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Catheter ablation for ventricular tachycardia (VT) in patients with ischemic heart disease: a systematic review and a meta-analysis of randomized controlled trials.

Publication ,  Journal Article
Patel, D; Hasselblad, V; Jackson, KP; Pokorney, SD; Daubert, JP; Al-Khatib, SM
Published in: J Interv Card Electrophysiol
March 2016

BACKGROUND: Patients with ischemic heart disease may have implantable cardioverter defibrillators (ICDs) implanted for primary or secondary prevention of sudden cardiac death. Although ICD shocks can be life saving, in some patients, they have been associated with increased mortality and/or morbidity. Several studies have suggested that catheter ablation may be superior to non-ablative strategies at preventing ICD shocks delivered for ventricular arrhythmias; however, this is still controversial. METHODS: We performed a meta-analysis of randomized controlled trials (RCTs) comparing catheter ablation with non-ablative strategies in treatment of ventricular tachycardia (VT) in patients with ischemic heart disease and an ICD. The primary endpoints of interest were recurrent episodes of VT and death. We used a binary random effects method to calculate the cumulative odds ratios (OR) for recurrent VT and deaths. RESULTS: Of a total of 643 potential citations, our search yielded three citations that met our inclusion and exclusion criteria. In the three trials, a total of 262 patients were randomized to ablation (n = 129) or non-ablative interventions (beta-blockers ± use of antiarrhythmics) (n = 133) group. The cumulative OR for recurrent VT was 0.471 (95% confidence interval (CI) = 0.176-1.257) for catheter ablation compared with non-ablative strategies, and for death, it was 0.766 (95% CI = 0.351-1.674). Excluding one study for being appreciably smaller than the other two, the OR for recurrent VT was 0.298 (95% CI = 0.164-0.543). CONCLUSIONS: In this meta-analysis, the rate of recurrent VT was lower with VT catheter ablation compared with non-ablative strategies. There was not a significant difference in rate of death among patients receiving catheter ablation versus non-ablative strategies for management of VT. Given the lack of adequately powered RCTs comparing ablation versus medical management of VT in patients with ischemic heart disease and an ICD, larger studies with longer follow-up are needed.

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Published In

J Interv Card Electrophysiol

DOI

EISSN

1572-8595

Publication Date

March 2016

Volume

45

Issue

2

Start / End Page

111 / 117

Location

Netherlands

Related Subject Headings

  • Treatment Outcome
  • Tachycardia, Ventricular
  • Survival Rate
  • Risk Factors
  • Randomized Controlled Trials as Topic
  • Prevalence
  • Myocardial Ischemia
  • Middle Aged
  • Humans
  • Evidence-Based Medicine
 

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Patel, D., Hasselblad, V., Jackson, K. P., Pokorney, S. D., Daubert, J. P., & Al-Khatib, S. M. (2016). Catheter ablation for ventricular tachycardia (VT) in patients with ischemic heart disease: a systematic review and a meta-analysis of randomized controlled trials. J Interv Card Electrophysiol, 45(2), 111–117. https://doi.org/10.1007/s10840-015-0083-4
Patel, Divyang, Vic Hasselblad, Kevin P. Jackson, Sean D. Pokorney, James P. Daubert, and Sana M. Al-Khatib. “Catheter ablation for ventricular tachycardia (VT) in patients with ischemic heart disease: a systematic review and a meta-analysis of randomized controlled trials.J Interv Card Electrophysiol 45, no. 2 (March 2016): 111–17. https://doi.org/10.1007/s10840-015-0083-4.
Patel D, Hasselblad V, Jackson KP, Pokorney SD, Daubert JP, Al-Khatib SM. Catheter ablation for ventricular tachycardia (VT) in patients with ischemic heart disease: a systematic review and a meta-analysis of randomized controlled trials. J Interv Card Electrophysiol. 2016 Mar;45(2):111–7.
Patel, Divyang, et al. “Catheter ablation for ventricular tachycardia (VT) in patients with ischemic heart disease: a systematic review and a meta-analysis of randomized controlled trials.J Interv Card Electrophysiol, vol. 45, no. 2, Mar. 2016, pp. 111–17. Pubmed, doi:10.1007/s10840-015-0083-4.
Patel D, Hasselblad V, Jackson KP, Pokorney SD, Daubert JP, Al-Khatib SM. Catheter ablation for ventricular tachycardia (VT) in patients with ischemic heart disease: a systematic review and a meta-analysis of randomized controlled trials. J Interv Card Electrophysiol. 2016 Mar;45(2):111–117.
Journal cover image

Published In

J Interv Card Electrophysiol

DOI

EISSN

1572-8595

Publication Date

March 2016

Volume

45

Issue

2

Start / End Page

111 / 117

Location

Netherlands

Related Subject Headings

  • Treatment Outcome
  • Tachycardia, Ventricular
  • Survival Rate
  • Risk Factors
  • Randomized Controlled Trials as Topic
  • Prevalence
  • Myocardial Ischemia
  • Middle Aged
  • Humans
  • Evidence-Based Medicine