Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Aug 18.
doi: 10.1111/jce.70061. Online ahead of print.

A Novel Predictive Score to Identify the Necessity for Epicardial Ventricular Tachycardia Ablation: EPI-VT-Score

Moneeb Khalaph  1 , Denise Guckel  1 , Nadica Trajkovska  1 , Maxim Didenko  1 , Mustapha El Hamriti  2 , Martin Braun  1 , Guram Imnadze  3 , Philip Lucas  1 , Thomas Fink  1 , Vanessa Sciacca  1 , Sebastian Beyer  1 , Yuri Bocchini  1 , Alessandro Guareschi  4 , Arseniy Goncharov  5 , Kawa Mohemed  5 , Volker Rudolph  5 , Christian Sohns  1 , Philipp Sommer  1
Affiliations

A Novel Predictive Score to Identify the Necessity for Epicardial Ventricular Tachycardia Ablation: EPI-VT-Score

Moneeb Khalaph et al. J Cardiovasc Electrophysiol. .

Abstract

Background: Epicardial ventricular tachycardia (VT) ablation is a therapeutic option for drug-refractory VT, particularly when endocardial ablation fails or is inadequate. However, accurately identifying patients who will benefit most from an epicardial approach remains challenging due to its higher procedure-related risks.

Objective: This study aimed to develop and validate a predictive scoring model - EPI-VT-Score - to identify patients likely to benefit from epicardial VT ablation.

Methods: We retrospectively analyzed data from 138 patients (mean age 64.9 ± 11.3 years, 89.9% male) who underwent VT ablation between 2018 and 2024. Four predictors - underlying cardiomyopathy, left ventricular ejection fraction (LVEF), number of prior VT ablations, and VT-QRS interval - were identified and incorporated into the EPI-VT-Score, which ranges from 4 to 12 points. Score performance was assessed using area under curve (AUC).

Results: Among 138 patients, 51 (37.0%) underwent epicardial ablation. The EPI-VT-Score accurately predicted epicardial ablation necessity with an AUC of 0.990 (95% CI, 0.978-1.000). A score ≥ 8 identified epicardial need with 92.2% sensitivity and 100% specificity. Patients scoring < 8 were effectively managed with endocardial-only ablation.

Conclusion: The EPI-VT-Score can be a clinical support to evaluate preprocedural necessity for epicardial access and the complexity of the procedure to improves procedural outcomes as well as minimize unnecessary procedural risks.

Keywords: EPI‐VT‐Score; VT ablation; VT‐score; epicardial VT ablation; indication of VT ablation.

PubMed Disclaimer

References

    1. R. Cardoso, A. Aryana, S. M. Singh, H. Tandri, and A. d'Avila, “Epicardial Ablation of Ventricular Tachycardia: A Review,” Korean Circulation Journal 48 (2018): 778–791.
    1. K. Zeppenfeld, J. Tfelt‐Hansen, M. de Riva, et al., “2022 ESC Guidelines for the Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death,” European Heart Journal 43 (2022): 3997–4126.
    1. R. Kumareswaran and F. E. Marchlinski, “Practical Guide to Ablation for Epicardial Ventricular Tachycardia: When to Get Access, How to Deal With Anticoagulation and How to Prevent Complications,” Arrhythmia & Electrophysiology Review 7 (2018): 159–164.
    1. F. Sacher, K. Roberts‐Thomson, P. Maury, et al., “Epicardial Ventricular Tachycardia Ablation,” Journal of the American College of Cardiology 55 (2010): 2366–2372.
    1. A. Sarkozy, M. Tokuda, U. B. Tedrow, et al., “Epicardial Ablation of Ventricular Tachycardia in Ischemic Heart Disease,” Circulation: Arrhythmia and Electrophysiology 6 (2013): 1115–1122.

LinkOut - more resources