Catheter ablation reduced appropriate ICD shocks by 34% (RR 0.66) and VT recurrence by 19% (RR 0.81) versus antiarrhythmic drugs, with no mortality difference.
Does catheter ablation reduce appropriate ICD shocks, recurrent VT, and all-cause mortality compared to antiarrhythmic drug therapy in patients with ventricular tachycardia?
Catheter ablation is superior to antiarrhythmic drug therapy for reducing VT recurrence and appropriate ICD shocks in patients with ventricular tachycardia, though it does not improve overall mortality.
Absolute Event Rate: 0% vs 0%
Abstract Background Ventricular tachycardia (VT) is a life-threatening arrhythmia, particularly in patients with structural heart disease. Standard management includes implantable cardioverter-defibrillators (ICDs) and antiarrhythmic drugs, but catheter ablation (CA) has emerged as a potential first-line therapy due to its ability to modify the arrhythmogenic substrate and reduce VT recurrence. Purpose This systematic review and meta-analysis aimed to assess whether catheter ablation is superior to antiarrhythmic drug therapy in the management of VT, focusing on their impact on clinical outcomes and treatment strategies. Methods A systematic search was conducted in PubMed, Embase, and the Cochrane Central Register of Controlled Trials to identify randomized controlled trials (RCTs) comparing catheter ablation with antiarrhythmic drug therapy for VT management. Statistical analysis was carried out utilizing Review Manager version 5.4 and R version 4.2.2. Heterogeneity was assessed with I² statistics; p-values inferior to 0.05 and I²25% were considered significant heterogeneity. The primary outcomes assessed included appropriate ICD shocks, recurrent VT, and all-cause mortality. Results Ten RCTs met the inclusion criteria, encompassing 1,519 participants, of whom 748 underwent CA. The CA group showed a significant reduction in appropriate ICD shocks (RR 0.66; CI 0.50-0.88; p = 0.005; Figure 1A) and VT recurrence (RR 0.81; CI 0.70-0.92; p = 0.002; Figure 1B) compared to antiarrhythmic therapy. However, no significant difference was observed in all-cause mortality (RR 0.92; CI 0.73-1.14; p = 0.439; Figure 2). Conclusion This systematic review and meta-analysis suggest that catheter ablation is more effective than antiarrhythmic drug therapy in reducing VT recurrence and ICD interventions, but does not impact overall mortality.
Lucena et al. (Sat,) reported a other. Catheter ablation reduced appropriate ICD shocks by 34% (RR 0.66) and VT recurrence by 19% (RR 0.81) versus antiarrhythmic drugs, with no mortality difference.