Meta-Analysis of Catheter Ablation as an Adjunct to Medical Therapy for Treatment of Ventricular Tachycardia in Patients With Structural Heart Disease

Study Questions:

How effective is radiofrequency catheter ablation (RFCA) of ventricular tachycardia (VT) in the setting of structural heart disease?

Methods:

This was a meta-analysis of four randomized studies and one nonrandomized study in which RFCA of VT plus medical therapy was compared to medical therapy alone in patients with ischemic or nonischemic cardiomyopathy. The primary outcome was the number of patients with recurrences of VT.

Results:

There were a total of 266 patients in the RFCA group and 191 patients in the control group. The mean age of the patients in the five studies was 60-70 years, and the mean left ventricular ejection fraction was 30-35%. The mean duration of follow-up was 6-22.5 months. The proportion of patients with recurrent VT was significantly lower in the RFCA group (35%) than in the control group (55%). There was no significant difference in electrical storm events or mortality between the two groups. The complication rate was 6.3%. Major complications consisted of death (1%), stroke (1%), cardiac perforation (1%), and high-degree atrioventricular block (1.6%).

Conclusions:

Adjunctive RFCA of VT in patients with structural heart disease is associated with a relative reduction of 38% in the proportion of patients with recurrent VT.

Perspective:

The only therapeutic endpoint examined in this meta-analysis was the number of patients with recurrent VT. This underestimates the clinical value of RFCA by not taking into account patients who experience a clinically meaningful reduction in the number of episodes of VT after ablation.

Clinical Topics: Arrhythmias and Clinical EP, Heart Failure and Cardiomyopathies, Implantable Devices, EP Basic Science, SCD/Ventricular Arrhythmias

Keywords: Heart Diseases, Atrioventricular Block, Recurrence, Tachycardia, Ventricular, Follow-Up Studies, Cardiomyopathies


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