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

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.