Skip to main content

Advertisement

SpringerLink
Log in

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

  • MULTIMEDIA REPORT
  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Abbreviations

PCA:

Prophylactic catheter ablation

ICD:

Implantable cardiac defibrillator

AAD:

Anti-arrhythmic drugs

RCT:

Randomized controlled trial

References

  1. Koplan BA, Stevenson WG. Ventricular tachycardia and sudden cardiac death. Mayo Clin Proc. 2009;84(3):289–97.

    Article  Google Scholar 

  2. MacIntyre CJ, Sapp JL. Treatment of persistent ventricular tachycardia: drugs or ablation? Trends Cardiovasc Med. 2017;27(7):506–13.

    Article  CAS  Google Scholar 

  3. Dunbar SB, Dougherty CM, Sears SF, et al. Educational and psychological interventions to improve outcomes for recipients of implantable cardioverter defibrillators and their families: a scientific statement from the American Heart Association. Circulation. 2012;126(17):2146–72.

    Article  Google Scholar 

  4. Antiarrhythmics versus Implantable Defibrillators (AVID) Investigators. A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. N Engl J Med. 1997;337(22):1576–83.

    Article  Google Scholar 

  5. Moss AJ, Zareba W, Hall WJ, et al. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med. 2002;346(12):877–83.

    Article  Google Scholar 

  6. Daubert JP, Zareba W, Cannom DS, et al. Inappropriate implantable cardioverter-defibrillator shocks in MADIT II: frequency, mechanisms, predictors, and survival impact. J Am Coll Cardiol. 2008;51(14):1357–65.

    Article  Google Scholar 

  7. Poole JE, Johnson GW, Hellkamp AS, et al. Prognostic importance of defibrillator shocks in patients with heart failure. N Engl J Med. 2008;359(10):1009–17.

    Article  CAS  Google Scholar 

  8. Connolly SJ, Dorian P, Roberts RS, et al. Comparison of beta-blockers, amiodarone plus beta-blockers, or sotalol for prevention of shocks from implantable cardioverter defibrillators: the OPTIC study: a randomized trial. JAMA. 2006;295(2):165–71.

    Article  CAS  Google Scholar 

  9. Aliot EM, Stevenson WG, Almendral-Garrote JM, et al. EHRA/HRS expert consensus on catheter ablation of ventricular arrhythmias: developed in a partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology (ESC), and the Heart Rhythm Society (HRS); in collaboration with the American College of Cardiology (ACC) and the American Heart Association (AHA). Europace. 2009;11(6):771–817.

    Article  Google Scholar 

  10. Pedersen CT, Kay GN, Kalman J, et al. EHRA/HRS/APHRS expert consensus on ventricular arrhythmias. Heart Rhythm. 2014;11(10):e166-e196.

    Article  Google Scholar 

  11. Liang JJ, Santangeli P, Callans DJ. Long-term outcomes of ventricular tachycardia ablation in different types of structural heart disease. Arrhythm Electrophysiol Rev. 2015;4(3):177–83.

    Article  Google Scholar 

  12. Dinov B, Arya A, Bertagnolli L, Schirripa - Circulation: … V, 2014. Early referral for ablation of scar-related ventricular tachycardia is associated with improved acute and long term outcomes: results from the heart center of …. Am Heart Assoc. 2014. http://circep.ahajournals.org/content/early/2014/09/27/CIRCEP.114.001953.short.

  13. Frankel DS, Mountantonakis SE, Robinson MR, Zado ES, Callans DJ, Marchlinski FE. Ventricular tachycardia ablation remains treatment of last resort in structural heart disease: argument for earlier intervention. J Cardiovasc Electrophysiol. 2011;22(10):1123–8.

    Article  Google Scholar 

  14. Romero J, Di Biase L, Diaz JC, et al. Early versus late referral for catheter ablation of ventricular tachycardia in patients with structural heart disease: a systematic review and meta-analysis of clinical outcomes. JACC: Clin Electrophysiol. 2018;4(3):374–82.

    Google Scholar 

  15. Mukherjee RK, O’Neill L, O’Neill MD. Prophylactic catheter ablation for ventricular tachycardia: are we there yet? Arrhythm Electrophysiol Rev. 2017;6(3):125–8.

    Article  Google Scholar 

  16. Reddy VY, Reynolds MR, Neuzil P, et al. Prophylactic catheter ablation for the prevention of defibrillator therapy. N Engl J Med. 2007;357(26):2657–65.

    Article  CAS  Google Scholar 

  17. Kuck K-H, Schaumann A, Eckardt L, et al. Catheter ablation of stable ventricular tachycardia before defibrillator implantation in patients with coronary heart disease (VTACH): a multicentre randomised controlled trial. Lancet. 2010;375(9708):31–40.

    Article  Google Scholar 

  18. Kuck K-H, Tilz RR, Deneke T, et al. Impact of substrate modification by catheter ablation on implantable cardioverter-defibrillator interventions in patients with unstable ventricular arrhythmias and coronary artery disease: results from the multicenter randomized controlled SMS (substrate modification study). Circ Arrhythm Electrophysiol. 2017;10(3) https://doi.org/10.1161/CIRCEP.116.004422.

