Is catheter ablation safe for treatment of ventricular arrhythmias in early phase after ACS?

Catheter ablation appears to be an effective procedure for patients with ventricular arrhythmias in the early phase following acute coronary syndrome (ACS), as shown by a study presented at EHRA 2025. 

“However, patients who experienced secondary arrhythmias without undergoing repeat ablation appeared to have an increased mortality risk,” said lead study author Dr Alexios Kotinas from the ASST Great Metropolitan Niguarda in Milan, Italy. 

Kotinas and his team conducted this retrospective multicentre cohort study to examine the short- and long-term outcomes of catheter ablation for incessant drug-refractory ventricular arrhythmias in the early post-ACS setting in a large series of consecutive patients. With this, they sought to improve clinical decision-making, treatment protocols, and prognostic outcomes in a high-risk patient population. 

A total of 148 patients (mean age 63.8 years, 87.8 percent male) from various locations across Europe and North America who underwent catheter ablation for drug-refractory ventricular arrhythmias within 30 days after ACS were included in this analysis. 

Ventricular arrhythmias occurred in patients with ST-elevation myocardial infarction (n=109, 73.6 percent) and severely compromised left ventricular ejection fraction. The first arrhythmic episode happened at about 9.2 days following ACS. Most of these episodes were monomorphic ventricular tachycardias, according to Kotinas. 

Of note, catheter ablation was conducted for an average of 4.3 days following the arrhythmic episode. The majority of these patients had an acute success of catheter ablation (70 percent), with only a few cases (n=19, 12.8 percent) of complications reported.  

A total of 103 procedures (69.6 percent) were successful, of which 20 had early recurrence during hospitalization. Eight of these patients who had recurrences underwent a second ablation, which then resulted in two deaths. Furthermore, 12 patients did not undergo a repeat ablation, of whom eight eventually died. 

“Among the remaining 45 procedures, 12 patients had recurrent arrhythmias,” according to Kotinas. 

Complications 

Moreover, several complications occurred, including cardiac tamponade in four patients (2.7 percent), left ventricular perforation in one (1.3 percent), atrioventricular block in six (4.1 percent), and vascular complications in three (2.0 percent). 

Unfortunately, 30 patients (20.2 percent) died while in the hospital. Twelve patients also had a recurrence over the long-term follow-up after discharge, of whom four required a repeat ablation. 

“Catheter ablation was shown to be a safe and a rather efficient procedure,” said Kotinas, noting that patients who suffered a secondary arrhythmia without undergoing a repeat ablation appeared to be at greater risk of death. 

“Ventricular arrhythmias are life-threatening cardiac conditions that frequently arise in the early phases following ACS,” according to Kotinas. 

“Catheter ablation has emerged as a crucial intervention for managing these patients; however, the timing, safety, and efficacy of this procedure in the acute setting of coronary syndromes remain inadequately understood,” he added. 

Catheter ablation is rarely performed in patients with ventricular arrhythmias during the acute phase of an ACS, and most ablations for incessant ventricular arrhythmias occur following myocardial infarction. [https://eurointervention.pcronline.com/article/cardiac-arrhythmias-in-acute-coronary-syndromes-position-paper-from-the-joint-ehra-acca-and-eapci-task-force]