Clinical outcomes of ischemic and non-ischemic cardiomyopathy following catheter ablation for ventricular tachycardia among elderly patients

Catheter ablation (CA) is an effective treatment for ventricular tachycardia (VT), but its role in elderly non-ischemic cardiomyopathy (NICM) patients remains unclear. We aim to evaluate the feasibility of VT ablation in this population by comparing outcomes with elderly ischemic cardiomyopathy (ICM) patients. We retrospectively analyzed patients ≥ 70 years with structural heart disease who underwent VT ablation at a tertiary center from 2016 to 2024. Patients were categorized as NICM (n = 52) or ICM (n = 70), and demographic, mapping, procedural, and long-term outcomes were compared. The mean age was 76.5 ± 5.2 and 76.6 ± 4.6 years in the NICM and ICM groups. The baseline demographic data were not different except for a lower left ventricular (LV) ejection fraction in the ICM group. The LV substrate map showed larger overall scars in ICM, whereas NICM had a relatively larger unipolar than bipolar scar, suggesting intramural substrate. In NICM, scars commonly involved the perivalvular region, with frequent basal septal involvement. During a median follow-up of 819 days, the rates of VA recurrence after multiple procedures and cardiovascular mortality were similar between the groups. The estimated one-year VA-free survival was 64.6 ± 7.0% in NICM and 74.9 ± 5.5% in ICM (log-rank P = 0.19), while cardiovascular mortality-free survival was 84.0 ± 5.2% and 85.7 ± 4.2%, respectively (log-rank P = 0.32). Furthermore, VA recurrence was associated with a higher risk of subsequent cardiovascular mortality (hazard ratio 2.12, 95% confidence interval 1.06–4.22, P = 0.03). CA for VT in elderly patients demonstrated comparable feasibility in both ICM and NICM. Effective VT control may contribute to favorable survival outcomes.