Venkatesh Ravi1, Abhushan Poudyal2, Smriti Khanal2, Charl Khalil2, Aviral Vij2, David Sanders3, Timothy Larsen3, Richard G Trohman3, Tolga Aksu4, Roderick Tung5, Pasquale Santangeli6, Jeffrey Winterfield7, Parikshit S Sharma3, Henry D Huang3. 1. Warren Clinic Cardiology, Saint Francis Health System, 6151 South Yale Ave, Tulsa, OK, 74136, USA. venkateshravi.8711@gmail.com. 2. Division of Cardiology, Cook County Health, Chicago, USA. 3. Section of Electrophysiology, Division of Cardiology, Department of Medicine, Rush University Medical Center, Chicago, USA. 4. Department of Cardiology, Yeditepe University Hospital, Istanbul, Turkey. 5. Section of Electrophysiology, Division of Cardiology, University of Arizona College of Medicine, Phoenix, USA. 6. Electrophysiology Section, Cardiovascular Division, Hospital of University of Pennsylvania, Philadelphia, USA. 7. Section of Electrophysiology, Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, USA.
Abstract
BACKGROUND: In patients with cardiomyopathy, radiofrequency catheter ablation (CA) for ventricular tachycardia (VT) is an adjunctive and alternative treatment option to long-term anti-arrhythmic drug therapy. We sought to compare CA with medical therapy for the management of VT in patients with ischemic and non-ischemic cardiomyopathies. METHODS: MEDLINE, Cochrane, and ClinicalTrials.gov databases were evaluated for relevant studies. RESULTS: Eleven studies with 2126 adult patients were included (711 in CA, 1415 in medical therapy). In the randomized controlled trial (RCT) analysis, CA reduced risk of recurrent VT (risk ratio (RR) 0.79 [95% CI 0.67 to 0.93], p = 0.005), ICD shocks (RR 0.64 [95% CI 0.45 to 0.89] p = 0.008), and cardiac hospitalizations (RR 0.76 [95% CI 0.63 to 0.92] p = 0.005). There was no difference in all-cause mortality (RR 0.94, p = 0.71). In combined RCT and observational study analysis, there was a trend for reduction in all-cause mortality (RR 0.75 [95% CI 0.55 to 1.02] p = 0.07). In subgroup analysis of studies with mean left ventricular ejection fraction (LVEF) < 35%, CA demonstrated reduction in mortality (RR 0.71, p = 0.004), ICD shocks (RR 0.63, p = 0.03), VT recurrence (RR 0.76, p = 0.004), and cardiac hospitalizations (RR 0.75, p = 0.02). The subgroup of early CA prior to ICD shocks demonstrated reduction in ICD shocks (RR 0.57, p < 0.001) and VT recurrence (RR 0.74, p = 0.01). CONCLUSIONS: CA for VT demonstrated a lower risk of VT recurrence, ICD shocks, and hospitalization in comparison to medical therapy. The subgroups of early CA and LVEF < 35% demonstrated better outcomes.
BACKGROUND: In patients with cardiomyopathy, radiofrequency catheter ablation (CA) for ventricular tachycardia (VT) is an adjunctive and alternative treatment option to long-term anti-arrhythmic drug therapy. We sought to compare CA with medical therapy for the management of VT in patients with ischemic and non-ischemic cardiomyopathies. METHODS: MEDLINE, Cochrane, and ClinicalTrials.gov databases were evaluated for relevant studies. RESULTS: Eleven studies with 2126 adult patients were included (711 in CA, 1415 in medical therapy). In the randomized controlled trial (RCT) analysis, CA reduced risk of recurrent VT (risk ratio (RR) 0.79 [95% CI 0.67 to 0.93], p = 0.005), ICD shocks (RR 0.64 [95% CI 0.45 to 0.89] p = 0.008), and cardiac hospitalizations (RR 0.76 [95% CI 0.63 to 0.92] p = 0.005). There was no difference in all-cause mortality (RR 0.94, p = 0.71). In combined RCT and observational study analysis, there was a trend for reduction in all-cause mortality (RR 0.75 [95% CI 0.55 to 1.02] p = 0.07). In subgroup analysis of studies with mean left ventricular ejection fraction (LVEF) < 35%, CA demonstrated reduction in mortality (RR 0.71, p = 0.004), ICD shocks (RR 0.63, p = 0.03), VT recurrence (RR 0.76, p = 0.004), and cardiac hospitalizations (RR 0.75, p = 0.02). The subgroup of early CA prior to ICD shocks demonstrated reduction in ICD shocks (RR 0.57, p < 0.001) and VT recurrence (RR 0.74, p = 0.01). CONCLUSIONS: CA for VT demonstrated a lower risk of VT recurrence, ICD shocks, and hospitalization in comparison to medical therapy. The subgroups of early CA and LVEF < 35% demonstrated better outcomes.
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