Abstract Background Ventricular tachycardia (VT) in ischemic heart disease (IHD) requires complex management strategies including catheter ablation (CA) and anti-arrhythmic drugs (AADs). Aim of the study To compare efficacy and safety of CA versus AADs in patients with IHD and VT. Methods We performed a meta-analysis of randomized controlled trials (RCTs) enrolling patients with IHD and ICD randomized to CA or AADs. Primary outcome was appropriate ICD therapy. Secondary outcomes included inappropriate ICD therapy, cardiovascular (CV) rehospitalization, all-cause/CV mortality, and adverse events. Subgroup analyses were conducted for amiodarone and sotalol, with an exploratory evaluation of a composite endpoint (ICD shock, VT storm, all-cause death). Results Four RCTs including 947 patients (mean age 68±2 years; 93% male) were analyzed. CA significantly reduced the risk of appropriate ICD therapy compared with AADs (149/47031.7% vs 229/47748.0%; RR 0.81; 95% CI0.67, 0.97; p=0.02). Among secondary outcomes, CA decreased the incidence of CV rehospitalization (RR 0.84; 95% CI0.72, 0.99; p=0.04) and adverse events (RR 0.42; 95% CI0.28, 0.62; p0.01), while no differences were observed in all-cause/CV mortality and inappropriate ICD therapy. In subgroup analyses, CA was superior to sotalol in reducing the composite endpoint of ICD shock, VT storm and all-cause death (RR: 0.82, 95% CI0.69, 0.98, p=0.03), whereas no significant benefit was seen compared to amiodarone (RR: 0.92; 95% CI0.78, 1.09, p=0.32). Conclusion In ischemic heart disease and VT, catheter ablation compared with anti-arrhythmic drugs is associated with a reduction of appropriate ICD therapy, cardiovascular rehospitalization and adverse events with benefits most evident versus sotalol.
Santoro et al. (2025) studied this question.