Catheter ablation versus medical therapy for treatment of ventricular tachycardia associated with structural heart disease: Systematic review and meta-analysis of randomized controlled trials and comparison with observational studies.
Anti-Arrhythmia Agents
/ therapeutic use
Australia
Catheter Ablation
/ methods
Defibrillators, Implantable
/ statistics & numerical data
Female
Heart Diseases
/ physiopathology
Humans
Male
Observational Studies as Topic
Prognosis
Randomized Controlled Trials as Topic
Risk Assessment
Survival Rate
Tachycardia, Ventricular
/ diagnostic imaging
Treatment Outcome
Antiarrhythmic therapy
Catheter ablation
Meta-analysis
Randomized controlled trial
Ventricular tachycardia
Journal
Heart rhythm
ISSN: 1556-3871
Titre abrégé: Heart Rhythm
Pays: United States
ID NLM: 101200317
Informations de publication
Date de publication:
10 2019
10 2019
Historique:
received:
18
03
2019
pubmed:
1
6
2019
medline:
2
12
2020
entrez:
1
6
2019
Statut:
ppublish
Résumé
Catheter ablation (CA) is an established therapeutic modality for ventricular tachycardia (VT). We compared the clinical outcomes of CA for VT vs medical therapy from all previously performed randomized controlled trials (RCTs) and compared these to contemporary observational studies. A comprehensive database search through to August 2018 identified 8 eligible studies enrolling 797 patients. In RCTs, VT recurrence and electrical VT storm were significantly reduced in the CA group vs medical therapy group (relative risk [RR] 0.78, 95% confidence interval [CI] 0.64-0.95, P = .01; RR 0.70, 95% CI 0.51-0.94, P = .02, respectively) at a mean follow-up of 22 months. All-cause or cardiac-specific mortality did not differ significantly (RR 0.92, 95% CI 0.67-1.27, P = .62; RR 0.82, 95% CI 0.54-1.26, P = .37, respectively). In 4 observational studies, including 3065 patients with a mean follow-up of 18.2 months, VT recurrence and mortality were significantly lower as compared to the RCTs (28.6% vs 39%, P < .001; 13.2% vs 18%, P = .01, respectively) despite greater incidence of electrical storm (33.2% vs 17%, P < .001), higher prevalence of nonischemic substrate (46.4% vs 3.6%, P < .001), and lower rate of implanted ICDs (68% vs 94.7%, P < .001). Meta-analysis of RCT data shows that CA is superior to medical therapy for predominantly postinfarct, scar-related VT in terms of VT recurrence and electrical VT storm, with no reduction in mortality. Real-world observational studies also demonstrate significant reduction in VT recurrence and mortality, despite a sicker cohort, demonstrating replicability and translation of RCT data in the real world.
Sections du résumé
BACKGROUND
Catheter ablation (CA) is an established therapeutic modality for ventricular tachycardia (VT).
OBJECTIVE
We compared the clinical outcomes of CA for VT vs medical therapy from all previously performed randomized controlled trials (RCTs) and compared these to contemporary observational studies.
METHODS
A comprehensive database search through to August 2018 identified 8 eligible studies enrolling 797 patients.
RESULTS
In RCTs, VT recurrence and electrical VT storm were significantly reduced in the CA group vs medical therapy group (relative risk [RR] 0.78, 95% confidence interval [CI] 0.64-0.95, P = .01; RR 0.70, 95% CI 0.51-0.94, P = .02, respectively) at a mean follow-up of 22 months. All-cause or cardiac-specific mortality did not differ significantly (RR 0.92, 95% CI 0.67-1.27, P = .62; RR 0.82, 95% CI 0.54-1.26, P = .37, respectively). In 4 observational studies, including 3065 patients with a mean follow-up of 18.2 months, VT recurrence and mortality were significantly lower as compared to the RCTs (28.6% vs 39%, P < .001; 13.2% vs 18%, P = .01, respectively) despite greater incidence of electrical storm (33.2% vs 17%, P < .001), higher prevalence of nonischemic substrate (46.4% vs 3.6%, P < .001), and lower rate of implanted ICDs (68% vs 94.7%, P < .001).
CONCLUSION
Meta-analysis of RCT data shows that CA is superior to medical therapy for predominantly postinfarct, scar-related VT in terms of VT recurrence and electrical VT storm, with no reduction in mortality. Real-world observational studies also demonstrate significant reduction in VT recurrence and mortality, despite a sicker cohort, demonstrating replicability and translation of RCT data in the real world.
Identifiants
pubmed: 31150816
pii: S1547-5271(19)30536-3
doi: 10.1016/j.hrthm.2019.05.026
pii:
doi:
Substances chimiques
Anti-Arrhythmia Agents
0
Types de publication
Comparative Study
Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
1484-1491Informations de copyright
Crown Copyright © 2019. Published by Elsevier Inc. All rights reserved.