David F Briceño1, Jorge Romero1, Kavisha Patel1, Wasla Liaqat1, Xiao-Dong Zhang1, Isabella Alviz1, Ruike Yang1,2, Daniel Rodriguez1, Dhanunjaya Lakkireddy3, Domenico Della Rocca4, Nicola Tarantino1, Rakesh Gopinathannair3, Andrea Natale4, Luigi Di Biase5,6. 1. Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA. 2. Division of Cardiology, Department of Medicine, Henan Provincial People's Hospital, Zhengzhou, China. 3. Kansas City Heart Rhythm Institute, Overland Park, KS, USA. 4. Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA. 5. Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA. dibbia@gmail.com. 6. Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA. dibbia@gmail.com.
Abstract
PURPOSE: First-line catheter ablation of ventricular tachycardia/ventricular fibrillation (VT/VF) in patients with ischemic cardiomyopathy (ICM) has been associated with improved outcomes; however, most benefit seems to be in patients with moderately depressed left ventricular ejection fraction (LVEF). Herein, outcomes were stratified based on LVEF. METHODS: A meta-analysis of randomized controlled trials (RCTs) evaluating first-line ablation versus medical therapy in patients with VT and ICM was performed. Risk estimates and 95% confidence intervals (CI) were measured. RESULTS: Four RCTs with a total of 505 patients (mean age 66 ± 9 years, 89% male, 80% with previous revascularization) were included. Mean LVEF was 35 ± 8%. At a mean follow-up of 24 ± 9 months, a significant benefit in survival-free from appropriate implantable cardioverter-defibrillator (ICD) therapies was observed in all patients undergoing first-line catheter ablation compared with medical management (RR 0.70, 95% CI 0.56-0.86). In patients with moderately depressed LVEF (> 30-50%), first-line VT ablation was associated with a statistically significant reduction in the composite endpoint of survival free from VT/VF and appropriate ICD therapies (HR 0.52, 95% CI 0.36-0.76), whereas there was no difference in patients with severely depressed LVEF (≤30%) (HR 0.56, 95% CI 0.24-1.32). Funnel plots did not show asymmetry suggesting lack of bias. CONCLUSIONS: Patients with ICM and VT undergoing first-line ablation have a significantly lower rate of appropriate ICD therapies without a mortality difference compared with patients receiving an initial approach based on medical therapy. The beneficial effect of a first-line ablation approach was only observed in patients with moderately depressed LVEF (> 30-50%).
PURPOSE: First-line catheter ablation of ventricular tachycardia/ventricular fibrillation (VT/VF) in patients with ischemic cardiomyopathy (ICM) has been associated with improved outcomes; however, most benefit seems to be in patients with moderately depressed left ventricular ejection fraction (LVEF). Herein, outcomes were stratified based on LVEF. METHODS: A meta-analysis of randomized controlled trials (RCTs) evaluating first-line ablation versus medical therapy in patients with VT and ICM was performed. Risk estimates and 95% confidence intervals (CI) were measured. RESULTS: Four RCTs with a total of 505 patients (mean age 66 ± 9 years, 89% male, 80% with previous revascularization) were included. Mean LVEF was 35 ± 8%. At a mean follow-up of 24 ± 9 months, a significant benefit in survival-free from appropriate implantable cardioverter-defibrillator (ICD) therapies was observed in all patients undergoing first-line catheter ablation compared with medical management (RR 0.70, 95% CI 0.56-0.86). In patients with moderately depressed LVEF (> 30-50%), first-line VT ablation was associated with a statistically significant reduction in the composite endpoint of survival free from VT/VF and appropriate ICD therapies (HR 0.52, 95% CI 0.36-0.76), whereas there was no difference in patients with severely depressed LVEF (≤30%) (HR 0.56, 95% CI 0.24-1.32). Funnel plots did not show asymmetry suggesting lack of bias. CONCLUSIONS:Patients with ICM and VT undergoing first-line ablation have a significantly lower rate of appropriate ICD therapies without a mortality difference compared with patients receiving an initial approach based on medical therapy. The beneficial effect of a first-line ablation approach was only observed in patients with moderately depressed LVEF (> 30-50%).
Authors: Nicola Tarantino; Domenico G Della Rocca; Nicole S De Leon De La Cruz; Eric D Manheimer; Michele Magnocavallo; Carlo Lavalle; Carola Gianni; Sanghamitra Mohanty; Chintan Trivedi; Amin Al-Ahmad; Rodney P Horton; Mohamed Bassiouny; J David Burkhardt; G Joseph Gallinghouse; Giovanni B Forleo; Luigi Di Biase; Andrea Natale Journal: Medicina (Kaunas) Date: 2021-02-26 Impact factor: 2.430
Authors: Jana Haskova; Petr Peichl; Marek Šramko; Jakub Cvek; Lukáš Knybel; Otakar Jiravský; Radek Neuwirth; Josef Kautzner Journal: Front Cardiovasc Med Date: 2022-03-28