BACKROUND:

Recurrence after ventricular tachycardia (VT) ablation remains a significant clinical problem. 

OBJECTIVE:

In this study we report the efficacy, risks, and current trends of repeat VT ablation in structural heart disease patients as reported in a tertiary single center over a 7-year period.

METHODS:

210 patients referred for repeat VT-ablation after previous ablation in our institution were included in the analysis (53% ischemic cardiomyopathy, 91% males, mean age 64 years, mean left-ventricular ejection fraction 35%). 

RESULTS:

After performing repeat ablation, the clinical VTs were acutely eliminated in 82% of the patients, but 46% of the cohort presented with VT recurrence during the 25-month follow-up. However, repeat ablation led to a 73% reduction of shock burden in the first year and 61% reduction until the end of follow up. Similarly, VT burden was reduced 55% in the first year and 36% until the end of the study. 52 patients (25%) reached the combined endpoint of ventricular assist-device implantation, heart transplantation or death. Low ejection fraction, advanced NYHA functional class, increased left ventricular diameter, anteroseptal substrate and VT recurrence in the first year after repeat ablation were associated with worse prognosis independently of the type of cardiomyopathy. 

CONCLUSION:

While complete freedom from VT after repeat ablation in structural heart disease was difficult to achieve, ablation led to a significant reduction in VT and shock burden. Besides advanced heart failure characteristics, anteroseptal substrate and VT recurrence in the first year predicted a worse outcome.