Key result
Preventive ventricular tachycardia ablation at the time of secondary prevention ICD implantation significantly reduced appropriate ICD shocks (OR 2.58; 95% CI 1.54-4.34; p<0.001).
Why the study?
Catheter ablation of VT aims to treat the underlying arrhythmia substrate to prevent ICD therapies, but the safety and efficacy of preventive ablation versus deferred ablation in CAD patients required evaluation.
Does preventive VT ablation reduce appropriate ICD shocks and therapies in patients with ischemic cardiomyopathy undergoing secondary prevention ICD implantation?
Meta-Analysis
Does preventive VT ablation reduce appropriate ICD shocks and therapies in patients with ischemic cardiomyopathy undergoing secondary prevention ICD implantation?
Odds Ratio: 2.58 (95% CI 1.54–4.34)
p-value: p=<0.001
Preventive VT ablation at the time of secondary prevention ICD implantation in patients with ischemic cardiomyopathy significantly reduces appropriate ICD shocks and therapies without increasing complications or mortality.
Supports preventive VT ablation at secondary prevention ICD implantation to reduce shocks; confirms benefit via meta-analysis.
Catheter ablation of ventricular tachycardia (VT) aims to treat the underlying arrhythmia substrate to prevent ICD therapies. The aim of this meta-analysis was to assess the safety and efficacy of VT ablation prior to or at the time of secondary prevention ICD implantation in patients with coronary artery disease, as compared with deferred VT ablation. Based on a systematic literature search, three randomised trials were considered eligible for inclusion in this analysis, and data on the number of patients with appropriate ICD shocks, appropriate ICD therapy, arrhythmic storm, death and major complications were extracted from each study. On pooled analysis, there was a significant reduction of appropriate ICD shocks (OR 2.58; 95% CI [1.54-4.34]; p<0.001) and appropriate ICD therapies (OR 2.04; 95% CI [1.15-3.61]; p=0.015) in patients undergoing VT ablation at the time of ICD implantation without significant differences with respect to complications (OR 1.39; 95% CI [0.43-4.51]; p=0.581). Mortality did not differ between both groups (OR 1.30; 95% CI [0.60-2.45]; p=0.422). Preventive catheter ablation of VT in patients with coronary heart disease at the time of secondary prevention ICD implantation results in a significant reduction of appropriate ICD shocks and any appropriate ICD therapy compared with patients without or with deferred VT ablation. No significant difference with respect to complications or mortality was observed between both treatment strategies.
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Tilz et al. (2019) conducted a meta-analysis in Ischaemic cardiomyopathy / Coronary artery disease. Preventive ventricular tachycardia (VT) ablation vs. Deferred VT ablation or no VT ablation was evaluated on Appropriate ICD shocks (OR 2.58, 95% CI 1.54-4.34, p=<0.001). Preventive ventricular tachycardia ablation at the time of secondary prevention ICD implantation significantly reduced appropriate ICD shocks (OR 2.58; 95% CI 1.54-4.34; p<0.001).
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