Key result
Catheter ablation cuts VT storms ~26% vs. medical therapy alone in ischemic heart disease.
Why the study?
Does catheter ablation reduce VT storms, ICD therapies, and mortality in patients with ischemic heart disease and ventricular tachycardia compared to medical therapy alone?
Meta-Analysis (n=1,252)
Does catheter ablation reduce VT storms, ICD therapies, and mortality in patients with ischemic heart disease and ventricular tachycardia compared to medical therapy alone?
In patients with ischemic heart disease and ventricular tachycardia, catheter ablation significantly reduces VT storms and appropriate ICD therapies compared to medical therapy alone, though it does not significantly reduce all-cause mortality.
Answers are grounded in this paper and cite their sources.
Supports ablation to reduce storms and ICD therapies in ischemic VT; reinforces Level 1 evidence over medical therapy alone.
BACKGROUND: Ventricular tachycardia (VT) is a common chronic complication of ischemic heart disease (IHD), even in the era of contemporary coronary intervention. The use of implantable cardioverter-defibrillators (ICDs) has reduced mortality, but ICD shocks can be painful and traumatizing. Catheter ablation has been posited to reduce VT incidence and is commonly used in IHD patients when antiarrhythmic drugs do not suppress VT. PURPOSE: We aim to review the clinical efficacy and safety of catheter ablation vs medical therapy in patients with IHD. METHODS: We conducted comprehensive searches across PubMed, CENTRAL, Web of Science, Scopus, and Embase until May 2024. Pooled data were reported using risk ratio (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes. This systematic review and meta-analysis was registered with PROSPERO ID: CRD42024551760. RESULTS: We included eight RCTs with a total of 1252 patients. Patients who underwent catheter ablation had a lower risk of VT storms compared to those who received medical therapy alone [RR: 0.74 with 95 % CI: (0.60, 0.91), P = 0.005), Compared to medical therapy, the catheter ablation group also required less appropriate ICD therapy [RR: 0.72 with 95 % CI: (0.57, 0.90), P = 0.005), and fewer appropriate ICD shocks [RR: 0.75 with 95 % CI: (0.57, 0.99), P = 0.04). However, there was no significant difference in Ventricular tachycardia/Ventricular fibrillation (VT/VF) recurrence [RR: 0.94 with 95 % CI: (0.83, 1.06), P = 0.33) and all-cause mortality [RR: 0.87 with 95 % CI: (0.70, 1.09), P = 0.22). CONCLUSION: Catheter ablation is associated with a significant reduction in ventricular storms, appropriate ICD therapy, and appropriate ICD shocks while demonstrating similar safety in managing VT in IHD patients compared to medical therapy alone.
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Khan et al. (2025) conducted a meta-analysis in Ventricular tachycardia in ischemic heart disease (n=1,252). Catheter ablation vs. Medical therapy alone was evaluated on VT storms (RR 0.74, 95% CI 0.60, 0.91, p=0.005). Catheter ablation reduced the risk of VT storms compared to medical therapy alone in patients with ischemic heart disease.
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