Outcome of catheter ablation for ventricular tachycardia in patients with ischemic cardiomyopathy: A systematic review and meta-analysis of randomized clinical trials

Abstract

Background: Current ventricular tachycardia (VT) management in patients with ischemic cardiomyopathy (ICM) includes optimal medical therapy, ICDs device therapy, and antiarrhythmic medications. Data about outcomes of catheter ablation (CA) in these patients is scarce. We aimed to perform a meta-analysis of RCTs to compare outcomes of CA vs conventional management of VT in ICM patients who had ICD.

Methods: A systematic review and meta-analysis of published RCTs between January 1970 and December 2016 were performed. Random effects DerSimonian-Laird risk ratios (RR) were calculated. Sensitivity analyses using fixed-effects summary odds ratios (OR) were performed using Peto model. Outcomes of interest were: all-cause mortality (ACM), cardiovascular death (CVD), CV disease-related hospitalization, VT storms, and ICD shocks.

Results: 4 RCTs were identified (521 patients (261 had CA), mean age: 66.4 ± 1.7 years, 91.5% male, mean follow-up: 19 months). No difference observed between VT ablation and conventional management regarding ACM (RR 0.94, 95% CI, 0.66-1.32, p = 0.70) or CVD (RR 0.82, 95% CI, 0.52-1.29, p = 0.39). VT ablation was associated with less CV disease-related hospitalization (RR 0.72, 95% CI, 0.54-0.96, p = 0.02), VT storms (RR 0.71, 95% CI, 0.52-0.97, p = 0.03), and trend towards reducing ICD shocks (RR 0.59, 95% CI, 0.34-1.05, p = 0.07). In sensitivity analysis using fixed-effects OR, CA was associated with significant reduction in ICD shocks.

Conclusion: In patients with ICM, VT ablation reduced CV disease-related hospitalization, VT storms, and ICD shocks when compared to conventional management with no mortality benefit over a relatively short mean follow-up period.

Keywords: Ablation; Arrhythmia; Ischemic cardiomyopathy; Ventricular tachycardia.