From recurrence to relevance: an international consensus survey on physician-defined outcomes that matters in ventricular tachycardia ablation

Background

The role of ventricular tachycardia (VT) ablation is expanding, with emerging data suggesting potential benefits as a first-line therapy compared to anti-arrhythmic drugs. However, comparison between VT ablation trials remains limited by the lack of standardised outcome reporting.

Objective

This international survey, conducted as a joint initiative between the Canadian Heart Rhythm Society (CHRS) and the European Heart Rhythm Association (EHRA) Scientific Initiative Committee, aim to identify physicians’ perspectives on clinically meaningful acute and long-term outcomes in VT ablation and their relevance for future clinical trials.

Methods

Between September and October 2025, a web-based questionnaire was distributed via EHRA/CHRS networks and social media to cardiac electrophysiologists performing VT ablation. Demographics and procedural practice details were collected. Participants ranked the importance of each outcome using a 9-point Likert scale (1= not at all important, 9 = critically important). Outcomes were categorised by the proportion of respondents rating them as important (score ≥7): critically important (≥ 90%), moderately important (50-89%), and less important if (<50%).

Results

A total of 189 responses were received, predominantly from academic centres (66.1%) with a median of 3.04 operators per centre. Most centres reported performing 1-50 VT ablations annually (73.9%) and 47.3% reported performing epicardial procedures. Nearly half had a dedicated arrhythmia unit (46.5%) and 77.7% had onsite cardiac surgery.

For acute procedural outcomes, non-inducibility of the clinical VT (95%) and avoidance of acute complications (90%) were considered critically important (Figure 1A). Non-inducibility of any VT (59.6%) and substrate modification indices such as de-channelling (69.8%) were considered moderately important.

For long-term outcomes, VT storm (96%, VT episodes requiring anti-tachycardia pacing or shock (95%) and all-cause mortality (94%) were deemed critically important (Figure 1B). Most respondents (77.2%) endorsed a minimum of 12 months follow-up for outcomes reporting, while 14.8% preferred 6 months.

There was broad agreement (66.7%) that implantable cardiac defibrillator (ICD) programming should be standardized across VT ablation trials. Most participants (66.1%) supported including patient-reported outcome measures (PROMs) in future studies, but not that existing tools inadequately capture the experiences of patients (63.8%). Commonly used instruments included EQ-5D and Kansas City Cardiomyopathy Questionnaire (KCCQ) (66.8%), though many advocated for the development of a VT-specific PROM tool (63.8%).

Conclusion

This survey defines key outcomes for VT ablation trials, emphasizing non-inducibility, complication avoidance, and arrhythmic recurrence. Findings call for harmonised definitions, standardized ICD programming and improved VT-specific patient-reported tools.Figure 1a – Heatmap displaying the distrFigure 1b – Heatmap displaying the distr