  19. Pokorney SD, Friedman DJ, Calkins H, et al. Catheter ablation of ventricular tachycardia: lessons learned from past clinical trials and implications for future clinical trials. Heart Rhythm. 2016;13(8):1748–54.

    Article  Google Scholar 

  20. Moher D, Liberati A, Tetzlaff J, Altman DG. PRISMA group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264–9. W64

    Article  Google Scholar 

  21. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7(3):177–88.

    Article  CAS  Google Scholar 

  22. Higgins JPT, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.

    Article  Google Scholar 

  23. Go AS, Mozaffarian D, Roger VL, et al. Heart disease and stroke statistics—2014 update: a report from the American Heart Association. Circulation. 2014;129(3):e28–e292.

    PubMed  Google Scholar 

  24. Lo R, Chia KKM, Hsia HH. Ventricular tachycardia in ischemic heart disease. Card Electrophysiol Clin. 2017;9(1):25–46.

    Article  Google Scholar 

  25. de Bakker JMT, van Capflle FJL, Janse MJ, et al. Macroreentry in the infarcted human heart: the mechanism of ventricular tachycardias with a “focal” activation pattern. J Am Coll Cardiol. 1991;18(4):1005–14.

    Article  Google Scholar 

  26. Palaniswamy C, Kolte D, Harikrishnan P, et al. Catheter ablation of postinfarction ventricular tachycardia: ten-year trends in utilization, in-hospital complications, and in-hospital mortality in the United States. Heart Rhythm. 2014;11(11):2056–63.

    Article  Google Scholar 

  27. Haqqani HM, Roberts-Thomson KC. Radiofrequency catheter ablation for ventricular tachycardia. Heart Lung Circ. 2012;21(6-7):402–12.

    Article  Google Scholar 

  28. Liang JJ, Muser D, Santangeli P. Ventricular tachycardia ablation clinical trials. Card Electrophysiol Clin. 2017;9(1):153–65.

    Article  Google Scholar 

  29. Tung R, Vaseghi M, Frankel DS, et al. Freedom from recurrent ventricular tachycardia after catheter ablation is associated with improved survival in patients with structural heart disease: an International VT Ablation Center Collaborative Group study. Heart Rhythm. 2015;12(9):1997–2007.

    Article  Google Scholar 

  30. Sapp JL, Wells GA, Parkash R, et al. Ventricular tachycardia ablation versus escalation of antiarrhythmic drugs. N Engl J Med. 2016;375(2):111–21.

    Article  CAS  Google Scholar 

  31. Suzuki A, Yoshida A, Takei A, et al. Prophylactic catheter ablation of ventricular tachycardia before cardioverter-defibrillator implantation in patients with non-ischemic cardiomyopathy: clinical outcomes after a single endocardial ablation. J Arrhythm. 2015;31(3):122–9.

    Article  Google Scholar 

  32. Irvine J, Dorian P, Baker B, et al. Quality of life in the Canadian implantable defibrillator study (CIDS). Am Heart J. 2002;144(2):282–9.

    Article  Google Scholar 

  33. Soejima K, Suzuki M, Maisel WH, et al. Catheter ablation in patients with multiple and unstable ventricular tachycardias after myocardial infarction: short ablation lines guided by reentry circuit isthmuses and sinus rhythm mapping. Circulation. 2001;104(6):664–9.

    Article  CAS  Google Scholar 

  34. Marchlinski FE, Callans DJ, Gottlieb CD, Zado E. Linear ablation lesions for control of unmappable ventricular tachycardia in patients with ischemic and nonischemic cardiomyopathy. Circulation. 2000;101(11):1288–96.

    Article  CAS  Google Scholar 

  35. Tung R, Josephson ME, Reddy V, Reynolds MR, SMASH-VT Investigators. Influence of clinical and procedural predictors on ventricular tachycardia ablation outcomes: an analysis from the substrate mapping and ablation in Sinus Rhythm to Halt Ventricular Tachycardia Trial (SMASH-VT). J Cardiovasc Electrophysiol. 2010;21(7):799–803.

    PubMed  Google Scholar 

  36. Muser D, Liang JJ, Pathak RK, et al. Long-term outcomes of catheter ablation of electrical storm in nonischemic dilated cardiomyopathy compared with ischemic cardiomyopathy. JACC: Clin Electrophysiol. 2017;3(7):767–78.

    Google Scholar 

  37. Di Biase L, Burkhardt JD, Lakkireddy D, et al. Ablation of stable VTs versus substrate ablation in ischemic cardiomyopathy: the VISTA randomized multicenter trial. J Am Coll Cardiol. 2015;66(25):2872–82.

