Substrate Ablation vs Antiarrhythmic Drug Therapy for Symptomatic Ventricular Tachycardia

Arenal, Ángel; Ávila, Pablo; Jiménez‐Candil, Javier; Tercedor, Luís; Calvo, David; Arribas, Fernando; Fernández-Portales, Javier; Merino, José Luís; Hernández‐Madrid, Antonio; Fernández‐Avilés, Francisco; Berruezo, Antonio

doi:10.1016/j.jacc.2022.01.050

Cited by 93 publications

(57 citation statements)

References 24 publications

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“…Eight randomized clinical trials satisfying the criteria were included in this review and meta-analysis–SMASH-VT ( 25 ), VTACH ( 26 ), VANISH ( 27 ), SMS ( 28 ), BERLIN VT ( 29 ), PARTITA ( 30 ), SURVIVE-VT ( 31 ), and PAUSE-SCD ( 32 ). These trials enrolled overall 1,076 patients–532 in the early ablation arm and 544 in the control arm.…”

Section: Resultsmentioning

confidence: 99%

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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Section: Resultsmentioning

confidence: 99%

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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“…Of note, the anti-arrhythmic effect of BBs may furthermore be affected by concomitant invasive treatment strategies, specifically VT ablation therapy. Thus, catheter ablation was recently shown to decrease the risk of cardiovascular death, appropriate ICD shock, hospitalization due to heart failure, or severe treatment-related complications as compared to anti-arrhythmic drugs [ 29 ]. To separate the effect of BB type and the effect of invasive therapies, further studies are necessary including patients with VT ablation therapy.…”

Section: Discussionmentioning

confidence: 99%

Carvedilol versus Metoprolol in Patients with Ventricular Tachyarrhythmias

Schupp

Behnes

Abumayyaleh

et al. 2022

JCDD

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The study investigates the prognostic role of treatment with carvedilol as compared to metoprolol in patients with ventricular tachyarrhythmias. A large retrospective registry was used including consecutive patients on beta-blocker (BB) treatment with episodes of ventricular tachycardia (VT) or fibrillation (VF) from 2002 to 2015. Patients treated with carvedilol were compared to patients with metoprolol. The primary prognostic outcome was all-cause mortality at three years. Secondary endpoints comprised a composite arrhythmic endpoint (i.e., recurrences of ventricular tachyarrhythmias, appropriate implantable cardioverter defibrillator (ICD) therapies) and cardiac rehospitalization. Kaplan–Meier survival curves, multivariable Cox regression analyses, and propensity score matching were applied for statistics. There were 1,098 patients included, 80% treated with metoprolol and 20% with carvedilol. Patients with carvedilol were older, more often presenting with VT (78% vs. 62%; p = 0.001) and with more advanced stages of heart failure. Treatment with carvedilol was associated with comparable all-cause mortality compared to metoprolol (20% vs. 16%, log rank p = 0.234; HR = 1.229; 95% CI 0.874–1.728; p = 0.235). However, secondary endpoints (i.e., composite arrhythmic endpoint: 32% vs. 17%; p = 0.001 and cardiac rehospitalization: 25% vs. 14%; p = 0.001) were more frequently observed in patients with carvedilol, which was still evident after multivariable adjustment. After propensity score matching (n = 194 patients with carvedilol and metoprolol), no further differences regarding the distribution of baseline characteristics were observed. Within the propensity-score-matched cohort, higher rates of the composite arrhythmic endpoint were still observed in patients treated with carvedilol, whereas the risk of cardiac rehospitalization was not affected by the type of beta-blocker treatment. In conclusion, carvedilol and metoprolol are associated with comparable all-cause mortality in patients with ventricular tachyarrhythmias, whereas the risk of the composite arrhythmic endpoint was increased in patients with carvedilol therapy.

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“…Our interest was to link active arrhythmia patterns to clinically relevant events and to prove that prevention of VT episodes by catheter ablation would have an effect on the prespecified end points of worsening heart failure and overall mortality. The consensus available at the time 2 stated that “antiarrhythmic medications can reduce the frequency of ICD therapies but have disappointing efficacy and side effects.” This skepticism was confirmed later by data from VANISH (Ventricular Tachycardia Ablation or Escalated Drug Therapy) 3 and SURVIVE-VT (Substrate Ablation vs Antiarrhythmic Drug Therapy for Symptomatic Ventricular Tachycardia) 4 ; the latter showed that long-term amiodarone did not affect survival but increased treatment-related complications where VT recurrences were the most common adverse event, leading to hospitalization and catheter ablation. When our study started, there were no randomized clinical trials on improvement of survival of catheter ablation for VT. Prophylactic ablation trials failed to prove it, 5 possibly because they enrolled a substantial number of patients who would not develop arrhythmias in the first place, being too early in the natural history.…”

Section: In Responsementioning

confidence: 95%

Response by Radinovic and Della Bella to Letter Regarding Article, “Does Timing of Ventricular Tachycardia Ablation Affect Prognosis in Patients With an Implantable Cardioverter Defibrillator? Results From the Multicenter Randomized PARTITA Trial”

Radinovic

Bella

2022

Circulation

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Substrate Ablation vs Antiarrhythmic Drug Therapy for Symptomatic Ventricular Tachycardia

Cited by 93 publications

References 24 publications

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

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

Carvedilol versus Metoprolol in Patients with Ventricular Tachyarrhythmias

Response by Radinovic and Della Bella to Letter Regarding Article, “Does Timing of Ventricular Tachycardia Ablation Affect Prognosis in Patients With an Implantable Cardioverter Defibrillator? Results From the Multicenter Randomized PARTITA Trial”

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