All-cause mortality and appropriate implantable cardioverter-defibrillator shocks with first-line catheter ablation versus antiarrhythmic drugs in ischemic ventricular tachycardia: A systematic review and Meta-analysis of randomized controlled trials.
Diego-Eduardo Garnica, Heider Bautista-Mier, Rafael Isaac et al.
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In 30 seconds
This systematic review and meta-analysis of randomized controlled trials compared first-line catheter ablation with antiarrhythmic drug therapy in antiarrhythmic-naïve patients with ischemic cardiomyopathy and ICD-confirmed ventricular tachycardia. Across three multicenter trials enrolling 618 patients, ablation was associated with fewer appropriate ICD shocks (RR 0.76, 95% CI 0.59-0.98; P = 0.033). All-cause mortality did not differ significantly (RR 0.88, 95% CI 0.63-1.22; P = 0.434); the authors noted that the mortality analysis was substantially underpowered.
Key findings
- Appropriate ICD shocks were reduced with ablation versus antiarrhythmic drugs (RR 0.76, 95% CI 0.59-0.98; P = 0.033).
- All-cause mortality did not differ significantly (RR 0.88, 95% CI 0.63-1.22; P = 0.434).
- VT storm and heart failure hospitalization did not differ significantly between strategies.
Why it matters
For patients with ischemic cardiomyopathy and VT, avoiding appropriate ICD shocks is a clinically relevant outcome. The pooled randomized evidence supports fewer shocks with first-line ablation, but it does not establish a survival benefit. Distinguishing these outcomes helps frame discussions of treatment goals without interpreting the absence of a significant mortality difference as proof of equivalent survival.
What to keep in mind
Only three trials were included, and the mortality analysis was substantially underpowered. Follow-up duration differed across trials.