Background— Catheter ablation for ventricular tachycardia (VT) from structural heart disease has a significant risk of recurrence, but the optimal duration for in-hospital monitoring is not defined. This study assesses the timing, correlates, and prognostic significance of early VT recurrence after ablation. Methods and Results— Of 370 patients (313 men; aged 63.0±13.2 years) who underwent a first radiofrequency ablation for sustained monomorphic VT associated with structural heart disease from 2008 to 2012, sustained VT recurred in 81 patients (22%) within 7 days. In multivariable analysis, early recurrence was associated with New York Heart Association classification ≥III (odds ratio [OR] 1.90, 95% confidence interval [CI] 1.03–3.48; P =0.04), dilated cardiomyopathy (OR 1.93, 95% CI 1.03–3.57; P =0.04), prevalence of VT storm before the procedure (OR 2.62, 95% CI 1.48–4.65; P =0.001), a greater number of induced VTs (OR 1.24, 95% CI 1.07–1.45; P =0.006), and acute failure or no final induction test (OR 1.88, 95% CI 1.03–3.40; P =0.04). During a median of 2.5 (1.2, 4.0) years of follow-up, early VT recurrence was an independent correlates of mortality (hazard ratio 2.59, 95% CI 1.52–4.34; P =0.0005). Conclusions— Patients who have early recurrences of VT after ablation are a high risk group who may be identifiable from their clinical profile. Further study is warranted to define the optimal treatment strategies for this patient group.