Systematic review and meta-analysis of catheter ablation of ventricular tachycardia in ischemic heart disease

BACKGROUND Patients with ischemic heart disease (IHD) are at risk for ventricular tachycardia (VT). Catheter ablation (CA) may reduce this risk. OBJECTIVE To perform a systematic review and meta-analysis of randomized controlled trials (RCTs) of CA of VT in patients with IHD. METHODS Literature searches of MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL), and the Cochrane Database of Systematic Reviews (CDSR) were performed from January 2000 through April 2018 to identify RCTs comparing a strategy of CA vs no ablation in patients with IHD and an implantable cardioverter defibrillator (ICD). Outcomes of interest included appropriate ICD therapies, appropriate ICD shocks, VT storm, recurrent VT/ventricular fibrillation (VF), cardiac hospitalizations, and all-cause mortality. Using an inverse variance random-effects model, odds ratios (ORs) and 95% confidence intervals (CIs) were calculated for each endpoint. RESULTS A total of 5 RCTs (N = 635 patients) were included, with a duration of follow-up ranging from 6 months to 27.9 months. Patients who underwent CA experienced decreased odds of appropriate ICD therapies (OR 0.49; 95% CI 0.28-0.87), appropriate ICD shocks (OR 0.52; 95% CI 0.28-0.96), VT storm (OR 0.64; 95% CI 0.43-0.95), and cardiac hospitalization (OR 0.67; 95% CI 0.46-0.97) vs those who did not undergo ablation. There was no evidence of a benefit for recurrent VT/VF (OR 0.87; 95% CI 0.41-1.85), although this endpoint was not reported in all trials, or for all-cause mortality (OR 0.89; 95% CI 0.60-1.34). CONCLUSION In this systematic review and meta-analysis of RCTs, CA was associated with a significant reduction in the odds of appropriate ICD therapies, appropriate ICD shocks, VT storm, and cardiac hospitalizations in patients with IHD.