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

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.