Outcomes of Ventricular Tachycardia Ablation in Cardiac Laminopathy: An Updated Systematic Review and Single-Arm...

Ventricular tachycardia (VT) is a life-threatening arrhythmia frequently observed in structural heart diseases, including LMNA-related cardiomyopathy, a genetic disorder associated with high risk of sudden cardiac death and progressive systolic dysfunction. While catheter ablation is an established therapeutic option for VT, its efficacy in cardiac laminopathy remains poorly defined.

To synthesize available evidence on the role and outcomes of VT ablation in patients with cardiac laminopathy.

A systematic review and single-arm meta-analysis was performed in accordance with PRISMA guidelines. PubMed, Embase, and Cochrane databases were searched for studies reporting VT ablation outcomes in LMNA-related cardiomyopathy. An inverse variance random-effects model was applied for meta-analysis of proportions.

Seven studies (six cohorts, one abstract) comprising 62 patients (mean age 53.2 ± 9.7 years; 85% male; 88% with implantable cardioverter-defibrillator) were included. An endocardial/endo-epicardial approach was used in 93% of cases. Acute procedural success was achieved in 37% (95% CI: 14%-63%; I² = 27.4%), and 28% required multiple procedures. Over a median follow-up of 26 (9-35) months, VT recurrence occurred in 91% (95% CI: 76%-100%; I² = 37.2%). All-cause mortality was 54% (95% CI: 39%-70%; I² = 28%), predominantly from cardiac causes (51%, 95% CI: 25%-76%; I² = 53%), and 14% (95% CI: 1%-34%; I² = 42%) underwent heart transplantation.

In LMNA-related cardiomyopathy, catheter ablation is associated with high VT recurrence, limited long-term success, and substantial cardiovascular mortality and transplantation rates, underscoring the importance of ICD implantation and the need for alternative strategies, including variant-specific and molecularly targeted therapies.