after epicardial VT ablation in SHD. METHODS: 74 patients with SHD undergoing epicardial VT ablation were included. Acute procedural outcomes, VT recurrence, and adverse clinical events were assessed. RESULTS: Nonischemic cardiomyopathy was the predominant etiology. Epicardial scar predominantly involved basal-lateral left ventricular regions with periannular and outflow tract extension. Acute procedural noninducibility was achieved in 49 patients (66%), whereas VT recurrence occurred in 37 patients (50%) during follow-up of 17 months. In cause-specific Cox analysis, electrical storm (hazard ratio [HR] 3.130; 95% confidence interval [CI] 1.421-6.893; P = .005), longer VT cycle length (HR 2.835; 95% CI 1.211-6.638; P = .016), and higher body mass index (HR 2.918; 95% CI 1.365-6.236; P = .006) were independently associated with VT recurrence. During follow-up, 7 patients died, 10 underwent heart transplantation, and 2 required ventricular assist device implantation. CONCLUSION: Combined endocardial and epicardial VT ablation in advanced SHD was associated with moderate acute success, whereas VT recurrence remained common during follow-up. Electrical storm, longer VT cycle length, and higher body mass index were independently associated with an increased risk of recurrence.