Cardiac magnetic resonance in predicting recurrence after ventricular tachycardia ablation: a meta-analysis of observational studies

Abstract Background Recurrence of ventricular tachycardia (VT) following catheter ablation remains a major clinical challenge, particularly in patients with structural heart disease. Cardiac magnetic resonance (CMR), through late gadolinium enhancement (LGE) imaging, offers detailed myocardial tissue characterization and may help identify structural substrates predictive of VT recurrence. However, the prognostic value of specific CMR-derived markers in this context remains uncertain. Purpose This meta-analysis aims to systematically compare CMR-derived myocardial parameters between patients with and without post-ablation VT recurrence, to identify specific imaging markers predictive of arrhythmic outcomes and inform preprocedural risk stratification. Methods A systematic search of PubMed, Embase and Cochrane databases was conducted to identify randomized controlled trials and observational studies evaluating CMR parameters in patients undergoing VT ablation, comparing those with and without recurrence. Pooled mean differences (MD) were calculated for continuous variables, and odds ratios (OR) for binary outcomes using a random-effects model. Heterogeneity was assessed by I² statistics. Results Five observational studies comprising 349 patients were included, of whom 129 (36.9%) presented recurrent TV after ablation. Compared to patients without VT recurrence, those with recurrence showed no significant differences in left ventricle mass (MD = 4.11 g; 95% CI: –20.06 - 28.28; I² = 72% ; Figure 2), left ventricle end-diastolic volume (MD = 13.49 mL; 95% CI: –20.77 - 47.75; I² = 50%) or left ventricle ejection fraction (MD = – 4.57 %; 95% CI: –10.95 - 1.81; I² = 55%). However, recurrence was significantly associated with septal LGE (OR = 4.28; 95% CI: 2.31 - 7.94; I² = 2% ; Figure 3), epicardial LGE (OR = 1.78; 95% CI: 1.07 - 2.98; I² = 0% ; Figure 4) and greater border zone mass (MD = 7.14 g; 95% CI: 2.64 - 11.64; I² = 0% ; Figure 5). No significant differences were observed in transmural LGE, LGE core mass or post-ablation conduction channel characteristics. Conclusion This meta-analysis highlights the prognostic value of specific CMR features, particularly septal and epicardial LGE, as well as border zone extent in predicting VT recurrence post-ablation. These findings support the integration of advanced CMR tissue characterization into preprocedural assessment and risk stratification strategies in patients undergoing VT ablation.Figure 1.PRISMA flow diagram Figure 2.Forest Plots of Outcomes