Substrate-based ablation for ventricular tachycardia showed no significant difference in VT recurrence compared to activation and entrainment mapping-guided ablation (RR 0.72; 95% CI 0.44-1.18; P=0.2).
Meta-Analysis (n=403)
Does predominantly substrate-based ablation reduce VT recurrence compared to ablation guided by activation and entrainment mapping in patients with scar-related ventricular tachycardia?
Substrate-based ablation and activation/entrainment-guided ablation demonstrate similar acute procedural efficacy, VT recurrence, and mortality rates for scar-related ventricular tachycardia.
Effect estimate: RR 0.72 (95% CI 0.44-1.18)
p-value: p=0.2
INTRODUCTION: Substrate-based ablation for scar-related ventricular tachycardia (VT) has gained prominence: however, there is limited data comparing it to ablation guided predominantly by activation and entrainment mapping of inducible and hemodynamically tolerated VTs. We compared the acute procedural efficacy and outcomes of predominantly substrate-based ablation versus ablation guided predominantly by activation and entrainment mapping. METHODS AND RESULTS: Database searches through April 2016 identified 6 eligible studies (enrolling 403 patients, with 1 randomized study) comparing the 2 strategies. The relative risk of VT recurrence at follow-up was assessed as the primary outcome using a random-effects meta-analysis. Secondary endpoints of acute success (based on noninducibility of VT), procedural complications, and mortality were assessed using weighted mean difference with the random effects model. At a median follow-up of 18 months, the relative risk (RR) of VT recurrence was not significantly different with substrate-based versus activation/entrainment guided VT ablation (0.72, 95% confidence interval CI 0.44-1.18), P = 0.2). Acute success (RR 1.02, 95% CI 0.95-1.1, P = 0.6), procedural complications (RR 0.8, 95% CI 0.35-1.82, P = 0.5) cardiovascular mortality and total mortality did not differ significantly (RR 0.83, 95% CI 0.38-1.79, P = 0.6 and RR 0.76, 95% CI 0.36-1.59, P = 0.5, respectively). CONCLUSIONS: This meta-analysis demonstrates similar acute procedural efficacy, and complications, VT recurrence and mortality rates when comparing a predominantly substrate-based ablation strategy to a strategy guided predominantly by activation and entrainment mapping of inducible and hemodynamically tolerated VTs.
Kumar et al. (Tue,) conducted a meta-analysis in scar-related ventricular tachycardia (VT) (n=403). Substrate-based ablation vs. Ablation guided by activation and entrainment mapping was evaluated on VT recurrence (RR 0.72, 95% CI 0.44-1.18, p=0.2). Substrate-based ablation for ventricular tachycardia showed no significant difference in VT recurrence compared to activation and entrainment mapping-guided ablation (RR 0.72; 95% CI 0.44-1.18; P=0.2).