Elsevier

Heart Rhythm

Volume 17, Issue 1, January 2020, Pages e206-e219
Heart Rhythm

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Systematic review and meta-analysis of catheter ablation of ventricular tachycardia in ischemic heart disease

https://doi.org/10.1016/j.hrthm.2019.04.024Get rights and content

Background

Patients with ischemic heart disease (IHD) are at risk for ventricular tachycardia (VT). Catheter ablation (CA) may reduce this risk.

Objective

To perform a systematic review and meta-analysis of randomized controlled trials (RCTs) of CA of VT in patients with IHD.

Methods

Literature searches of MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL), and the Cochrane Database of Systematic Reviews (CDSR) were performed from January 2000 through April 2018 to identify RCTs comparing a strategy of CA vs no ablation in patients with IHD and an implantable cardioverter defibrillator (ICD). Outcomes of interest included appropriate ICD therapies, appropriate ICD shocks, VT storm, recurrent VT/ventricular fibrillation (VF), cardiac hospitalizations, and all-cause mortality. Using an inverse variance random-effects model, odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for each endpoint.

Results

A total of 5 RCTs (N = 635 patients) were included, with a duration of follow-up ranging from 6 months to 27.9 months. Patients who underwent CA experienced decreased odds of appropriate ICD therapies (OR 0.49; 95% CI 0.28–0.87), appropriate ICD shocks (OR 0.52; 95% CI 0.28–0.96), VT storm (OR 0.64; 95% CI 0.43–0.95), and cardiac hospitalization (OR 0.67; 95% CI 0.46–0.97) vs those who did not undergo ablation. There was no evidence of a benefit for recurrent VT/VF (OR 0.87; 95% CI 0.41–1.85), although this endpoint was not reported in all trials, or for all-cause mortality (OR 0.89; 95% CI 0.60–1.34).

Conclusion

In this systematic review and meta-analysis of RCTs, CA was associated with a significant reduction in the odds of appropriate ICD therapies, appropriate ICD shocks, VT storm, and cardiac hospitalizations in patients with IHD.

Section snippets

Background

Patients with ischemic heart disease (IHD) are at increased risk of incident or recurrent ventricular tachycardia (VT), ventricular fibrillation (VF), and sudden cardiac death. Implantable cardioverter defibrillators (ICDs) are the mainstay of treatment to reduce the incidence of sudden cardiac death by terminating ventricular arrhythmias either by antitachycardia pacing (ATP) or by delivering a shock.1, 2, 3 However, ICD shocks, whether appropriate or inappropriate, can have negative effects

Methods

This meta-analysis conforms to standard guidelines and is written in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.11 The PICOT format (P = population, I = intervention, C = comparator, O = outcome, T = timing, S = setting)12 was used to derive the key clinical question. This question was, “In adults with a history of sustained ventricular tachycardia and ischemic cardiomyopathy, what are the effectiveness and harms of catheter

Results

The inclusion and exclusion of citations and articles identified through our systematic literature search is illustrated in Figure 1. A total of 5 studies evaluating the use of CA in patients with IHD and an ICD published between 2007 and 2017 were included in the analysis (Table 1).16, 17, 18, 19, 20 All included studies were multicenter RCTs. Individual study sample sizes ranged from 27 patients to 259 patients. The mean patient age ranged from 64 years to 68 years, and the duration of

Discussion

In this systematic review of the literature and a meta-analysis of 5 RCTs, we found that CA reduced the likelihood of appropriate ICD therapies, appropriate ICD shocks, VT storm, and cardiac hospitalization vs controls. In a sensitivity analysis, excluding the 2 studies that specifically randomized patients to CA versus AAD, the magnitude of such reductions was increased, although CIs also widened. This result might suggest an effect of AAD in reducing the risk of VT recurrence and ICD

Conclusion

This systematic review and meta-analysis of 5 RCTs found that patients with IHD who underwent CA for VT experienced decreased odds of appropriate ICD therapies, appropriate ICD shocks, VT storm, and cardiac hospitalization vs those who did not undergo ablation.

Acknowledgments

The authors thank Sana M. Al-Khatib, MD, MHS, FHRS, CCDS (Duke University Medical Center, Durham, North Carolina) and John L. Sapp, Jr., MD, FHRS (Queen Elizabeth II Health Sciences Centre, Halifax, Canada) for their assistance in providing additional data.

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