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Publications

Journal Article Review Epublish

PubMed: 42610028 DOI: 10.1016/j.cjco.2026.04.009

Ventricular Tachycardia Recurrence After Catheter Ablation in Nonischemic Cardiomyopathy with Mildly to Moderately Reduced Ejection Fraction.

CJC Open 8(8):958-967

Authors: Boldizsar Kovacs, Leon Dinshaw, Alvaro Marco Del Castillo, Christiane Jungen, Stefan Kurath-Koller, Stefan Stojković, Francesco Santoro, Giacomo Mugnai, Laura Perrotta, Rachel M A Ter Bekke, Kevin Vernooy, Paul G A Volders, Bert Vandenberk

Affiliations

  • Department of Cardiology, Inselspital Bern, University Bern, Berne, Switzerland.
  • Department of Cardiology, Sana Hanse Hospital Wismar, Wismar, Germany.
  • Hospital Universitario 12 de Octubre, Madrid, Spain.
  • Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, University Hospital Essen, Essen, Germany.
  • Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Graz, Austria.
  • University Clinic for Internal Medicine II, Divison of Cardiology, Medical University of Vienna, Vienna, Austria.
  • Cardiology Unit, Department of Medical and Surgery Sciences, University of Foggia, Foggia, Italy.
  • Division of Cardiology, Cardio-Thoracic Department, University Hospital of Verona, Verona, Italy.
  • Arrhythmia Unit, Cardio-thoracic Department, Careggi University Hospital, Florence, Italy.
  • Department of Cardiology, Maastricht University Medical Center +, Cardiovascular Research Institute, Maastricht, the Netherlands.
  • Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.

Abstract

BACKGROUND

Patients with nonischemic cardiomyopathy (NICM) are at risk for sustained ventricular tachycardia (VT). Implantable cardioverter-defibrillators (ICDs) are guideline-recommended for secondary prevention, but the necessity of routine ICD implantation after successful catheter ablation (CA) in patients with preserved or mildly reduced left ventricular ejection fraction (LVEF > 35%) remains uncertain. This review summarizes the current evidence.

METHODS

A PROSPERO-registered systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Embase, and Cochrane were searched through June 2025. Studies including adults with NICM and LVEF > 35% undergoing CA for sustained monomorphic VT were eligible. Data on patient characteristics, ablation outcomes, VT recurrence, mortality, and ICD therapies were extracted. Results were descriptively synthesized, and weighted means were calculated when feasible.

RESULTS

Eleven studies (1995-2024), including 1430 patients, were identified; 936 (66%) were analyzable. The weighted mean LVEF was 38% ± 14%; mean age was 59 ± 14 years. Sustained VT recurrence ranged from 14%-67% during a weighted mean follow-up period of 608 ± 745 days. Procedural noninducibility consistently predicted lower recurrence rates (18%-32%), than those in inducible patients (up to 75%). Two studies using cardiac magnetic resonance imaging found non-circumferential mid-myocardial late gadolinium enhancement with septal involvement associated with higher recurrence risk. Risk of bias was moderate to serious.

CONCLUSIONS

In NICM patients with LVEF > 35%, noninducibility after CA predicts favourable arrhythmic outcomes. Non-circumferential mid-myocardial late gadolinium enhancement with septal involvement, and inducibility after VT ablation, identify higher-risk patients.

REGISTRATION

PROSPERO CRD420251075109.

MeSH

Tachycardia, Ventricular, Tachycardia, Catheter Ablation, Cardiomyopathies, Catheters