Journal
HEART RHYTHM
Volume 16, Issue 10, Pages 1484-1491Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.hrthm.2019.05.026
Keywords
Antiarrhythmic therapy; Catheter ablation; Meta-analysis; Randomized controlled trial; Ventricular tachycardia
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BACKGROUND Catheter ablation (CA) is an established therapeutic modality for ventricular tachycardia (VT). OBJECTIVE We compared the clinical outcomes of CA for VT vs medicaltherapy from all previously performed randomized controlled trials (RCTs) and compared these to contemporary observational studies. METHODS A comprehensive database search through to August 2018 identified 8 eligible studies enrolling 797 patients. RESULTS In RCTs, VT recurrence and electrical VT storm were significantly reduced in the CA group vs medical therapy group (relative risk [RR] 0.78, 95% confidence interval [CI] 0.64-0.95, P = .01; RR 0.70, 95% CI 0.51-0.94, P = .02, respectively) at a mean follow-up of 22 months. All-cause or cardiac-specific mortality did not differ significantly (RR 0.92, 95% CI 0.67-1.27, P = .62; RR 0.82, 95% CI 0.54-1.26, P = .37, respectively). In 4 observational studies, including 3065 patients with a mean follow-up of 18.2 months, VT recurrence and mortality were significantly lower as compared to the RCTs (28.6% vs 39%, P < .001; 13.2% vs 18%, P = .01, respectively) despite greater incidence of electrical storm (33.2% vs 17%, P < .001), higher prevalence of nonischemic substrate (46.4% vs 3.6%, P < .001), and lower rate of implanted ICDs (68% vs 94.7%, P < .001). CONCLUSION Meta-analysis of RCT data shows that CA is superior to medical therapy for predominantly postinfarct, scar-related VT in terms of VT recurrence and electrical VT storm, with no reduction in mortality. Real-world observational studies also demonstrate significant reduction in VT recurrence and mortality, despite a sicker cohort, demonstrating replicability and translation of RCT data in the real world.
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