    Article  Google Scholar 

  38. Silberbauer J, Oloriz T, Maccabelli G, et al. Noninducibility and late potential abolition: a novel combined prognostic procedural end point for catheter ablation of postinfarction ventricular tachycardia. Circ Arrhythm Electrophysiol. 2014;7(3):424–35.

    Article  Google Scholar 

  39. Mizuno H. Mapping of ventricular tachycardia in patients with structural heart disease. J Arrhythmia. 2014;30(4):283–91.

    Article  Google Scholar 

  40. Yoshiga Y, Mathew S, Wissner E, et al. Correlation between substrate location and ablation strategy in patients with ventricular tachycardia late after myocardial infarction. Heart Rhythm. 2012;9(8):1192–9.

    Article  Google Scholar 

  41. Sacher F, Roberts-Thomson K, Maury P, et al. Epicardial ventricular tachycardia ablation a multicenter safety study. J Am Coll Cardiol. 2010;55(21):2366–72.

    Article  Google Scholar 

  42. Di Biase L, Santangeli P, Burkhardt DJ, et al. Endo-epicardial homogenization of the scar versus limited substrate ablation for the treatment of electrical storms in patients with ischemic cardiomyopathy. J Am Coll Cardiol. 2012;60(2):132–41.

    Article  Google Scholar 

  43. Santangeli P, Muser D, Maeda S, et al. Comparative effectiveness of antiarrhythmic drugs and catheter ablation for the prevention of recurrent ventricular tachycardia in patients with implantable cardioverter-defibrillators: a systematic review and meta-analysis of randomized controlled trials. Heart Rhythm. 2016;13(7):1552–9.

    Article  Google Scholar 

  44. Carbucicchio C, Santamaria M, Trevisi N, et al. Catheter ablation for the treatment of electrical storm in patients with implantable cardioverter-defibrillators. Circulation. 2008;117(4):462–9.

    Article  Google Scholar 

  45. Sesselberg HW, Moss AJ, McNitt S, et al. Ventricular arrhythmia storms in postinfarction patients with implantable defibrillators for primary prevention indications: a MADIT-II substudy. Heart Rhythm. 2007;4(11):1395–402.

    Article  Google Scholar 

  46. Winterfield JR, Kent AR, Karst E, et al. Impact of ventricular tachycardia ablation on health care utilization. Heart Rhythm. 2017; https://doi.org/10.1016/j.hrthm.2017.10.009.

    Article  Google Scholar 

  47. Preventive aBlation of vEntricular tachycaRdia in Patients With myocardiaL INfarction - Full Text View - ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT02501005. Accessed 26 Nov 2017.

  48. Does Timing of VT Ablation Affect Prognosis in Patients With an Implantable Cardioverter-defibrillator? - Full Text View - ClinicalTrials.gov. https://clinicaltrials.gov/ct2/show/NCT01547208. Accessed 26 Nov 2017.

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Michigan State University, East Lansing, MI, USA

    Varunsiri Atti

  2. Department of Cardiovascular Disease, Harvard Medical School, Boston, MA, USA

    Venkat Vuddanda

  3. Helmsley Electrophysiology Center, Mount Sinai School of Medicine, New York, NY, USA

    Mohit K. Turagam & Luigi Di Biase

  4. Department of Internal Medicine, Sparrow Hospital, Lansing, MI, USA

    Praveen Vemula

  5. Department of Cardiovascular Diseases, University of Utah, Salt Lake City, UT, USA

    Zubair Shah

  6. University of California, Berkeley, CA, USA

    Himakar Nagam

  7. Department of Cardiovascular Diseases, New York Medical College, Valhalla, NY, USA

    Srikanth Yandrapalli

  8. Cardiovascular Research Institute, Kansas University Hospital, Kansas City, KS, USA

    Mohammad-Ali Jazayeri & Dhanunjaya R. Lakkireddy

  9. Department of Cardiac Electrophysiology, Medical University of South Carolina, Columbia, SC, USA

    Scott Koerber

  10. Heart and Vascular Institute, Tulane University School of Medicine, New Orleans, LA, USA

    Juan Viles Gonzalez

  11. Texas Cardiac Arrhythmia Center, Austin, Texas, USA

    Andrea Natale

Authors
  1. Varunsiri Atti
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Venkat Vuddanda
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mohit K. Turagam
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Praveen Vemula
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Zubair Shah
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Himakar Nagam
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Srikanth Yandrapalli
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Mohammad-Ali Jazayeri
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Scott Koerber
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Juan Viles Gonzalez
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Andrea Natale
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Luigi Di Biase
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Dhanunjaya R. Lakkireddy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Varunsiri Atti.

Ethics declarations

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.

Electronic supplementary material

ESM 1

(DOCX 27 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Atti, V., Vuddanda, V., Turagam, M.K. et al. Prophylactic catheter ablation of ventricular tachycardia in ischemic cardiomyopathy: a systematic review and meta-analysis of randomized controlled trials. J Interv Card Electrophysiol 53, 207–215 (2018). https://doi.org/10.1007/s10840-018-0376-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-018-0376-5

Keywords

Search

Navigation