What is the percentage of recurrence for ventricular tachycardia (VT) after successful ablation?

Ventricular Tachycardia Recurrence After Ablation

VT recurrence after successful catheter ablation occurs in approximately 41-49% of patients during long-term follow-up, though the definition of "successful" ablation and patient populations vary significantly across studies. 1, 2

Recurrence Rates by Clinical Context

Post-Myocardial Infarction VT

• Freedom from VT recurrence ranges from 47-73% at 2 years after initially successful ablation in patients with ischemic cardiomyopathy 1
• The VTACH study demonstrated 47% survival free from recurrent VT at 24 months in the ablation group versus 29% in controls 1
• In a large European cohort, 27% of successfully ablated patients experienced VT recurrence at 3 years, compared to 60% in those with partial or failed procedures 3
• Only 42.5% of patients remain completely free from VT/VF at 3 years post-ablation, though shock burden decreases dramatically 4

Mixed Structural Heart Disease Populations

• The Euro-VT study reported 51% freedom from recurrent VT after ablation in patients with structural heart disease 1
• The Multicenter Thermocool study showed 53% mid-term freedom from VT over 6 months 1
• The Cooled RF Multi Center study demonstrated 46% freedom from recurrent VA during 8±5 months of follow-up 1
• A recent 2023 study of repeat ablations found 46% VT recurrence during 25-month follow-up after the repeat procedure 5

Idiopathic VT (Fascicular VT)

• Recurrence rates are substantially lower at 0-20% for idiopathic left fascicular VT after catheter ablation by experienced operators 6
• This represents the most favorable recurrence profile among VT subtypes 6

Critical Distinction: Recurrence vs. Burden Reduction

Even when VT recurs, ablation provides substantial clinical benefit through burden reduction:

• Overall VT burden decreases by 99.6% (median episodes per year: 3.5 pre-procedure vs 0.001 post-procedure) 2
• ICD shock burden reduces by 96.3% (1.1 shocks/year pre-procedure vs 0.04/year post-procedure) 2
• Even in patients who experience recurrence, VT burden still decreases by 69.2% 2
• The SMASH-VT trial showed VT incidence decreased from 33% to 12%, with ICD shocks dropping from 31% to 9% 1
• Mean ICD shocks per patient per year decreased from 3.4±9.2 to 0.6±2.1 after ablation 1

Predictors of VT Recurrence

Key factors associated with higher recurrence risk include:

• Persistence of late potentials after ablation (67% recurrence vs 19% without late potentials; HR 3.18) 2
• Lower left ventricular ejection fraction (median EF 30% in recurrence group vs 39% in non-recurrence group) 2
• Non-ischemic cardiomyopathy tends to have worse outcomes than post-MI scar-related VT 1
• Advanced NYHA functional class predicts worse prognosis 5
• Anteroseptal substrate location is associated with worse outcomes 5
• Periprocedural complications predict worse long-term results 5

Acute Success vs. Long-Term Freedom

There is a critical distinction between acute procedural success and long-term freedom from VT:

• Acute success (elimination of all inducible VTs) ranges from 41-81% depending on the study and technique 1
• Patients with successful acute ablation have 19% recurrence rates versus 64% in those with unsuccessful procedures (P<0.001) 7
• Complete non-inducibility after ablation strongly predicts better long-term outcomes 3

Clinical Implications

Catheter ablation should be positioned as adjunctive therapy rather than curative:

• ICD implantation remains recommended in patients undergoing catheter ablation whenever they satisfy eligibility criteria 1
• Ablation cannot substitute for ICDs and antiarrhythmic drugs in most patients with structural heart disease 4
• Repeat ablation is reasonable for early recurrences, with 75% of patients achieving long-term success after a second procedure 3
• Low-dose amiodarone and/or beta-blockers are typically maintained in 86% of patients post-ablation 3

Mortality Context

Despite recurrence rates, mortality outcomes remain favorable:

• Sudden cardiac death occurs in only 2-2.4% of ablated patients during long-term follow-up 7, 3
• Overall cardiac mortality ranges from 8-12%, primarily from heart failure rather than arrhythmic death 7, 3
• The combined endpoint of VAD, transplant, or death occurs in 25% of patients with structural heart disease 5