Radiofrequency catheter ablation of ventricular tachycardia in ischemic heart disease in light of current practice: a systematic review and meta-analysis of randomized controlled trials

Silva, Gustavo Lima da; Nunes-Ferreira, A; Cortez‐Dias, Nuno; Sousa, João de; Pinto, Fausto J.; Caldeira, Daniel

doi:10.1007/s10840-020-00870-3

Cited by 11 publications

(7 citation statements)

References 36 publications

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“…Mortality outcomes were not impacted by this stratification; hence, one can speculate that VT recurrence (as reflected by appropriate ICD therapy and shocks) is only a marker for mortality risk. Moreover, there is a known association between ICD shocks and mortality ( 3 – 6 ), but the reduction of shocks in this and previous meta-analyses ( 10 , 11 ) did not translate into mortality benefit.…”

Section: Discussioncontrasting

confidence: 73%

“…Irrespective of our better understanding of the arrhythmogenic substrate in various etiologies, technological advances, and the use of epicardial approach, the mortality outcomes in this meta-analysis, compared to previously published (10,11), remained mostly unchanged with early CA vs. deferred of no ablation in patients with structural heart disease and an ICD implanted. The cause for such a lack of improvement might be the lack of tools providing complete single-stepped elimination of the substrate, but more probably it is the underlying disease process that progresses over time and creates new substrate or leads to pump failure and death.…”

Section: Discussionmentioning

confidence: 75%

“…Moreover, the ablation of non-ischemic cardiomyopathy and the use of epicardial approach in two of the included trials did not increase mortality or procedure-related complications, which is reassuring despite the small number of patients. Also, the advantages of early ablation on a significant reduction of ICD therapies, shocks, and VT storm, known from previous publications (10,11), were preserved. In contrast to a previously published meta-analysis (10), we found a significant reduction in cardiovascular hospitalizations.…”

Section: Discussionmentioning

confidence: 89%

“…Also, the advantages of early ablation on a significant reduction of ICD therapies, shocks, and VT storm, known from previous publications (10,11), were preserved. In contrast to a previously published meta-analysis (10), we found a significant reduction in cardiovascular hospitalizations. All these findings may translate into reduced health-related expenditures thus potentially further reducing the burden on the healthcare systems (34).…”

Section: Discussionmentioning

confidence: 89%

“…Implantable cardioverterdefibrillators (ICDs) are usually considered first-line treatment in patients with structural heart disease and VT, but this therapy does not prevent VT recurrences and ICD shocks are associated with increased mortality and decreased quality of life (3)(4)(5)(6)(7). Several studies and a few meta-analyses in patients with previous myocardial infarction and severe/moderate LV systolic dysfunction have shown that endocardial catheter ablation (CA) can reduce VT recurrences, ICD therapy/shocks, and VT storm (8)(9)(10)(11). However, data on patients with nonischemic cardiomyopathy have shown that ablation more often necessitates an epicardial approach and is less effective, probably due to the more frequent presence of midmyocardial or subepicardial arrhythmogenic substrate (12)(13)(14)(15).…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of early catheter ablation for ventricular tachycardia in adult patients with structural heart disease and implantable cardioverter-defibrillator: An updated systematic review and meta-analysis of randomized trials

Shalganov

Stoyanov

Traykov

2022

Front. Cardiovasc. Med.

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AimsCatheter ablation (CA) for ventricular tachycardia (VT) can improve outcomes in patients with ischemic cardiomyopathy. Data on patients with non-ischemic cardiomyopathy are scarce. The purpose of this systematic review and meta-analysis is to compare early CA for VT to deferred or no ablation in patients with ischemic or non-ischemic cardiomyopathy.Methods and resultsStudies were selected according to the following PICOS criteria: patients with structural heart disease and an implantable cardioverter-defibrillator (ICD) for VT, regardless of the antiarrhythmic drug treatment; intervention–early CA; comparison–no or deferred CA; outcomes–any appropriate ICD therapy, appropriate ICD shocks, all-cause mortality, VT storm, cardiovascular mortality, cardiovascular hospitalizations, complications, quality of life; published randomized trials with follow-up ≥12 months. Random-effect meta-analysis was performed. Outcomes were assessed using aggregate study-level data and reported as odds ratio (OR) or mean difference with 95% confidence intervals (CIs). Stratification by left ventricular ejection fraction (LVEF) was also done. Eight trials (n = 1,076) met the criteria. Early ablation was associated with reduced incidence of ICD therapy (OR 0.53, 95% CI 0.33–0.83, p = 0.005), shocks (OR 0.52, 95% CI 0.35–0.77, p = 0.001), VT storm (OR 0.58, 95% CI 0.39–0.85, p = 0.006), and cardiovascular hospitalizations (OR 0.67, 95% CI 0.49–0.92, p = 0.01). All-cause and cardiovascular mortality, complications, and quality of life were not different. Stratification by LVEF showed a reduction of ICD therapy only with higher EF (high EF OR 0.40, 95% CI 0.20–0.80, p = 0.01 vs. low EF OR 0.62, 95% CI 0.34–1.12, p = 0.11), while ICD shocks (high EF OR 0.54, 95% CI 0.25–1.15, p = 0.11 vs. low EF OR 0.50, 95% CI 0.30–0.83, p = 0.008) and hospitalizations (high EF OR 0.95, 95% CI 0.58–1.58, p = 0.85 vs. low EF OR 0.58, 95% CI 0.40–0.82, p = 0.002) were reduced only in patients with lower EF.ConclusionEarly CA for VT in patients with structural heart disease is associated with reduced incidence of ICD therapy and shocks, VT storm, and hospitalizations. There is no impact on mortality, complications, and quality of life. (The review protocol was registered with INPLASY on June 19, 2022, #202260080).Systematic review registration[https://inplasy.com/], identifier [202260080].

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