Meta-analysis of catheter ablation in patients with post-infarct cardiomyopathy undergoing defibrillator implantation
Babikir Kheiri1, Timothy F Simpson1, Babak Nazer1
1Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon.
Insights
Preventive catheter ablation reduces appropriate implantable cardioverter defibrillator (ICD) therapies and ventricular tachycardia (VT) in post-infarct cardiomyopathy patients. While improving physical quality-of-life, this strategy does not reduce mortality.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Interventions
Background:
- Patients with post-infarct cardiomyopathy and ventricular arrhythmias (VT) often require implantable cardioverter defibrillators (ICDs).
- These patients face risks of recurrent shocks and increased morbidity.
Purpose of the Study:
- To evaluate the efficacy of catheter ablation as a preventive strategy during secondary prevention ICD implantation.
- To assess the impact of preventive ablation on device therapies, mortality, and quality-of-life.
Main Methods:
- A systematic search of randomized clinical trials was conducted.
- Meta-analysis using random-effects models calculated hazard ratios (HR) and 95% confidence intervals (CI).
- Four trials involving 505 patients were analyzed.
Main Results:
- Preventive ablation significantly reduced appropriate device therapies (HR=0.62) and sustained VT (HR=0.74).
- No significant differences were observed in inappropriate shocks, all-cause death, cardiac death, arrhythmic death, or cardiac hospitalization.
- An improvement was noted in the physical component of SF-36 quality-of-life scores (P=.02).
Conclusions:
- Preventive catheter ablation at ICD implantation reduces appropriate ICD therapy and sustained VT in post-infarct cardiomyopathy patients.
- The procedure improves physical quality-of-life but does not impact overall mortality.
- Catheter ablation is a viable strategy for managing VT in this patient population.
Background:
Patients with post-infarct cardiomyopathy and ventricular arrhythmias (VT) necessitating implantable cardioverter defibrillators (ICD) are at risk of recurrent shocks with increased morbidity.
Methods:
A comprehensive search of electronic databases for all randomized clinical trials that evaluated the role of catheter ablation as a preventive strategy at the time of secondary prevention ICD implantation was performed. We calculated hazard ratios (HR) and 95% confidence intervals (CI) using random-effects model.
Results:
Four trials were identified with a total of 505 patients (average age 66.4 ± 9.0 years; 87.7% were male). Preventive ablation was associated with a significant reduction in appropriate device therapies (shocks and/or anti-tachycardia therapy) (HR = 0.62; 95% CI = 0.46-0.82; P < .01), sustained VT (HR = 0.74; 95% CI = 0.55-0.99; P = .04) compared to control. There were no differences in inappropriate device shocks (HR = 0.80; 95% CI = 0.38-1.71), all-cause death (HR = 0.93; 95% CI = 0.53-1.64), cardiac death (HR = 0.63; 95% CI = 0.29-1.36), arrhythmic death (HR = 0.26; 95% CI = 0.05-1.31), or cardiac hospitalization (HR = 0.79; 95% CI = 0.57-1.11) between strategies. Preventive ablation was associated with improved SF-36 physical component (mean difference = 2.81; 95% CI-0.53-5.10; P = .02), but not the mental component (mean difference = 1.30; 95% CI = -2.06-4.66).
Conclusion:
Among patients with post-infarct cardiomyopathy and VT, preventive catheter ablation at the time of ICD implantation is associated with a significant reduction of appropriate ICD therapy and sustained VT, and improvement in the physical component of quality-of-life, but no reduction in mortality.
