Outcome of catheter ablation for ventricular tachycardia in patients with ischemic cardiomyopathy

A systematic review and meta-analysis of randomized clinical trials

Waddah Maskoun, Marwan Saad, Amjad Abualsuod, Ramez Nairooz, John Miller

Research output: Contribution to journalArticle

3 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)107-113
Number of pages7
JournalInternational Journal of Cardiology
Volume267
DOIs
StatePublished - Sep 15 2018
Externally publishedYes

Fingerprint

Catheter Ablation
Ventricular Tachycardia
Cardiomyopathies
Meta-Analysis
Randomized Controlled Trials
Odds Ratio
Shock
Hospitalization
Mortality
Equipment and Supplies
Therapeutics

Keywords

  • Ablation
  • Arrhythmia
  • Ischemic cardiomyopathy
  • Ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Outcome of catheter ablation for ventricular tachycardia in patients with ischemic cardiomyopathy : A systematic review and meta-analysis of randomized clinical trials. / Maskoun, Waddah; Saad, Marwan; Abualsuod, Amjad; Nairooz, Ramez; Miller, John.

In: International Journal of Cardiology, Vol. 267, 15.09.2018, p. 107-113.

Research output: Contribution to journalArticle

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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.",
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T1 - Outcome of catheter ablation for ventricular tachycardia in patients with ischemic cardiomyopathy

T2 - A systematic review and meta-analysis of randomized clinical trials

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AU - Saad, Marwan

AU - Abualsuod, Amjad

AU - Nairooz, Ramez

AU - Miller, John

PY - 2018/9/15

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AB - 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.

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KW - Arrhythmia

KW - Ischemic cardiomyopathy

KW - Ventricular tachycardia

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