Causes of Early Mortality After Ventricular Tachycardia Ablation in Patients With Reduced Ejection Fraction

BACKGROUND Recognition of the causes of early mortality after ventricular tachycardia (VT) ablation in patients with reduced left ventricular ejection fraction (LVEF) is an essential step toward improving postprocedural outcomes. OBJECTIVES This study sought to determine the causes of early mortality (<= 30 days) after VT ablation in patients with reduced LVEF and to understand further the circumstances surrounding death after the procedure. METHODS We performed a retrospective analysis of all patients undergoing VT ablation in patients with reduced LVEF from January 1, 2013, to November 10, 2021, at the Mayo Clinic (Rochester, Phoenix, and Jacksonville). Causes of death were identified through a detailed chart review of the electronic health record within the Mayo Clinic system and outside records. RESULTS A total of 503 patients (mean age 63 +/- 13 years, 11.2% women) with ejection fraction <50% were included in the study. The 30-day all-cause mortality rate was 5.0% (n = 25), and the mortality rate due to a procedural complication was 0.4%. Among all 30-day deaths, recurrent VT was the most common primary cause of death (44.0%). This was followed by decompensated heart failure (28.0%), procedure-related death (8.0%), cerebrovascular accident (4.0%), and infection (4.0%). Most patients (91.0%) who died from VT had VT recurrence within 3 days of the ablation. The average PAINESD score among early mortality was 20 +/- 4, and 92.0% of these patients (n = 23) had a score >15. Significant predictors of early mortality included nonischemic cardiomyopathy, lower LVEF, electrical storm, and ventricular fibrillation. CONCLUSIONS The overall early mortality (<= 30 days) rate after catheter ablation of VT in patients with reduced LVEF was 5.0%, but the death rate directly due to a procedural complication was only 0.4%. The most common cause of death was recurrent VT, followed by heart failure. Further research into ablation strategies is vital to improving the safety, efficacy, and durability of VT ablation. (c) 2023 Published by Elsevier on behalf of the American College of Cardiology Foundation.