Outcomes of endocardial versus endo-epicardial catheter ablation for ventricular arrhythmia in patients with arrhythmogenic right ventricular cardiomyopathy: a meta analysis.
Ashish Yadav, Jacqueline Mirza, Eisha Gupta et al.
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In 30 seconds
This systematic review and Bayesian meta-analysis compared endocardial-only with combined endocardial and epicardial catheter ablation for ventricular arrhythmia in patients with arrhythmogenic right ventricular cardiomyopathy. Seventeen studies involving 976 patients contributed primary or secondary outcomes. The combined approach was associated with lower arrhythmia recurrence (Bayesian OR 0.47, 95% CrI 0.34-0.64), while analysis across 15 studies and 866 patients found higher major complication risk (Bayesian OR 6.28, 95% CI 2-24). Reconstructed patient-level survival data also showed reduced recurrence with combined ablation.
Key findings
- Combined endo-epicardial ablation was associated with lower ventricular arrhythmia recurrence: Bayesian OR 0.47, 95% CrI 0.34-0.64.
- Reconstructed data from 460 patients showed reduced recurrence with combined ablation (HR 0.39, 95% CI 0.28-0.52; log-rank p < 0.001).
- Across 15 studies and 866 patients, combined ablation was associated with increased major complication risk (Bayesian OR 6.28, 95% CI 2-24).
Why it matters
The findings highlight a clinically important trade-off in ARVC ablation: a strategy addressing both endocardial and epicardial substrate was associated with fewer recurrences, but also with more major complications. Considering both outcomes is essential when interpreting comparative ablation evidence and weighing procedural benefits against harms.
What to keep in mind
The meta-analysis combined studies with single- and double-arm designs; reconstructed individual patient data were available for 460 patients, fewer than the 976 included in the overall analyses.