Meta‐analysis of catheter ablation in patients with post‐infarct cardiomyopathy undergoing defibrillator implantation

BACKGROUND: Patients with post-infarct cardiomyopathy and ventricular arrhythmias (VT) necessitating implantable cardioverter defibrillators (ICD) are at risk of recurrent shocks with increased morbidity. METHODS: A comprehensive search of electronic databases for all randomized clinical trials that evaluated the role of catheter ablation as a preventive strategy at the time of secondary prevention ICD implantation was performed. We calculated hazard ratios (HR) and 95% confidence intervals (CI) using random-effects model. RESULTS: Four trials were identified with a total of 505 patients (average age 66.4 ± 9.0 years; 87.7% were male). Preventive ablation was associated with a significant reduction in appropriate device therapies (shocks and/or anti-tachycardia therapy) (HR = 0.62; 95% CI = 0.46-0.82; P < .01), sustained VT (HR = 0.74; 95% CI = 0.55-0.99; P = .04) compared to control. There were no differences in inappropriate device shocks (HR = 0.80; 95% CI = 0.38-1.71), all-cause death (HR = 0.93; 95% CI = 0.53-1.64), cardiac death (HR = 0.63; 95% CI = 0.29-1.36), arrhythmic death (HR = 0.26; 95% CI = 0.05-1.31), or cardiac hospitalization (HR = 0.79; 95% CI = 0.57-1.11) between strategies. Preventive ablation was associated with improved SF-36 physical component (mean difference = 2.81; 95% CI-0.53-5.10; P = .02), but not the mental component (mean difference = 1.30; 95% CI = -2.06-4.66). CONCLUSION: Among patients with post-infarct cardiomyopathy and VT, preventive catheter ablation at the time of ICD implantation is associated with a significant reduction of appropriate ICD therapy and sustained VT, and improvement in the physical component of quality-of-life, but no reduction in mortality.