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Prophylactic catheter ablation of ventricular tachycardia in ischemic cardiomyopathy: a systematic review and meta-analysis of randomized controlled trials

  • Varunsiri Atti
  • Venkat Vuddanda
  • Mohit K. Turagam
  • Praveen Vemula
  • Zubair Shah
  • Himakar Nagam
  • Srikanth Yandrapalli
  • Mohammad-Ali Jazayeri
  • Scott Koerber
  • Juan Viles Gonzalez
  • Andrea Natale
  • Luigi Di Biase
  • Dhanunjaya R. Lakkireddy
MULTIMEDIA REPORT

Abstract

Background

Catheter ablation is proven to be an effective strategy for drug refractory ventricular tachycardia (VT) in ischemic cardiomyopathy. However, the appropriate timing of VT ablation and identifying the group of patients that may receive the greatest benefit remains uncertain. There is limited data on the effect on prophylactic catheter ablation (PCA) in the prevention of implantable cardioverter defibrillator (ICD) therapy, electrical storm, and mortality.

Methods

We performed a comprehensive literature search through November 1, 2017, for all eligible studies comparing PCA + ICD versus ICD only in eligible patients with ischemic cardiomyopathy. Clinical outcomes included all ICD therapies including ICD shocks and electrical storm. Additional outcomes included all-cause mortality, cardiovascular mortality, and complications.

Results

Three randomized controlled trials (RCTs) (N = 346) met inclusion criteria. PCA was associated with a significantly lower ICD therapies (OR 0.49; CI 0.28 to 0.87; p = 0.01) including ICD shocks [OR 0.38; CI 0.22 to 0.64; p = 0.0003) and electrical storm (OR 0.55; CI 0.30 to 1.01; p = 0.05) when compared with ICD only. There was no significant difference in all-cause mortality (OR 0.77; CI 0.41 to 1.46; p = 0.42), cardiovascular mortality (OR 0.49; CI 0.16 to 1.50; p = 0.21), and major adverse events (OR 1.45; CI 0.52 to 4.01; p = 0.47) between two groups.

Conclusion

These results suggest prophylactic catheter ablation decreases ICD therapies, including shocks and electrical storm with no improvement in overall mortality. There is a need for future carefully designed randomized clinical trials.

Keywords

Ventricular tachycardia ablation ICD shock Electrical storm 

Abbreviations

PCA

Prophylactic catheter ablation

ICD

Implantable cardiac defibrillator

AAD

Anti-arrhythmic drugs

RCT

Randomized controlled trial

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The manuscript has not been submitted or is under consideration elsewhere in any other journal. No data has been fabricated or manipulated. Consent to submit has been received explicitly from all co-authors.

Supplementary material

10840_2018_376_MOESM1_ESM.docx (28 kb)
ESM 1 (DOCX 27 kb)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Varunsiri Atti
    • 1
  • Venkat Vuddanda
    • 2
  • Mohit K. Turagam
    • 3
  • Praveen Vemula
    • 4
  • Zubair Shah
    • 5
  • Himakar Nagam
    • 6
  • Srikanth Yandrapalli
    • 7
  • Mohammad-Ali Jazayeri
    • 8
  • Scott Koerber
    • 9
  • Juan Viles Gonzalez
    • 10
  • Andrea Natale
    • 11
  • Luigi Di Biase
    • 3
  • Dhanunjaya R. Lakkireddy
    • 8
  1. 1.Department of Internal MedicineMichigan State UniversityEast LansingUSA
  2. 2.Department of Cardiovascular DiseaseHarvard Medical SchoolBostonUSA
  3. 3.Helmsley Electrophysiology CenterMount Sinai School of MedicineNew YorkUSA
  4. 4.Department of Internal MedicineSparrow HospitalLansingUSA
  5. 5.Department of Cardiovascular DiseasesUniversity of UtahSalt Lake CityUSA
  6. 6.University of CaliforniaBerkeleyUSA
  7. 7.Department of Cardiovascular DiseasesNew York Medical CollegeValhallaUSA
  8. 8.Cardiovascular Research InstituteKansas University HospitalKansas CityUSA
  9. 9.Department of Cardiac ElectrophysiologyMedical University of South CarolinaColumbiaUSA
  10. 10.Heart and Vascular InstituteTulane University School of MedicineNew OrleansUSA
  11. 11.Texas Cardiac Arrhythmia CenterAustinUSA

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