Catheter Ablation for Ventricular Tachycardia in Ischemic Cardiomyopathy: A Meta-Analysis With Reconstructed...

Area of Science:

• Cardiology
• Electrophysiology
• Medical Interventions

Background:

• Ventricular tachycardia (VT) is a significant cause of sudden cardiac death in patients with ischemic heart disease (IHD).
• Catheter ablation is used to manage VT, but its long-term efficacy in IHD patients requires further evaluation.
• Implantable cardioverter-defibrillators (ICDs) are crucial for managing life-threatening arrhythmias in this population.

Purpose of the Study:

• To assess the efficacy of catheter ablation in reducing arrhythmic burden and improving outcomes for patients with IHD.
• To compare catheter ablation combined with ICD therapy against ICD-only therapy and ICD with antiarrhythmic drugs (AADs).

Main Methods:

• A systematic meta-analysis was conducted, including seven studies with 1192 participants.
• Pairwise and reconstructed time-to-event data meta-analyses were performed.
• Trial Sequential Analyses were utilized to evaluate the certainty of evidence for various outcomes.

Main Results:

• VT ablation significantly reduced ICD shocks (RR=0.50) and showed trends toward reduced VT storm and cardiovascular hospitalizations compared to ICD alone.
• No significant differences in mortality or VT/ventricular fibrillation (VF) recurrence were observed between VT ablation and ICD-only or ICD plus AADs.
• Trial Sequential Analysis provided conclusive evidence for VT/VF recurrence, indicating a need for more data on other endpoints.

Conclusions:

• Catheter ablation in IHD patients with ICDs effectively reduces ICD shocks, VT storm, and cardiovascular hospitalizations compared to ICD-only therapy.
• VT ablation offers no significant advantage over combined ICD and AAD therapy regarding these outcomes.
• VT ablation does not influence overall mortality or the recurrence of VT/VF, with conclusive evidence for VT/VF recurrence established by TSA.