Among patients with an ICD, amiodarone significantly reduced VT recurrence compared with control (HR 0.34; 95% CrI 0.15-0.74), and both amiodarone and catheter ablation reduced ICD shocks.
Meta-Analysis (n=3,828)
Do antiarrhythmic drugs or catheter ablation reduce recurrent VT and ICD shocks in patients with an implantable cardioverter-defibrillator?
In patients with an ICD, amiodarone reduces VT recurrence and ICD shocks, and catheter ablation reduces ICD shocks, while sotalol increases both compared to amiodarone.
Effect estimate: HR 0.34 (95% CI 0.15-0.74)
BACKGROUND: In patients with an implantable cardioverter-defibrillator (ICD), shocks are associated with increased morbidity and mortality. Therefore, we conducted this study to evaluate the efficacy and safety of antiarrhythmic drugs and catheter ablation (CA) in the treatment of ventricular tachyarrhythmias (VT) in patients with an ICD. METHODS: An electronic database search for randomized controlled trials that evaluated antiarrhythmic drugs and CA in patients with ICD was conducted. The primary outcome was recurrent VT. Secondary outcomes were ICD shocks and any deaths. Bayesian and frequentist network meta-analyses were performed to calculate hazard ratios (HRs) and 95% credible intervals (CrIs)/CIs. RESULTS: Twenty-two randomized controlled trials were identified (3828 total patients; age 64.3±11.4; 79% males). The use of amiodarone was associated with a significantly reduced rate of VT recurrence compared with control (HR=0.34 95% CrI=0.15-0.74; absolute risk difference=-0.23 95% CrI=-0.23 to -0.09; number needed to treat=4). Sotalol was associated with increased risk of VT recurrence compared with amiodarone (HR=2.88 95% CrI=1.35-6.46). Compared with control, amiodarone (HR=0.33 95% CrI=0.15-0.76; absolute risk difference=-0.17 95% CrI=-0.32 to -0.06; number needed to treat=6) and CA (HR=0.52 95% CrI=0.30-0.89; absolute risk difference=-0.12 [95% CrI=-0.24 to -0.03; number needed to treat=8) were associated with significantly reduced ICD shocks. Compared with amiodarone, sotalol was associated with significantly increased ICD shocks (HR=2.70 95% CrI=1.17-6.71). The rate of death was not significantly different between the competing strategies. The node-splitting method showed no inconsistency. CONCLUSIONS: Among patients with an ICD, amiodarone significantly reduced VT recurrence and ICD shocks, while CA reduced ICD shocks. Sotalol significantly increased VT recurrence and ICD shocks compared with amiodarone. The long-term side effects of amiodarone and early complications of CA should be weighed carefully according to specific patient characteristics.
Kheiri et al. (Fri,) conducted a meta-analysis in Ventricular tachyarrhythmias in patients with an implantable cardioverter-defibrillator (n=3,828). Antiarrhythmic drugs (amiodarone, sotalol) and catheter ablation vs. Control was evaluated on Recurrent VT (HR 0.34, 95% CI 0.15-0.74). Among patients with an ICD, amiodarone significantly reduced VT recurrence compared with control (HR 0.34; 95% CrI 0.15-0.74), and both amiodarone and catheter ablation reduced ICD shocks.