Abstract Backround Recurrences of ventricular tachycardia (VT) after initial catheter ablation is a significant clinical problem. Objective In this study we report the efficacy and risks of repeat VT ablation in patients with structural heart disease in a tertiary single center over a 7-year period. Methods 210 consecutive patients referred for repeat VT ablation after previous ablation in our institution were included in the analysis (53% ischemic cardiomyopathy, 91% males, median age 65 years, mean left-ventricular ejection fraction 35%). Results After performing repeat ablation, the clinical VTs were acutely eliminated in 82% of the patients, but 46% of the cohort presented with VT recurrence during the 25-month follow-up. Repeat ablation led to a 73% reduction of shock burden in the first year and 61% reduction until the end of follow-up. Similarly, VT burden was reduced 55% in the first year and 36% until the end of the study. 52 patients (25%) reached the combined endpoint of ventricular assist-device implantation, heart transplantation or death. Advanced NYHA functional class, anteroseptal substrate and periprocedural complication after repeat ablation were associated with worse prognosis independently of the type of cardiomyopathy. Conclusion While complete freedom from VT after repeat ablation in structural heart disease was difficult to achieve, ablation led to a significant reduction in VT and shock burden. Besides advanced heart failure characteristics, anteroseptal substrate and periprocedural complications predicted a worse outcome.