Cardiac magnetic resonance parameters and ventricular tachycardia recurrence after catheter ablation: a systematic review and meta-analysis.

Association of Cardiovascular Magnetic Resonance-Derived Papillary Muscle Abnormalities with Non-Sustained Ventricular Tachycardia in Hypertrophic Cardiomyopathy

Background: Risk stratification for ventricular arrhythmias in hypertrophic cardiomyopathy (HCM) remains challenging, particularly in patients who do not fulfill conventional high-risk criteria. This study aimed to investigate the association between cardiovascular magnetic resonance (CMR)-derived phenotypic characteristics and non-sustained ventricular tachycardia (NSVT) in patients with HCM. Methods: A total of 69 consecutive patients with HCM who underwent comprehensive CMR imaging and 24 h Holter monitoring were retrospectively analyzed. CMR assessment included phenotypic characteristics of the left ventricle, mitral valve apparatus, and papillary muscles, as well as late gadolinium enhancement (LGE). Ventricular arrhythmic events were defined as the presence of a premature ventricular complex burden >10%, NSVT, and/or sustained ventricular tachycardia. Univariable logistic regression and multivariable Firth penalized logistic regression analyses were performed to identify variables associated with NSVT. Results: The study population had a mean age of 57.5 years, and 23 patients (33.3%) were female. Ventricular arrhythmic events were detected in 16 patients (23.1%), all of whom had NSVT. Median LGE burden was 4%. LGE was present in 43 patients (62.3%), including papillary muscle (PM)-LGE in 13 patients (19.0%). Anterolateral PM–septum systolic contact was observed in 7 patients (10.0%). In univariable analysis, maximal left ventricular wall thickness (OR 1.29, 95% CI 1.09–1.53; p = 0.004), abnormal chordal attachment (OR 5.56, 95% CI 1.09–28.19; p = 0.039), anterolateral PM mobility (OR 1.45 per 0.1-unit increase, 95% CI 1.10–1.91; p = 0.009), anterolateral PM–septum systolic contact (OR 31.20, 95% CI 3.38–288.0; p = 0.002), and PM-LGE (OR 9.60, 95% CI 2.50–36.84; p < 0.001) were associated with NSVT. In the four-variable Firth penalized logistic regression model, abnormal chordal attachment (OR 9.09, 95% CI 1.18–67.42; p = 0.036), anterolateral PM–septum systolic contact (OR 23.08, 95% CI 2.18–385.17; p = 0.008), and PM-LGE (OR 17.26, 95% CI 2.37–176.64; p = 0.004) remained associated with NSVT. Given the limited number of events, these multivariable findings should be considered exploratory. Conclusions: CMR-derived PM abnormalities were associated with NSVT in patients with HCM. In particular, PM-LGE, abnormal chordal attachment, and anterolateral PM–septum systolic contact emerged as exploratory CMR characteristics that warrant further evaluation in larger prospective studies.

Ablation outcomes in PVC-induced cardiomyopathy: A systematic review and meta-analysis stratified by site of origin

Background: Frequent premature ventricular complexes (PVC) can lead to a reversible form of left ventricular (LV) dysfunction termed PVC-induced cardiomyopathy (PIC). Catheter ablation is increasingly recognized as the most effective treatment; however, outcomes may differ by the anatomical site-of-PVC origin. Methods: We conducted a systematic review and meta-analysis of studies published from 2000 to 2025 evaluating catheter ablation in patients with PIC. Eligible studies reported outcomes stratified by PVC origin, including right ventricular outflow tract (RVOT), LV outflow tract (LVOT), papillary muscle, and epicardial/para-His regions. Primary outcomes were change in LV ejection fraction (LVEF) and normalization (≥ 50%). Secondary outcomes included PVC recurrence, repeat ablation, and major complications. Pooled estimates were calculated using random-effects models. Results: Twelve studies (n = 718) met inclusion. Overall, ablation improved LVEF by a mean of 11.0% (95% confidence interval 9.5–12.5; P < .001), with normalization in ~65% of patients. Outcomes varied by PVC origin: RVOT (ΔLVEF ~12.5%, normalization ~70%), LVOT (ΔLVEF ~11.0%, normalization ~65%), papillary muscle (ΔLVEF ~8.0%, normalization ~55%), and epicardial/para-His (ΔLVEF ~6.5–7.0%, normalization ~50%). Recurrence rates were lowest for RVOT/LVOT (~12–20%) and highest for papillary and epicardial sites (~28–30%). Major complications were infrequent (~3–5%), but more common with epicardial or para-His ablations. Conclusion: Catheter ablation provides substantial and often reversible improvement in LVEF for patients with PIC, with generally low complication rates. However, outcomes are strongly site-dependent, favoring RVOT and LVOT origins.

Ventricular Tachycardia Ablation in Structural Heart Disease With LVEF > 35%: Clinical Outcomes and Recurrence Patterns.

