Key result
Catheter ablation fails to reduce VT recurrence versus medical therapy in ICD patients with ischemic cardiomyopathy.
Why the study?
Managing ischemic cardiomyopathy-related VT remains clinically challenging due to a lack of definitive consensus on the optimal therapeutic approach.
Does catheter ablation reduce VT recurrence, composite endpoints, and adverse events in patients with ischemic cardiomyopathy and ventricular tachycardia compared to medical therapy?
Meta-Analysis (n=1,064)
Does catheter ablation reduce VT recurrence, composite endpoints, and adverse events in patients with ischemic cardiomyopathy and ventricular tachycardia compared to medical therapy?
Effect estimate: RR 0.94 (95% CI 0.83-1.06)
p-value: p=0.33
In patients with ischemic cardiomyopathy and VT, catheter ablation reduces composite endpoints, cardiac hospitalizations, and adverse events compared to medical therapy, though it does not significantly reduce VT recurrence or all-cause mortality.
Does not support routine ablation to prevent VT recurrence in ischemic CM; leaves open benefits on composites, hospitalizations, and adverse events.
Background: Managing ischemic cardiomyopathy-related ventricular tachycardia (VT) remains clinically challenging since no definitive consensus exists regarding the optimal therapeutic approach. Therefore, this study aimed to assess the safety and efficacy of catheter ablation for VT in patients with ischemic cardiomyopathy. Methods: We systematically searched the PubMed, EMBASE, and Cochrane Library databases to identify pertinent clinical trials. We selected the relative risk (RR) and mean difference (MD) as the effect measures, which were calculated using Review Manager software. Additionally, we used trial sequential analysis to assess each outcome. Results: Our study included six randomized controlled trials with 1064 patients. Catheter ablation was found to reduce the risk of the composite endpoint (RR 0.83, 95% confidence interval (CI) 0.74–0.94; p = 0.002), cardiac hospitalizations (RR 0.82, 95% CI 0.71–0.95; p = 0.007), and adverse events (RR 0.75, 95% CI 0.62–0.91; p = 0.003). Additionally, no significant differences were observed between the two groups regarding VT recurrence (RR 0.94, 95% CI 0.83–1.06; p = 0.33), appropriate implantable cardioverter-defibrillator (ICD) shocks (RR 0.85, 95% CI 0.72–1.01; p = 0.06), or all-cause mortality (RR 0.93, 95% CI 0.73–1.18; p = 0.53). Conclusions: Catheter ablation reduced the incidence of composite endpoints, cardiac hospitalizations, and adverse events related to VT in patients with ischemic cardiomyopathy. However, no statistically significant differences were found between the two groups for VT recurrence, appropriate ICD shocks, and all-cause mortality. The PROSPERO Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251011744.
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Sp et al. (2026) conducted a meta-analysis in Patients with ischemic cardiomyopathy and ventricular tachycardia with mean LVEF ranging from 23% to 35%, implanted ICD (n=1,064). Catheter ablation plus ICD implantation vs. ICD implantation alone or ICD plus antiarrhythmic drugs (AADs) was evaluated on Ventricular tachycardia recurrence (RR 0.94, 95% CI 0.83-1.06, p=0.33). Catheter ablation plus ICD did not significantly reduce ventricular tachycardia recurrence compared with medical therapy plus ICD in patients with ischemic cardiomyopathy (RR 0.94, 95% CI 0.83–1.06, p = 0.33).
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