Po-05-101 clinical predictors of long-term mortality after first ablation of ventricular tachycardia in patients with structural heart disease

Catheter ablation is a well-established treatment modality for a wide spectrum of ventricular tachycardias (VT). However, in the presence of structural heart disease (SHD), the long-term prognosis remains poor. The aim of this study was to investigate the predictors of all-cause mortality after SHD-related VT ablation in a high-volume expert centre. We evaluated 1143 patients (age: 63 ± 13 years, males: 87%, ischemic cardiomyopathy [ICM]: 67%, electrical storm [ES]: 25%, NYHA Class: 2.1 ± 1.0, left ventricular ejection fraction [LVEF]: 34 ± 13%, diabetes mellitus [DM]: 32%, chronic obstructive pulmonary disease [COPD]: 12%) who underwent the first ablation for SHD-related VT between August 2006 and December 2020 and were followed up to September 2022. Univariate and multivariate Cox regression analyses were used to assess the predictors of all-cause mortality. During a median follow-up of 4.1 years (IQR: 2.0 – 7.2 years), a total of 322 patients (28%) underwent repeated VT ablation and 548 patients (48%) died. Univariate Cox regression analysis revealed eight parameters associated with all-cause mortality (Figure). After multivariate adjustment, only age >60 years (HR: 1.82, 95% CI: 1.4–2.2, P <0.0001), ICM (HR: 1.48, 95% CI: 1.1–1.8, P <0.001), NYHA class ≥ III (HR: 1.6, 95% CI: 1.3–1.9, P <0.0001), a serum creatinine >1.3 mg/dL (HR: 1.7, 95% CI: 1.4–2.0, P <0.00001), LVEF <25% (HR: 2.2, 95% CI: 1.8–2.6, P <0.00001), ES (HR: 1.26, 95% CI: 1.04–1.5, P <0.05) and DM (HR: 1.4, 95% CI: 1.1–1.6, P <0.001) were strong and independent predictors of mortality. In a large cohort of patients with long-term follow-up after ablation for SHD-related VT, multiple clinical factors were independently associated with all-cause death. Such data could be exploited to propose the composite mortality score.