Catheter Ablation Versus Antiarrhythmic Drugs in the Management of Ventricular Tachycardia in Ischemic Cardiomyopathy: An Updated Systematic Review and Meta-analysis

Ventricular tachycardia (VT) is a major cause of morbidity and mortality in patients with ischemic cardiomyopathy. Prior randomized controlled trials comparing catheter ablation (CA) with antiarrhythmic drug (AAD) therapy have reported inconsistent findings. We conducted an updated meta-analysis to compare the efficacy and safety of CA versus AAD therapy in this population. Four randomized controlled trials involving 846 patients were included. The weighted mean age was 58.7 years, the weighted mean left ventricular ejection fraction was 33.5%, and 88% of participants were male. In the AAD group, amiodarone and sotalol were used in 60% and 40% of patients, respectively. CA significantly reduced the primary composite outcome compared with AAD therapy (risk ratio RR = 0.85, 95% confidence interval CI: 0.75-0.97, P = 0.01), mainly driven by a lower incidence of treated sustained VT below the implantable cardioverter-defibrillator detection limit (RR = 0.25, 95% CI: 0.15-0.43, P < 0.01). CA also significantly reduced treatment-related adverse events (RR = 0.49, 95% CI: 0.36-0.65, P < 0.01). No significant differences were observed in all-cause mortality, appropriate implantable cardioverter-defibrillator shocks, or VT storm. In patients with ischemic cardiomyopathy and VT, CA reduces arrhythmic events and treatment-related adverse events compared with AAD therapy, although a survival benefit remains unproven.