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The commentary highlights limitations including a small sample of 65, unstratified age range, potential confounding from heterogeneous baseline left ventricular ejection fraction (LVEF), and the need for proper statistical handling of competing risks. It recommends cumulative incidence functions with Gray’s test and suggests future prospective, multicenter cohort studies with refined subgroup analyses and multidisciplinary follow-up strategies.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/long-term-outcomes-and-follow-up-management-in-patients-with-ventricular-tachycardia-electrical-storm-after-catheter-ablation-letter-to-the-editor/468524/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/long-term-outcomes-and-follow-up-management-in-patients-with-ventricular-tachycardia-electrical-storm-after-catheter-ablation-letter-to-the-editor/468524.png","ImageObject",300,407,{"name":92,"@type":93},"Kyle","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-08","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":81},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What main limitations are raised about the ablation study of VT-ES?","Question",{"text":112,"@type":113},"The letter points to a retrospective, single-center design with a small sample size (65) and an unstratified age range (18–85 years), which may reduce generalizability and introduce bias.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"Why does the letter question the finding that LVEF is the strongest predictor of mortality?",{"text":117,"@type":113},"It notes the cohort’s heterogeneous low LVEF (mean 35.3 ± 13%) and argues that reduced LVEF may reflect preexisting high-risk disease progression rather than an independent ablation effect, with no subgroup analysis or serial LVEF measurements.",{"name":119,"@type":110,"acceptedAnswer":120},"How does the letter recommend analyzing outcomes given competing risks?",{"text":121,"@type":113},"Because some patients die from end-stage heart failure before VT recurrence, it argues Kaplan–Meier is inappropriate. The letter recommends cumulative incidence functions and Gray’s test to quantify recurrence and death accurately.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},468524,1792789555,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":81,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":14,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":24,"preview_page_count":4},3985741905716,"https://ap-avatar.wpscdn.com/davatar_994ba38a5ba835b3df7d355c54d3ed8d","Clinical Cardiology   \nLETTER TO THE EDITOR   \nLong‐Term Outcomes and Follow‐Up Management in Patients With Ventricular Tachycardia Electrical Storm After Catheter Ablation  \nZhijie Song  | Haizhen Guo   \nTianjin University of Traditional Chinese Medicine, Tianjin, China  \nCorrespondence: Zhijie Song ([15203579693@163.com](15203579693@163.com))  \nReceived: 22 December 2025 | Revised: 22 December 2025 | Accepted: 6 January 2026  \nTo the Editor,  \nWe read with great interest the article by Çöteli et al. [1] reporting long‐term outcomes of catheter ablation in patients with ventricular tachycardia‐related electrical storm (VT‐ES) . The study confirms that catheter ablation is beneficial for managing ES, especially during the acute phase. Also, this high‐risk group faces substantial long‐term morbidity and mortality following the procedure. These data are valuable for guiding ES management, but several methodological limitations may undermine the reliability and generalizability of the findings and warrant further discussion.  \nFirst, the retrospective, single‐center design and small sample size of 65 patients limit the generalizability of the findings. Notably, the wide, unstratified age range (18–85 years) introduces bias because age is a well‐known risk factor for cardiovascular disease (CVD) . Hence, most of the CVD studies use age stratification or restricted ranges to minimize this bias [2, 3], a safeguard that was absent here which constitutes a significant limitation.  \nSecond, the authors identify left ventricular ejection fraction (LVEF) as the strongest predictor of post‐ablation mortality. However, the mean LVEF in this cohort was 35.3 ± 13% . It characterizes a heterogeneous group with advanced systolic dysfunction and a correspondingly high sudden‐death risk. This observation mainly mirrors the population's preexisting high‐ risk profile rather than an independent ablation effect. Because reduced LVEF itself is a well‐established determinant of mortality [1], as a result, long‐term outcomes may be confounded by ongoing disease progression, thereby limiting the clinical utility of the findings. Moreover, current guidelines use 40% LVEF as a critical prognostic threshold for heart failure [4] . In a recent report, patients with ischemic heart disease, VT, and LVEF >  \n30% derive more long‐term benefit from early ablation than those with LVEF \u003C 30%[5] . The impact of catheter ablation on long‐term outcome could not be properly interpreted due to not performing any subgroup analysis for either of these LVEF thresholds, nor serial postoperative LVEF measurements.  \nIn addition, competitive risks hinder subgroup analysis between ischemic and non‐ischemic groups. Given an all‐cause mortality rate of 40%, a number of patients died from end‐stage heart failure before any recurrence of VT occurred, rendering the traditional Kaplan−Meier method inappropriate. Because it ignores competing risks and consequently misrepresents clinical reality, we recommend that Cumulative incidence functions and Gray's test are better suited to quantify the risks of recurrence and death, thereby enabling an accurate evaluation of ablation's antiarrhythmic efficacy.  \nTo sum things up, methodological limitations warrant caution when interpreting the findings. Nevertheless, the study provides insightful evidence on the long‐term outcomes of ES patients following catheter ablation. The findings of this investigation would suggest that future investigations should prioritize prospective, multicenter cohort studies with refined subgroup analyses to inform personalized follow‐up strategies. We also propose to establish a multidisciplinary collaborative model in which pharmacovigilance for the adverse reactions of antiarrhythmic drugs is considered in prognostic assessment and follow‐up whenever applicable.  \nConflicts of Interest  \nThe authors declare no conflicts of interest.  \nThis is an open access article under the terms of the Creative Commons Att","cbCaikQGN0MW4VW1","https://ap.wps.com/l/cbCaikQGN0MW4VW1","pdf",233829,"English","# Letter to the Editor\n## Study design limitations\n## LVEF as predictor and confounding concerns\n## Competing risks and statistical recommendations\n## Conclusion and future directions","[{\"question\":\"What main limitations are raised about the ablation study of VT-ES?\",\"answer\":\"The letter points to a retrospective, single-center design with a small sample size (65) and an unstratified age range (18–85 years), which may reduce generalizability and introduce bias.\"},{\"question\":\"Why does the letter question the finding that LVEF is the strongest predictor of mortality?\",\"answer\":\"It notes the cohort’s heterogeneous low LVEF (mean 35.3 ± 13%) and argues that reduced LVEF may reflect preexisting high-risk disease progression rather than an independent ablation effect, with no subgroup analysis or serial LVEF measurements.\"},{\"question\":\"How does the letter recommend analyzing outcomes given competing risks?\",\"answer\":\"Because some patients die from end-stage heart failure before VT recurrence, it argues Kaplan–Meier is inappropriate. The letter recommends cumulative incidence functions and Gray’s test to quantify recurrence and death accurately.\"}]","Long-Term Outcomes and Follow-Up Management in Patients With Ventricular Tachycardia Electrical Storm After Catheter Ablation - Letter to the Editor | PDF",1790774350]