Mechanical Circulatory Support During Ventricular Tachycardia Ablation: A Systematic Review and Meta‐Analysis of Procedural and Clinical Outcomes

Abstract

Catheter ablation is an established therapy for ventricular tachycardia (VT); however, hemodynamic instability frequently limits procedural mapping and success. Temporary mechanical circulatory support (tMCS) devices are increasingly used to maintain end-organ perfusion during VT ablation, yet their impact on clinical outcomes remains uncertain. We aimed to evaluate the impact of tMCS on clinical outcomes and periprocedural complications in patients undergoing VT ablation. A systematic search of PubMed/MEDLINE, Scopus, Web of Science, and Cochrane CENTRAL was conducted from database inception through December 2025. We included observational studies enrolling adult patients undergoing VT ablation with tMCS, compared with VT ablation performed without MCS. Primary outcomes were all-cause mortality, in-hospital mortality, procedural success, VT recurrence, and major adverse cardiovascular events (MACE). Ten observational studies comprising 16,838 patients were included, of whom 1402 received tMCS. There was no significant difference in all-cause mortality between tMCS and no-MCS groups (RR 1.71, 95% CI 0.68 to 4.26), procedural success (RR 1.05, 95% CI 0.92 to 1.21), VT recurrence (RR 0.99, 95% CI 0.80 to 1.22), or MACE (RR = 0.79, 95% CI: 0.62 to 1.01). However, tMCS use was associated with significantly higher in-hospital mortality (RR 7.41, 95% CI 4.77 to 11.66). The tMCS group also demonstrated increased risks of stroke, pericardial effusion or tamponade, and periprocedural complications. In non-randomized studies, tMCS during VT ablation was not associated with improved long-term outcomes, while higher in-hospital mortality and complications likely reflected patient selection and timing of support rather than adverse device effects.