Catheter ablation versus medical therapy for ventricular tachycardia in patients with ischemic heart disease: A systematic review and meta-analysis of randomized controlled trials

Q3 Medicine

Indian Pacing and Electrophysiology Journal Pub Date : 2025-03-01 DOI:10.1016/j.ipej.2025.03.004

Ubaid Khan , Yehya Khlidj , Ahmed A. Ibrahim , Ahmed Mazen Amin , Mohamed Saad Rakab , Majd M. AlBarakat , Muhammad Haris Khan , Zuhair Majeed , Muhammad Imran , Junaid Ali , Chet RanaBhat , Wajeeh Ur Rehman , Justin Brilliant , Kashif Chaudhry

{"title":"Catheter ablation versus medical therapy for ventricular tachycardia in patients with ischemic heart disease: A systematic review and meta-analysis of randomized controlled trials","authors":"Ubaid Khan , Yehya Khlidj , Ahmed A. Ibrahim , Ahmed Mazen Amin , Mohamed Saad Rakab , Majd M. AlBarakat , Muhammad Haris Khan , Zuhair Majeed , Muhammad Imran , Junaid Ali , Chet RanaBhat , Wajeeh Ur Rehman , Justin Brilliant , Kashif Chaudhry","doi":"10.1016/j.ipej.2025.03.004","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Ventricular tachycardia (VT) is a common chronic complication of ischemic heart disease (IHD), even in the era of contemporary coronary intervention. The use of implantable cardioverter-defibrillators (ICDs) has reduced mortality, but ICD shocks can be painful and traumatizing. Catheter ablation has been posited to reduce VT incidence and is commonly used in IHD patients when antiarrhythmic drugs do not suppress VT.</div></div><div><h3>Purpose</h3><div>We aim to review the clinical efficacy and safety of catheter ablation vs medical therapy in patients with IHD.</div></div><div><h3>Methods</h3><div>We conducted comprehensive searches across PubMed, CENTRAL, Web of Science, Scopus, and Embase until May 2024. Pooled data were reported using risk ratio (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes. This systematic review and meta-analysis was registered with PROSPERO ID: CRD42024551760.</div></div><div><h3>Results</h3><div>We included eight RCTs with a total of 1252 patients. Patients who underwent catheter ablation had a lower risk of VT storms compared to those who received medical therapy alone [RR: 0.74 with 95 % CI: (0.60, 0.91), P = 0.005), Compared to medical therapy, the catheter ablation group also required less appropriate ICD therapy [RR: 0.72 with 95 % CI: (0.57, 0.90), P = 0.005), and fewer appropriate ICD shocks [RR: 0.75 with 95 % CI: (0.57, 0.99), P = 0.04). However, there was no significant difference in Ventricular tachycardia/Ventricular fibrillation (VT/VF) recurrence [RR: 0.94 with 95 % CI: (0.83, 1.06), P = 0.33) and all-cause mortality [RR: 0.87 with 95 % CI: (0.70, 1.09), P = 0.22).</div></div><div><h3>Conclusion</h3><div>Catheter ablation is associated with a significant reduction in ventricular storms, appropriate ICD therapy, and appropriate ICD shocks while demonstrating similar safety in managing VT in IHD patients compared to medical therapy alone.</div></div>","PeriodicalId":35900,"journal":{"name":"Indian Pacing and Electrophysiology Journal","volume":"25 2","pages":"Pages 91-103"},"PeriodicalIF":0.0000,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Indian Pacing and Electrophysiology Journal","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0972629225000221","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"Medicine","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Ventricular tachycardia (VT) is a common chronic complication of ischemic heart disease (IHD), even in the era of contemporary coronary intervention. The use of implantable cardioverter-defibrillators (ICDs) has reduced mortality, but ICD shocks can be painful and traumatizing. Catheter ablation has been posited to reduce VT incidence and is commonly used in IHD patients when antiarrhythmic drugs do not suppress VT.

Purpose

We aim to review the clinical efficacy and safety of catheter ablation vs medical therapy in patients with IHD.

Methods

We conducted comprehensive searches across PubMed, CENTRAL, Web of Science, Scopus, and Embase until May 2024. Pooled data were reported using risk ratio (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes. This systematic review and meta-analysis was registered with PROSPERO ID: CRD42024551760.

Results

We included eight RCTs with a total of 1252 patients. Patients who underwent catheter ablation had a lower risk of VT storms compared to those who received medical therapy alone [RR: 0.74 with 95 % CI: (0.60, 0.91), P = 0.005), Compared to medical therapy, the catheter ablation group also required less appropriate ICD therapy [RR: 0.72 with 95 % CI: (0.57, 0.90), P = 0.005), and fewer appropriate ICD shocks [RR: 0.75 with 95 % CI: (0.57, 0.99), P = 0.04). However, there was no significant difference in Ventricular tachycardia/Ventricular fibrillation (VT/VF) recurrence [RR: 0.94 with 95 % CI: (0.83, 1.06), P = 0.33) and all-cause mortality [RR: 0.87 with 95 % CI: (0.70, 1.09), P = 0.22).

Conclusion

Catheter ablation is associated with a significant reduction in ventricular storms, appropriate ICD therapy, and appropriate ICD shocks while demonstrating similar safety in managing VT in IHD patients compared to medical therapy alone.

查看原文本刊更多论文

缺血性心脏病患者室性心动过速的导管消融与药物治疗：随机对照试验的系统评价和荟萃分析

背景：室性心动过速（VT）是缺血性心脏病（IHD）常见的慢性并发症，即使在当代冠状动脉介入治疗时代也是如此。植入式心律转复除颤器（ICD）的使用降低了死亡率，但ICD电击可能会带来痛苦和创伤。导管消融被认为可以降低室性心动过速的发生率，在抗心律失常药物不能抑制室性心动过速的IHD患者中经常使用。目的：我们的目的是回顾导管消融与药物治疗在IHD患者中的临床疗效和安全性。方法：我们在PubMed， CENTRAL， WOS， Scopus和EMBASE中进行了全面的检索，直到2024年2月。用风险比（RR）报告二分结局，用平均差（MD）报告连续结局。该系统评价和荟萃分析已注册为PROSPERO ID: CRD42024551760。结果：我们纳入了8项随机对照试验，共1252例患者。与内科治疗组相比，行消融术组VT风暴发生风险较低[RR: 0.74, 95% CI:(0.60, 0.91), P =0.005]，与内科治疗组相比，导管消融术组所需适当的ICD治疗较少[RR: 0.72, 95% CI (0.57, 0.90), P < 0.01)，适当的ICD电击较少[RR: 0.75, 95% CI (0.57, 0.0.99), P = 0.04]。然而，两组VT/VF复发率[RR: 0.94, 95% CI (0.83, 1.04), P = 0.33]和全因死亡率[RR: 0.87, 95% CI (0.70, 1.09), P = 0.22]无显著差异。结论：导管消融与心室风暴、ICD治疗和ICD冲击的减少有关，同时与单独药物治疗相比，在处理IHD患者的VT方面显示出相似的安全性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Indian Pacing and Electrophysiology Journal Medicine-Cardiology and Cardiovascular Medicine

CiteScore

2.20

自引率

0.00%

发文量

审稿时长

61 days

期刊介绍： Indian Pacing and Electrophysiology Journal is a peer reviewed online journal devoted to cardiac pacing and electrophysiology. Editorial Advisory Board includes eminent personalities in the field of cardiac pacing and electrophysiology from Asia, Australia, Europe and North America.