Key result
Radiofrequency catheter ablation for ventricular tachycardia in hypertrophic cardiomyopathy achieved an acute procedural success rate of 84.5%.
Why the study?
Monomorphic VT is rare and challenging to manage in patients with HCM, with limited data on the utility of catheter ablation.
Does radiofrequency catheter ablation improve acute procedural success and freedom from recurrent VT in drug-refractory HCM patients?
Meta-Analysis (n=68)
Yes
Does radiofrequency catheter ablation improve acute procedural success and freedom from recurrent VT in drug-refractory HCM patients?
Radiofrequency catheter ablation for ventricular tachycardia in patients with hypertrophic cardiomyopathy is associated with high acute procedural success and freedom from recurrent VT.
Answers are grounded in this paper and cite their sources.
May support ablation for refractory monomorphic VT in HCM; extends sparse observational data but leaves practice implications open.
BACKGROUND: Monomorphic ventricular tachycardia (VT) is rare in patients with hypertrophic cardiomyopathy (HCM), management of which is challenging. Limited data exists on the utility of catheter ablation for the treatment of VT in this population. OBJECTIVES: We aimed to assess clinical outcomes of catheter ablation for VT in HCM patients. METHODS: A systematic search, without language restriction, using PubMed, EMBASE, SCOPUS, Google Scholar, and ClinicalTrials.gov was performed. The meta-analysis was performed using a meta-package for R version 4.0/RStudio version 1.2 and Freeman Tukey double arcsine method to establish the variance of raw proportions. Outcomes measured included (1) acute procedure success (defined as noninducible for clinical VT), (2) freedom from VT at follow-up, (3) mortality. RESULTS: This systematic review of six studies (three from the United States and three from Japan) incorporated a total of 68 drug-refractory HCM patients who underwent VT radiofrequency catheter ablation (mean age 57.6 ± 13.3 years, mean LVEF 45.8 ± 15.4%, 85% men, maximum septal wall thickness 17.4 ± 4.6 mm, and 32.3% with an apical aneurysm). Acute procedural success was achieved in 84.5% patients (95% confidence interval [CI]: 70.6%-95.2%) with 27.9% patients had recurrent VT requiring multiple ablations (median 1, IQR 1-3). During the follow-up period (18.3 ± 11.7 months), the pooled incidence of freedom from recurrent VT after index procedure was 70.2% (95% CI: 51.9%-86.2%), while after the last ablation was 82.8% (95% CI: 57%-99.2%). There were two deaths during follow-up, one from heart failure and one from SCD 0.8% (95% CI: 0%-5.8%). CONCLUSION: The results of our pooled analysis demonstrated that catheter ablation for VT in HCM patients was associated with high acute procedural success, and reduced VT recurrence-findings comparable to previously published reports in other disease substrates.
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Garg et al. (2022) conducted a meta-analysis in Hypertrophic cardiomyopathy with ventricular tachycardia (n=68). Radiofrequency catheter ablation was evaluated on Acute procedure success (defined as noninducible for clinical VT) (95% CI 70.6-95.2). Radiofrequency catheter ablation for ventricular tachycardia in hypertrophic cardiomyopathy achieved an acute procedural success rate of 84.5%.
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