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

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

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

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).

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.

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.