Catheter ablation combined with an implantable cardioverter defibrillator significantly reduced the incidence of ICD therapy (OR 0.49), ICD shock (OR 0.50), and VT storm (OR 0.60) compared to control in patients with ischemic heart disease.
Meta-Analysis (n=605)
Does catheter ablation combined with ICD reduce ICD therapy and shocks in patients with ischemic heart disease?
In patients with ischemic heart disease, adding catheter ablation to ICD therapy significantly reduces ICD therapies, shocks, and VT storms, but does not improve all-cause mortality.
Effect estimate: OR 0.49 (95% CI 0.28-0.87)
PURPOSE: Although implantable cardioverter defibrillator (ICD) could prevent the sudden death of ventricular tachycardia (VT) in patients with ischemic heart disease, it could not effectively prevent the recurrence of ventricular tachycardia. Several studies have suggested that catheter ablation may effectively decrease the incidence of ICD events, but relevant dates from randomized controlled trials were limited. METHODS: A systematic review and meta-analysis of randomized controlled trials were performed to evaluate the effect of catheter ablation for the prevention of VT in patients with ischemic heart disease. Random-effects model with inverse-variance weighting method was used to pool odds ratios. Egger method was performed to evaluate whether there was public bias in each outcome. RESULTS: Four studies enrolling a total of 605 patients were included in the present meta-analysis. Compared with the control group (ICD ± AAD), catheter ablation could significantly reduce the incidence of ICD therapy (OR, 0.49; 95% CI, 0.28 ~ 0.87), ICD shock (OR, 0.50; 95% CI, 0.28 ~ 0.87), VT storm (OR, 0.60; 95% CI, 0.40 ~ 0.90), and cardiovascular-related hospitalization (OR, 0.66; 95% CI, 0.45 ~ 0.9). But there was no significant difference among the risk of all-cause mortality (OR, 0.89; 95% CI, 0.59 ~ 1.34), cardiovascular mortality (OR, 0.76; 95% CI, 0.44 ~ 1.30), and complication (OR, 0.89; 95% CI, 0.30 ~ 2.67). CONCLUSION: These results showed that catheter ablation combined with ICD could reduce ICD therapy, ICD shock, and VT storm in patients with ischemic heart disease, but there was no improvement in all-cause mortality. Meanwhile, it also provided a basic guidance for the design of larger clinical randomized trials with longer follow-up in the future.
Liu et al. (Mon,) conducted a meta-analysis in Ischemic heart disease with ventricular tachycardia (n=605). Catheter ablation combined with ICD vs. ICD (with or without antiarrhythmic drugs) was evaluated on Incidence of ICD therapy (ATP + ICD shock) (OR 0.49, 95% CI 0.28-0.87). Catheter ablation combined with an implantable cardioverter defibrillator significantly reduced the incidence of ICD therapy (OR 0.49), ICD shock (OR 0.50), and VT storm (OR 0.60) compared to control in patients with ischemic heart disease.
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