Background: The optimal timing for catheter ablation (CA) in patients with ventricular arrhythmias (VA), including ventricular tachycardia (VT) and premature ventricular contractions (PVC) remain a subject of ongoing debate. Early CA of VA has been proposed as a beneficial approach in some studies; however, the safety of immediate CA for VA in patients hospitalized directly from the emergency department (ED) needs further evaluation. Therefore, the aim of this study was to assess the acute safety of CA for VA by comparing periprocedural adverse events with a control group of patients who underwent elective CA of VA.

Methods: Consecutive patients hospitalized from the ED because of/due to VA between September 2016 and December 2022 who received immediate CA within the same hospital stay were included. The control group consisted of patients who underwent elective CA for VA within the same timeframe. Patient demographics, including age, gender, and comorbidities, were identified using ICD-10 codes. Periprocedural adverse events related to the CA procedure were assessed using ICD-10 and OPS codes.

Results: Sixty patients who were hospitalized from the ED for VA and received immediate CA were included in the study (mean age 65±14 years, 15% female, 47% heart failure, and 58% coronary artery disease). The control group consisted of 1,045 patients who received elective CA for VA (mean age 60±15 years, 32% female, 20% heart failure, and 36% coronary artery disease). After performing CA of VA, patients in the ED admission group had a higher incidence of groin bleeding/hematoma (21.7% vs. 10.0%, p=0.009), pneumonia (8.3% vs. 2.0%, p=0.007), and urinary tract infection (6.7% vs. 1.3%, p=0.008). However, there were no differences in the rates of pericardial tamponade (1.7 % vs. 3.2%, p>0.05) and periprocedural stroke (0.0% vs. 0.4%, p>0.05). Nine patients (15.0%) in the ED admission group received an ICD implantation within the same hospital stay compared to 3.9% in the control group (p<0.001). Duration of hospitalization was longer in patients admitted from the ED (median length of stay 9 [IQR 6, 12] days vs. 3 [IQR 2, 7] days, p<0.001) and had more concomitant diagnoses (14 [IQR 11, 19] vs. 6 [IQR 4, 10], p<0.001) compared to patients who were scheduled for elective CA of VA.

Conclusion: These findings suggest that immediate CA in patients admitted from the ED for VA is generally safe. Compared to a younger, healthier group of patients admitted for elective CA of VA periprocedural complications were more frequent; however, potentially life-threatening complications such as pericardial tamponades and thromboembolic events were similar. Further prospective studies are warranted to confirm these findings and assess the long-term outcomes associated with immediate CA for VA in this patient population.