INTRODUCTION
Patients with ischemic (IHD) and nonischemic (NICM) dilated heart
disease and reduced left ventricular ejection fraction are at increased
risk of ventricular tachycardias (VTs) or sudden cardiac
death1. Implantable cardioverter-defibrillators (ICDs)
are indicated in these patients and have shown to reduce
mortality1. However, some studies suggest that ICD
shocks reduce the quality of life and may be linked to increased
mortality, particularly after an electrical storm
(ES)2. VT catheter ablation is an invasive treatment
modality for antiarrhythmic drugs-resistant VT that reduces arrhythmic
episodes, improves quality of life and improves survival in patients
with ES3. Current guidelines for VT
ablation3 recommend epicardial catheter ablation for
NICM patients after a first failed endocardial catheter ablation or as
first intention when there is a suspicion of an epicardial circuit.
Epicardial ablation role is not as established in the IHD population,
although some studies show potential VT-free survival improvement after
a combined endo-epicardial approach (C-ABL)4. However,
complex arrhythmia substrates and potential life-threating procedure
complications increase the technical difficulty of the epicardial
catheter ablation5. Direct comparisons of combined and
non-combined endo-epicardial ablations outcomes are limited by patient
characteristics, follow-up duration, protocols heterogeneity and
scarcity of randomized trials4,5. We aim to
investigate the long-term clinical outcomes of these 2 strategies in the
IHD and NICM populations. To overcome said limitations, a propensity
score-matched sensitivity analysis was performed.