Waddah Maskoun1, Marwan Saad2, Amjad Abualsuod3, Ramez Nairooz4, John M Miller5. 1. Division of Cardiovascular Medicine, Henry Ford Health System, Detroit, MI, United States. Electronic address: wmaskou1@hfhs.org. 2. Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States; Division of Cardiovascular Medicine, Ain Shams University, Cairo, Egypt. 3. Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States. 4. Division of Cardiovascular Medicine, University of Southern California, Los Angeles, CA, United States. 5. Division of Cardiovascular Medicine, Indiana University Health, Indianapolis, IN, United States.
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.
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.
Authors: Cristiano Q M Reis; Brian Little; Robert Lee MacDonald; Alasdair Syme; Christopher G Thomas; James L Robar Journal: J Appl Clin Med Phys Date: 2021-10-22 Impact factor: 2.102
Authors: Mark K Elliott; Caroline Mendonca Costa; John Whitaker; Philip Gemmell; Vishal S Mehta; Baldeep S Sidhu; Justin Gould; Steven E Williams; Mark O'Neill; Reza Razavi; Steven Niederer; Martin J Bishop; Christopher A Rinaldi Journal: Heart Rhythm O2 Date: 2022-01-26