Catheter Ablation Versus Antiarrhythmic Drugs for Ventricular Tachycardia: A Systematic Review and Meta-Analysis

Sustained ventricular tachycardia (VT) and fibrillation-related sudden cardiac death account for nearly 450,000 deaths annually in the United States. Catheter ablation (CA) and antiarrhythmic drugs (AADs) are commonly used to manage VT recurrence; however, their comparative efficacy and safety remain uncertain. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing CA and AADs in patients with ischemic cardiomyopathy and implantable cardioverter-defibrillators (ICDs). PubMed, Embase, and Cochrane Cochrane Central Register of Controlled Trials (CENTRAL) Library were searched up to February 15, 2025. Primary outcomes included all-cause mortality, cardiovascular mortality, VT storm, and appropriate ICD shock. Secondary outcomes included inappropriate ICD shock, appropriate antitachycardia pacing, heart failure hospitalization, stroke/transient ischemic attack, and myocardial infarction. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Three RCTs encompassing 587 patients (287 CA, 300 AADs) were included. No significant differences were found between CA and AADs in all-cause mortality (RR, 0.88; 95% CI, 0.63-1.22; P = 0.43), cardiovascular mortality (RR, 1.23; 95% CI, 0.77-1.98; P = 0.39), VT storm (RR, 0.76; 95% CI, 0.39-1.46; P = 0.41), or appropriate ICD shock (RR, 0.87; 95% CI, 0.69-1.10; P = 0.24). Secondary outcomes, including inappropriate ICD shock, antitachycardia pacing, heart failure hospitalization, stroke/transient ischemic attack, and myocardial infarction, were also comparable between the 2 groups. In this meta-analysis of RCTs, CA and AADs demonstrated comparable efficacy and safety in patients with VT. Larger high-quality trials are warranted to confirm these findings and further define the role of CA as a potential first-line therapy.