Key result
VT ablation reduces appropriate ICD shocks ~32% vs antiarrhythmic drugs with similar safety.
Why the study?
Ventricular tachycardia ablation and class III antiarrhythmic drugs are commonly used to prevent recurrent ventricular arrhythmias in ischemic cardiomyopathy with an ICD, but their relative benefits remain uncertain.
Does ventricular tachycardia ablation reduce appropriate ICD shocks and electrical storm compared to antiarrhythmic drugs in patients with ischemic cardiomyopathy and an ICD for secondary prevention?
Meta-Analysis (n=2,177)
Does ventricular tachycardia ablation reduce appropriate ICD shocks and electrical storm compared to antiarrhythmic drugs in patients with ischemic cardiomyopathy and an ICD for secondary prevention?
In patients with ischemic cardiomyopathy and an ICD, ventricular tachycardia ablation reduces appropriate ICD shocks, heart failure decompensation, and undetected VT compared to antiarrhythmic drugs, with similar safety.
Background Ventricular tachycardia ablation (VTA) and class III antiarrhythmic drugs (AADs) are commonly used strategies to prevent recurrent ventricular arrhythmias (VAs) in individuals with ischemic cardiomyopathy (ICM) who carry an implantable cardioverter-defibrillator (ICD). Although several randomized controlled trials (RCTs) have compared these approaches, their relative benefits remain uncertain. Objective To compare the efficacy and safety of VTA versus AAD (amiodarone or sotalol) for secondary prevention of VA in patients with ICM and an ICD using network meta-analysis (NMA) methods. Methods We systematically searched MEDLINE (PubMed), Scopus, the Cochrane Library, and ClinicalTrials.gov from inception to October 15, 2025, for RCTs evaluating VTA versus AAD therapy. Study screening, data extraction, and risk-of-bias assessment were performed independently by two reviewers. The principal effectiveness endpoints were appropriate ICD shocks and electrical storm (ES), while any serious adverse event was the primary safety endpoint. Random-effects frequentist NMA models generated risk ratios (RRs) with 95% confidence intervals (CIs). Results Thirteen studies (2,177 patients) were eligible. VTA significantly lowered the occurrence of appropriate ICD shocks versus AAD therapy (RR=0.68; 95% CI [0.47–0.99]; p=0.043). 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) were numerically reduced with VTA, although not statistically significant. VTA ranked highest overall and demonstrated superiority regarding heart failure (HF) decompensation (RR=0.76; 95% CI [0.58–0.99]; p=0.043) and undetected ventricular tachycardia (RR=0.27; 95% CI [0.15–0.46]; p<0.001). Serious adverse events did not differ between strategies (RR=0.63; 95% CI [0.33–1.23]; p=0.176), nor were there notable differences in all-cause or cardiovascular mortality, cardiovascular or VA-related hospitalizations. Conclusions In patients with ICM and an ICD treated for secondary VA prevention, VTA provides superior efficacy to AAD therapy—particularly in reducing appropriate ICD shocks, HF worsening, and undetected ventricular tachycardia episodes (below ICD detection limit)—with similar safety. No significant benefit was observed for ES, overall VA recurrence, mortality or hospitalization outcomes.
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Pamporis et al. (2026) conducted a meta-analysis in Ischemic cardiomyopathy with an ICD for secondary arrhythmia prevention (n=2,177). Ventricular tachycardia ablation (VTA) vs. Antiarrhythmic drugs (amiodarone or sotalol) was evaluated on Appropriate ICD shocks (RR 0.68, 95% CI 0.47-0.99, p=0.043). Ventricular tachycardia ablation significantly lowered the occurrence of appropriate ICD shocks compared to antiarrhythmic drugs (RR 0.68; 95% CI 0.47-0.99; p=0.043) with similar safety.
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