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Radiofrequency catheter ablation of ventricular tachycardia in ischemic heart disease in light of current practice: a systematic review and meta-analysis of randomized controlled trials

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Abstract

Purpose

Ventricular tachycardia (VT) is a frequent cause of mortality and morbidity in patients with ischemic heart disease (IHD). We aim to perform a systematic review and meta-analysis of randomized controlled trials (RCT) of radiofrequency catheter ablation (RCA) of VT in patients with IHD and to discuss its appropriate timing and limitations.

Methods

Literature searches of MEDLINE, CENTRAL, the Cochrane Database of Systematic Reviews, Health Technology Assessment, and PsycINFO were performed in February 2020. RCTs comparing RCA vs conventional management for VT in patients with IHD and previous or planned implantable cardioverter defibrillator (ICD) were identified. Clinical outcomes included all-cause mortality, cardiovascular mortality, cardiovascular hospitalization, VT storm, recurrent VT/ventricular fibrillation (VF), appropriate ICD therapies, and appropriate ICD shocks. Using a random-effects model, relative risk (RR) and 95% confidence intervals (CI) were calculated for each outcome.

Results

A total of 6 RCTs (N = 791) met inclusion criteria. RCA was associated with significantly lower VT storm (RR 0.70; CI95% 0.51 to 0.94, p = 0.02) and appropriate ICD therapies (RR 0.69; CI95% 0.54 to 0.88, p = 0.003), including appropriate ICD shocks (RR 0.66; CI95% 0.47 to 0.92, p = 0.02). There was no significant difference in all-cause or cardiovascular mortality, cardiovascular hospitalization, and recurrent VT/VF.

Conclusions

Radiofrequency catheter ablation for VT in patients with IHD was associated with a reduced risk of VT storm, ICD therapies, and ICD shocks. There is a need for future carefully designed RCTs that incorporate improved RCA procedural aspects.

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Data availability

The data underlying this article are available in the article and in its online supplementary material.

Abbreviations

AAD:

Antiarrhythmic drug

CI:

Confidence interval

ICD:

Implantable cardioverter defibrillator

IHD:

Ischemic heart disease

RCA:

Radiofrequency catheter ablation

RCT:

Randomized controlled trial

RR:

Relative risk

VF:

Ventricular fibrillation

VT:

Ventricular tachycardia

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Code availability

The data underlying this article are available in the article and in its online supplementary material.

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Authors and Affiliations

  1. Serviço de Cardiologia, Departamento de Coração e Vasos, CHULN Hospital de Santa Maria, Av Prof. Egas Moniz, 1649-028, Lisbon, Portugal

    Gustavo Lima da Silva, Afonso Nunes-Ferreira, Nuno Cortez-Dias, João de Sousa, Fausto J. Pinto & Daniel Caldeira

  2. Cardiac Rhythm Abnormalities Unit, Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Av Prof. Egas Moniz, 1649-028, Lisbon, Portugal

    Gustavo Lima da Silva, Nuno Cortez-Dias, João de Sousa & Fausto J. Pinto

  3. Cardiovascular Pharmacology and Therapeutics Unit, Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Av Prof. Egas Moniz, 1649-028, Lisbon, Portugal

    Afonso Nunes-Ferreira, Fausto J. Pinto & Daniel Caldeira

  4. Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Av Prof. Egas Moniz, 1649-028, Lisbon, Portugal

    Daniel Caldeira

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  1. Gustavo Lima da Silva
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Lima da Silva, G., Nunes-Ferreira, A., Cortez-Dias, N. et al. Radiofrequency catheter ablation of ventricular tachycardia in ischemic heart disease in light of current practice: a systematic review and meta-analysis of randomized controlled trials. J Interv Card Electrophysiol 59, 603–616 (2020). https://doi.org/10.1007/s10840-020-00870-3

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