Prolonged hospitalization after catheter ablation of ventricular tachycardia: Predictors and outcomes

Tess Calcagno; Andrew Cesmat; Joseph Sipko; Bryan Baranowski; Mandeep Bhargava; Thomas D Callahan; Mina K Chung; Thomas Dresing; Ayman A Hussein; Samuel A Irefin; Mohamed Kanj; Arshneel Kochar; David O Martin; Walid I Saliba; Tyler L Taigen; Niraj Varma; Koji Higuchi; Shady Nakhla; Justin Z Lee; Oussama M Wazni; Pasquale Santangeli; Jakub Sroubek

doi:10.1016/j.hrthm.2025.05.063

Prolonged hospitalization after catheter ablation of ventricular tachycardia: Predictors and outcomes

Heart Rhythm. 2025 Jun 3:S1547-5271(25)02524-X. doi: 10.1016/j.hrthm.2025.05.063. Online ahead of print.

Authors

Tess Calcagno¹, Andrew Cesmat¹, Joseph Sipko¹, Bryan Baranowski², Mandeep Bhargava², Thomas D Callahan², Mina K Chung², Thomas Dresing², Ayman A Hussein², Samuel A Irefin³, Mohamed Kanj², Arshneel Kochar², David O Martin², Walid I Saliba², Tyler L Taigen², Niraj Varma², Koji Higuchi², Shady Nakhla², Justin Z Lee², Oussama M Wazni², Pasquale Santangeli², Jakub Sroubek⁴

Affiliations

¹ Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio.
² Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
³ Department of General Anesthesiology, Cleveland Clinic, Cleveland, Ohio.
⁴ Cardiac Electrophysiology Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio. Electronic address: sroubej@ccf.org.

PMID: 40472946
DOI: 10.1016/j.hrthm.2025.05.063

Abstract

Background: In patients with structural heart disease undergoing catheter ablation of ventricular tachycardia (VT), prolonged postablation hospitalization may be a predictor of poor outcomes.

Objective: This study sought to identify predictors of prolonged hospitalization after VT ablation and their impact on subsequent outcomes.

Methods: This retrospective cohort study analyzed 318 patient cases undergoing VT ablation from January 2022 to October 2024. Prolonged hospitalization was defined as postablation length of stay of > 3 days. Predictors of prolonged hospitalization were identified through multivariable logistic regression, and associations with adverse outcomes, including mortality, left ventricular assist device implantation, and cardiac transplant, were assessed using Cox survival analysis. Substratified analysis was performed based on the Prediction of Acute In-Hospital Events After Defibrillator Implantation Score (PAINESD) (high-risk [PAINESD of ≥ 17] and low/moderate risk [PAINESD of < 17] strata).

Results: Prolonged postablation hospitalization was observed in 95 cases (29.9%). Independent predictors included New York Heart Association class > II (odds ratio [OR] 3.12, P < .001), moderate/severe right ventricular dysfunction (OR 3.54, P = .012), nonelective ablation (OR 7.42, P < .001) and acute procedural complication/pericardial effusion (OR 4.30, P = .048). Prolonged procedural duration (> 255 minutes) was a significant predictor in low-/moderate-risk patients (OR 2.89, P = .010) but not in high-risk patients. Prolonged postablation hospitalization was associated with a higher risk of mortality, left ventricular assist device implantation, or transplant in high-risk patients (hazard ratio 3.35, P = .008), but not in low-/moderate-risk patients.

Conclusion: Prolonged postablation hospitalization after VT ablation adversely affects outcomes in high-risk patients but not in low-/moderate-risk patients. Procedural factors, such as prolonged ablation duration, are modifiable predictors in low-/moderate-risk populations. Baseline disease severity factors dominate in high-risk groups. Tailored perioperative strategies are needed to optimize outcomes in high-risk patients.

Keywords: Catheter ablation; NYHA class; PAINESD; Prolonged hospitalization; Renal dysfunction; Ventricular tachycardia.