BACKGROUND In patients with structural heart disease (SHD) and moderately impaired left ventricular ejection fraction (LVEF > 35%), data on outcomes after ventricular tachycardia (VT) ablation remain limited. This analysis focuses on VT recurrence after ablation in patients presenting with sustained VT and LVEF > 35% within a secondary-prevention population. OBJECTIVE To evaluate procedural outcomes and long-term VT recurrence after catheter ablation in SHD patients with LVEF > 35%. METHODS We analyzed 219 consecutive patients with SHD and LVEF > 35% undergoing VT ablation, including 89 with ischemic cardiomyopathy (ICM) and 130 with non-ischemic cardiomyopathy (NICM). Procedural characteristics, complications, and VT recurrence during follow-up were compared between groups. RESULTS ICM patients were older, more frequently hypertensive, and had slightly lower LVEF than NICM patients. Ablation was predominantly endocardial in ICM, whereas combined endocardial-epicardial ablation was required in 28% of NICM patients (p < 0.001). Acute VT non-inducibility was achieved more frequently in ICM than in NICM (93% vs 67%; p < 0.001). Procedural complications were infrequent and comparable between groups (6% overall; p = 0.342). During follow-up, VT recurred in 35% of patients, more frequently in NICM than ICM (42% vs 25%; p = 0.004). Cardiomyopathy type emerged as the only independent predictor of VT recurrence (HR 2.312, CI 1.3-4.0, p = 0.004), while acute non-inducibility was associated with a lower recurrence risk. CONCLUSION VT ablation in SHD patients with LVEF > 35% was associated with acceptable safety and moderate arrhythmia control. Outcomes were more favorable in ICM than in NICM, reflecting the heterogeneity of arrhythmic risk in this secondary prevention population.

The CAMERA-MRI Score to Predict LVEF Normalization Post Ablation for Primary Atrial Fibrillation Mediated Cardiomyopathy: a Pooled Analysis of Two Randomized Clinical Trials.

BACKGROUND Primary AF-mediated cardiomyopathy is a retrospective diagnosis in which left ventricular ejection fraction (LVEF) normalizes following catheter ablation. Identifying prospectively which patients will achieve LVEF normalization remains challenging. OBJECTIVE To determine predictors of LVEF normalization in AF-mediated cardiomyopathy patients following catheter ablation. METHODS This was a pooled analysis of the CAMERA-MRI and CAMERA-MRI II multicentre randomized trials, which included baseline and serial cardiac magnetic resonance (CMR). This sub-study included all patients who underwent catheter ablation. LVEF normalization predictors were assessed using univariable and multivariable logistic regression. Continuous variables were dichotomized to develop a practical score, internally validated through bootstrap resampling (200 iterations) and 5-fold cross-validation. RESULTS 113 patients (mean age 60.6±11.1, 13.3% female, 90.3% persistent AF, baseline LVEF 31.0±8.7%) were included, and 70 (63.7%) achieved LVEF normalization on serial CMR. On multivariable analysis, there were three independent predictors: normal indexed LV end-diastolic volume (OR=3.20, 95%CI 1.20-8.56, p=0.021), absence of alternate aetiology (OR=4.31, 95%CI 1.14-16.39, p=0.023), and absence of late gadolinium enhancement (OR=2.53, 95%CI 1.01-6.39, p=0.049), with an AUC of 0.788 (95%CI 0.703-0.873). Normalization likelihood by score was 12% (0/3), 38% (1/3), 67% (2/3), and 88% (3/3). CONCLUSION Absence of late gadolinium enhancement, normal LV volumes, and absence of an alternative aetiology identified the AF-induced cardiomyopathy phenotype most likely to achieve LVEF normalization following catheter ablation.

Cardiac magnetic resonance imaging predictors of outcomes in noncompaction cardiomyopathy: A systematic review and meta-analysis.

Early Catheter Ablation for Atrial Fibrillation After Acute Decompensated Heart Failure: A Systematic Review and Meta-Analysis with Reconstructed Kaplan-Meier Individual Patient Data.

BACKGROUND Catheter ablation (CA) for atrial fibrillation (AF) reduces mortality and heart failure (HF) hospitalizations in stable chronic HF, but optimal timing following acute decompensated heart failure (ADHF) remains uncertain. This meta-analysis aimed to evaluate whether early CA reduces mortality, rehospitalization, and improves cardiac function compared with delayed or no ablation. METHODS We conducted a systematic review and meta-analysis following PRISMA 2020 guidelines. PubMed and Scopus databases were searched through December 16, 2025. Studies reporting outcomes of CA performed during ADHF hospitalization or within 90 days post-discharge were included. RESULTS Four studies (n=396 patients, 221 early ablation) were included. Qualitatively, early CA was consistently associated with improved clinical outcomes across included studies. Early CA improved left ventricular ejection fraction and reduced left atrial dimensions. Procedural complication rates were low with no significant difference between groups. Quantitatively, early CA significantly reduced the composite outcomes of cardiovascular mortality or HF rehospitalization (RR 0.35, 95% CI 0.17-0.70; p = 0.003). Reconstructed survival analysis demonstrated an association between early CA and higher event-free survival for the composite of cardiovascular death and HF-rehospitalization (HR 0.24, 95% CI 0.12-0.50; p < 0.0001) and all-cause mortality (HR 0.51, 95% CI 0.27-0.94; p = 0.033). CONCLUSIONS Early CA following ADHF was associated with substantial reductions in mortality or HF rehospitalization with acceptable safety. These findings suggest a potential role of early CA during or shortly after ADHF in hemodynamically stable patients, though randomized trials are needed to confirm efficacy and optimize patient selection.