Catheter Ablation for Ventricular Tachycardia in Ischemic Cardiomyopathy: A Meta-Analysis With Reconstructed Time-to-Event and Trial Sequential Analysis.

Background: Ventricular tachycardia (VT) is a major contributor to sudden cardiac death among patients with ischemic heart disease (IHD). While catheter ablation reduces the arrhythmic burden, the impact on long-term outcomes remains uncertain. We assess the efficacy of catheter ablation in patients with IHD.

Methods: We performed a meta-analysis by systematically searching electronic databases from inception to April 2025. Pairwise, reconstructed time-to-event data meta-analyses and Trial Sequential analyses were conducted.

Results: A total of seven studies (1192 participants) were included. Among patients with IHD with ICD, VT ablation was associated with a significant reduction in ICD shocks (RR = 0.50, 95% CI = [0.34-0.74]), a trend toward reduced VT storm (RR = 0.64, 95% CI = [0.40-1.04], p = 0.07), and lower rates of cardiovascular hospitalization (RR = 0.73, 95% CI = [0.53-1.01], p = 0.06) compared to ICD alone. However, no significant differences were observed when compared to patients receiving ICD plus antiarrhythmic drugs (AADs). VT ablation showed no significant impact on mortality or VT/VF recurrence compared to either ICD alone or ICD with AADs. Reconstructed Kaplan-Meier analysis for all-cause mortality showed no significant difference between VT ablation and AAD  +  ICD. Trial Sequential Analysis provided conclusive evidence for VT/VF recurrence, while further data is required for other outcomes.

Conclusion: Among patients with IHD with ICD, VT ablation reduces ICD shocks, VT storm, and cardiovascular hospitalizations compared to ICD-only therapy, but offers no significant advantage over ICD combined with AADs. VT ablation does not impact overall mortality or the recurrence of VT/VF. Trial sequential analysis confirmed conclusive evidence for VT/VF recurrence, while additional data is needed for other outcomes.