What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Adults with ischemic cardiomyopathy (ICM) and implantable cardioverter-defibrillator (ICD) for secondary prevention of ventricular arrhythmias (n=2237). Intervention: catheter ablation (CA) vs. class III antiarrhythmic drugs (AADs: amiodarone, sotalol). Primary outcome: Appropriate ICD shock (RR 0.68, 95% CI 0.47-0.99, p=0.043).

What question did this study set out to answer?

This study evaluates the efficacy and safety of catheter ablation versus antiarrhythmic drugs in patients with ischemic cardiomyopathy.

February 22, 2026Open Access

Efficacy and safety of ventricular tachycardia ablation versus antiarrhythmics in ischemic cardiomyopathy: a network meta-analysis

Key Result

Catheter ablation reduced appropriate ICD shocks by 32% compared to class III antiarrhythmic drugs in patients with ischemic cardiomyopathy and ICD for secondary prevention (RR 0.68, 95% CI 0.47-0.99, p=0.043).

Key Points

This study evaluates the efficacy and safety of catheter ablation versus antiarrhythmic drugs in patients with ischemic cardiomyopathy.
Conducted a network meta-analysis of randomized controlled trials
Searched databases including MEDLINE and Cochrane
Analyzed 14 RCTs with 2,237 patients
Conducted risk ratio calculations via random-effects models
Performed quality assessment and sensitivity analyses
Catheter ablation showed superior efficacy in reducing appropriate shocks (RR = 0.68)
Ablation reduced heart failure exacerbation (RR = 0.76) and undetected ventricular tachycardia (RR = 0.27)
No significant differences in adverse events or mortality rates
Ablation was better than amiodarone in serious adverse events (RR = 0.33)

Study Design

Type

Meta-Analysis (n=2,237)

Multicenter

Yes

Structured PICO

Does catheter ablation reduce appropriate shocks and electrical storm compared to class III antiarrhythmic drugs in patients with ischemic cardiomyopathy and an ICD for secondary prevention?

Population

2,237 patients (from 14 RCTs) with ischemic cardiomyopathy (ICM) and an implantable cardioverter-defibrillator (ICD) for secondary prevention of ventricular arrhythmias (VA).

Intervention

Catheter ablation (CA)

Comparator

Class III antiarrhythmic drugs (amiodarone, sotalol) or standard care

Outcome

Appropriate shock and electrical storm (ES)hard clinical

Catheter ablation provides superior efficacy in reducing appropriate ICD shocks, undetected VT, and heart failure exacerbations with comparable safety to class III antiarrhythmic drugs in patients with ischemic cardiomyopathy.

Main Result

Effect estimate: RR 0.68 (95% CI 0.47-0.99)

p-value: p=0.043

Limitations

Heterogeneity in ICD programming and definitions of ventricular arrhythmias among included studies may affect generalizability.
Technological advancements in catheter ablation over time might lead to underestimation of current CA efficacy.
Analysis limited to RCTs which may not reflect broad clinical practice scenarios.
Limited power to detect significant effects in some underrepresented outcomes.
Subgroup analyses for very low LVEF or electrical storm not feasible due to incomplete data.

Abstract

Several randomized controlled trials (RCTs) have examined catheter ablation (CA) and class III antiarrhythmic drugs (AAD) in secondary prevention of ventricular arrhythmias (VA) in patients with ischemic cardiomyopathy (ICM) and an implantable cardioverter-defibrillator (ICD). This study sought to evaluate the efficacy and safety of CA versus AADs (amiodarone, sotalol) in this population. MEDLINE (Pubmed), Scopus, Cochrane and ClinicalTrials.gov were searched until October 26, 2025 for RCTs. Double-independent study selection, data extraction and quality assessment were performed. Appropriate shock and electrical storm (ES) were the primary efficacy outcomes. Risk ratios (RR) with 95% confidence intervals (CI) were calculated via random-effects frequentist models. Registered in PROSPERO: CRD42025640326. Totally, 14 RCTs (13 in main analysis) and 2,237 patients (2,177 in main analysis) were analyzed. CA was superior against AAD in appropriate shocks (RR = 0.68, 95%CI = 0.47,0.99; p = 0.043). A nonsignificant reduction was found in ES (RR = 0.81, 95%CI = 0.63,1.03; p = 0.088) and VA recurrence (RR = 0.86, 95%CI = 0.68,1.08; p = 0.197). CA was superior to AAD in heart failure (HF) exacerbation (RR = 0.76, 95%CI = 0.58,0.99, p = 0.043) and undetected ventricular tachycardia (VT) (RR = 0.27, 95%CI = 0.15,0.46, p < 0.001). No differences were noted regarding any serious adverse event, all-cause or cardiovascular mortality and cardiovascular or VA hospitalization. In secondary analyses, CA was superior against amiodarone in serious adverse events (RR = 0.33, 95%CI = 0.15,0.75). The results remained robust in sensitivity analyses. CA was superior in efficacy with comparable safety compared to AAD in reducing appropriate shocks, HF and undetected VT in patients with ICM and an ICD for secondary prevention. No significant differences were found in overall VA recurrences, ES, all-cause or cardiovascular mortality. Effect estimates are expressed as risk ratios with 95% confidence intervals, while outcomes where ablation is superior are marked with asterisk (*). Abbreviations: ICD, implantable cardioverter-defibrillator; VA, ventricular arrhythmia; VT, ventricular tachycardia; CV, cardiovascular; HF, heart failure; AE, adverse events.

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