News From the Heart Rhythm SocietySystematic review and meta-analysis of catheter ablation of ventricular tachycardia in ischemic heart disease
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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Cited by (28)
Catheter Ablation of Ventricular Arrhythmia in Patients With an Implantable Cardioverter-Defibrillator: A Systematic Review and Meta-analysis
2023, Canadian Journal of CardiologySubstrate-based approaches in ventricular tachycardia ablation
2022, Indian Pacing and Electrophysiology JournalCitation Excerpt :Since then, multiple approaches to substrate-based VT ablation have been described [8–15]. Substrate-based ablation has been shown to reduce rates of VT recurrence and hospitalization but, like all VT ablation trials, has failed to demonstrate a mortality benefit [16]. As such, a substrate-based approach, with or without complementary activation/entrainment mapping, is considered the gold standard when performing a VT ablation [17].
Structure and function of the ventricular tachycardia isthmus
2022, Heart RhythmCitation Excerpt :Ventricular tachycardia (VT) is an important clinical problem in patients with structural heart disease, including ischemic and nonischemic cardiomyopathies.1–4
Impact of substrate-based ablation for ventricular tachycardia in patients with frequent appropriate implantable cardioverter-defibrillator therapy and dilated cardiomyopathy: Long-term experience with high-density mapping
2021, Revista Portuguesa de CardiologiaCitation Excerpt :Few studies have reported long-term results after substrate-based VT ablation in patients with severe left ventricular (LV) dysfunction. Moreover, despite the association of catheter VT ablation with a significant reduction in appropriate ICD therapies, VT storm and cardiac hospitalizations in patients with ischemic cardiomyopathy,4 preventive VT ablation strategies before ICD shocks seem not to affect hard clinical outcomes.5 We therefore sought to assess long-term outcomes of a substrate-based ablation strategy using high-density mapping in patients with severe LV dysfunction and recurrent appropriate ICD therapy.
When to ablate or not ventricular tachycardia?
2020, Archives des Maladies du Coeur et des Vaisseaux - Pratique
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