The Liverpool Heart and Chest Hospital is a National Health Service hospital in Liverpool. It is one of several specialist hospitals located within the Liverpool City Region, alongside Liverpool Women's Hospital, Alder Hey Children's Hospital, the Walton Centre, Mersey Regional Burns and Plastic Surgery Unit, and Clatterbridge Cancer Centre. It is managed by the Liverpool Heart and Chest Hospital NHS Foundation Trust.
AIMS:We sought to systematically catalogue and compare outcomes definitions across prospective clinical trials and registries evaluating ablation in VT to assess the impact of heterogeneous definitions on reported outcomes. METHODS AND RESULTS:A systematic review (PROSPERO: CRD 42024595265) was performed in accordance with PRISMA guidelines. We searched for prospective studies from January 2000 to November 2024. Randomized trials, single-arm feasibility studies, and prospective registries involving ≥10 patients undergoing VT ablation were included. Study outcomes and their definitions were extracted and categorized. Pooled analyses were performed for comparable randomized trial subgroups, and meta-regression evaluated the effect of VT outcome definitions on reported success and complications. Fifty-nine studies were included: 15 randomized trials, 6 feasibility studies, and 38 prospective studies/registries. Definitions of acute procedural success varied, with most using acute clinical VT non-inducibility and others using only elimination of the clinical VT. VT recurrence was the most frequently reported long-term outcome; however, definitions differed markedly (VT recurrence or recurrence causing device therapy). Pooled analysis of prophylactic ablation vs. delayed ablation showed reduced VT recurrence (HR 0.63, 95% CI: 46-0.86) but no difference in hospitalization or mortality. Meta-regression demonstrated that an outcome of any VT recurrence yielded a higher failure rate of 51.0% compared to stricter definitions, such as VT-causing therapy at 37.3% or VT-causing shock only at 23.4% (P = 0.002). Safety outcomes were inconsistently reported. CONCLUSION:Outcome definition in VT ablation trials showed substantial heterogeneity, limiting cross-trial comparability and meta-analytic synthesis. Development of a minimum set of standardized outcomes for VT ablation may improve consistency and clinical interpretability of VT trials.
BACKGROUND:The purpose of this study was to prospectively validate the MIRACLE2 score in the GLOBAL-MIRACLE registry, a multicenter, international, prospective registry of patients admitted with resuscitated out-of-hospital cardiac arrest of presumed cardiac cause. METHODS:From January 1, 2022 to May 31, 2023, 770 patients were recruited from 11 centers across 5 countries. The primary end point was poor neurological outcome (Cerebral Performance Category 3-5) at hospital discharge. Model discrimination was assessed by the area under the receiver operating characteristic curve. We compared the discriminatory performance of the MIRACLE2 score against Cardiac Arrest Hospital Prognosis, out-of-hospital cardiac arrest, Target Temperature Management, NULL-PLEASE, C-GRAPH, and rCAST. RESULTS:The primary end point occurred in 395 (51.2%) patients. The MIRACLE2 score had an area under the curve of 0.861 (95% CI, 0.835-0.887). A MIRACLE2 score ≤2 had a negative predictive value of 87.8%, while a score of ≥7 had a positive predictive value of 98.3%. The MIRACLE2 score had equal performance to the TTM risk tool (P=0.12) but better discriminatory performance than other risk tools (P<0.0001). The MIRACLE2 score showed good performance in those with ST-segment-elevation myocardial infarction (0.851 [95% CI, 0.816-0.886]) and without ST-segment-elevation myocardial infarction (0.873 [95% CI, 0.834-0.912]) and in those with cardiogenic shock (0.832 [95% CI, 0.789-0.875]) and without cardiogenic shock (0.853 [95% CI, 0.810-0.895]). CONCLUSIONS:The MIRACLE2 score is a practical risk tool that shows excellent discrimination performance for poor neurological outcome after presumed cardiac cause out-of-hospital cardiac arrest, including based on hemodynamic status and admission 12-lead ECG. Early stratification of out-of-hospital cardiac arrest patients using the MIRACLE2 score should be evaluated in future randomized controlled trials.
Abstract Background The role of ventricular tachycardia (VT) ablation is expanding, with emerging data suggesting potential benefits as a first-line therapy compared to anti-arrhythmic drugs. However, comparison between VT ablation trials remains limited by the lack of standardised outcome reporting. Objective This international survey, conducted as a joint initiative between the Canadian Heart Rhythm Society (CHRS) and the European Heart Rhythm Association (EHRA) Scientific Initiative Committee, aim to identify physicians’ perspectives on clinically meaningful acute and long-term outcomes in VT ablation and their relevance for future clinical trials. Methods Between September and October 2025, a web-based questionnaire was distributed via EHRA/CHRS networks and social media to cardiac electrophysiologists performing VT ablation. Demographics and procedural practice details were collected. Participants ranked the importance of each outcome using a 9-point Likert scale (1= not at all important, 9 = critically important). Outcomes were categorised by the proportion of respondents rating them as important (score ≥7): critically important (≥ 90%), moderately important (50-89%), and less important if (<50%). Results A total of 189 responses were received, predominantly from academic centres (66.1%) with a median of 3.04 operators per centre. Most centres reported performing 1-50 VT ablations annually (73.9%) and 47.3% reported performing epicardial procedures. Nearly half had a dedicated arrhythmia unit (46.5%) and 77.7% had onsite cardiac surgery. For acute procedural outcomes, non-inducibility of the clinical VT (95%) and avoidance of acute complications (90%) were considered critically important (Figure 1A). Non-inducibility of any VT (59.6%) and substrate modification indices such as de-channelling (69.8%) were considered moderately important. For long-term outcomes, VT storm (96%, VT episodes requiring anti-tachycardia pacing or shock (95%) and all-cause mortality (94%) were deemed critically important (Figure 1B). Most respondents (77.2%) endorsed a minimum of 12 months follow-up for outcomes reporting, while 14.8% preferred 6 months. There was broad agreement (66.7%) that implantable cardiac defibrillator (ICD) programming should be standardized across VT ablation trials. Most participants (66.1%) supported including patient-reported outcome measures (PROMs) in future studies, but not that existing tools inadequately capture the experiences of patients (63.8%). Commonly used instruments included EQ-5D and Kansas City Cardiomyopathy Questionnaire (KCCQ) (66.8%), though many advocated for the development of a VT-specific PROM tool (63.8%). Conclusion This survey defines key outcomes for VT ablation trials, emphasizing non-inducibility, complication avoidance, and arrhythmic recurrence. Findings call for harmonised definitions, standardized ICD programming and improved VT-specific patient-reported tools.Figure 1a – Heatmap displaying the distrFigure 1b – Heatmap displaying the distr
