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

https://doi.org/10.1007/s00392-025-02737-x

Moneeb Khalaph (Bad Oeynhausen)1, D. Guckel (Bad Oeynhausen)2, N. Trajkovska (Bad Oeynhausen)1, M. Didenko (Bad Oeynhausen)1, M. El Hamriti (Wetzikon)3, M. Braun (Bad Oeynhausen)1, G. Imnadze (Bad Oeynhausen)1, P. Lucas (Bad Oeynhausen)1, T. Fink (Bad Oeynhausen)1, V. Sciacca (Bad Oeynhausen)1, S. Beyer (Bad Oeynhausen)1, Y. Bocchini (Bad Oeynhausen)1, A. Goncharov (Bad Oeynhausen)4, K. Mohemed (Bad Oeynhausen)5, V. Rudolph (Bad Oeynhausen)4, C. Sohns (Bad Oeynhausen)1, P. Sommer (Bad Oeynhausen)1

1Herz- und Diabeteszentrum NRW Klinik für Elektrophysiologie/ Rhythmologie Bad Oeynhausen, Deutschland; 2Herz- und Diabeteszentrum NRW Klinik für Elektrophysiologie/Rhythmologie Bad Oeynhausen, Deutschland; 3GZO Spital Wetzikon Klinik für Kardiologie und Angiologie Wetzikon, Schweiz; 4Herz- und Diabeteszentrum NRW Allgemeine und Interventionelle Kardiologie/Angiologie Bad Oeynhausen, Deutschland; 5Herz- und Diabeteszentrum NRW Klinik für Kardiologie Bad Oeynhausen, Deutschland

 

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 (Figure 1). 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.

Figure 1:
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