Prophylactic catheter ablation of ventricular tachycardia in ischemic cardiomyopathy: A systematic review and meta-analysis of randomized controlled trials. Electrophysiology collaborative consortium for metaanalysis – Electram investigators

Kuldeep Shah, Mohit Turagam, Brijesh Patel, Andrea Natale, Dhanunjaya Lakkireddy, Jalaj Garg

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1 Scopus citations

Abstract

Aims: Catheter ablation is an effective strategy for drug-refractory ventricular tachycardia (VT) in ischemic cardiomyopathy. We aimed to perform a systematic review and meta-analysis of outcomes of prophylactic catheter ablation (PCA) of Ventricular Tachycardia (VT) in ischemic cardiomyopathy patients Methods We performed a comprehensive literature search through February 10, 2020, for all eligible randomized controlled trials that compared “PCA” versus “No PCA” for VT. Primary efficacy outcomes included - appropriate ICD therapy (composite of anti-tachycardia pacing and ICD shock), appropriate ICD shocks, electrical storm, cardiac mortality, and all-cause mortality. The primary safety outcome was any adverse events. Results. Four randomized controlled trials (N = 505) met inclusion criteria. Prophylactic catheter ablation was associated significant reduction in appropriate ICD therapies (RR 0.70; 95% CI 0.55 - 0.89, p = 0.004), appropriate ICD shocks (RR 0.57 95% CI 0.40 - 0.80, p = 0.001) with a trend towards reduced risk of electrical storm (RR 0.64; CI 0.39 - 1.05; p = 0.075) compared to “No PCA”. There was no significant difference in cardiac mortality (RR 0.66, 95% CI 0.31 – 1.43, p = 0.29) and all-cause mortality (RR 0.98, 95% CI 0.52 – 1.82, p = 0.94) with similar adverse events (RR 1.46, 95% CI 0.73 – 2.95, p = 0.29) between two groups. Conclusion. Prophylactic catheter ablation in ischemic cardiomyopathy patients was associated with a lower risk of ICD therapies, including ICD shocks and VT storm with no difference in cardiac and all-cause mortality.

Original languageEnglish
Pages (from-to)1-8
Number of pages8
JournalJournal of Atrial Fibrillation
Volume13
Issue number2
DOIs
StatePublished - 2021

Keywords

  • Ischemic cardiomyopathy
  • Prophylactic catheter ablation
  • Ventricular tachycardia

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