Preventive Ventricular Tachycardia Ablation in Patients with Ischaemic Cardiomyopathy: Meta-analysis of Randomised Trials.

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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Disclosure: RT received research grants from Hansen, Abbot, Medtronic and Biotronik; travel grants from Biosense Webster, Medtronic, Abbot, Sentrheart and Daiichi Sankyo; speakers’ bureau honoraria/proctor for Biosense Webster, Medtronic, Abbot, Biotronik, Boston Scientific, Pfizer, Bristol-Myers Squibb, Bayer, Sanofi Aventis and AstraZeneca; and worked as a consultant for Biosense Webster and Biotronik. CE received presentation fees from Bayer, Biosense Webster, Impulse Dynamic, St Jude Medical/Abbott, Pfizer, Liva Nova, Zoll, Boston Scientific, Novartis, Daiichi Sankyo and AstraZeneca; and travel grants from St Jude Medical, Biotronik and Medtronic. EL received travel grants from Biosense Webster, Abbott, Medtronic and Boston Scientific; and speakers’ bureau honoraria from Biosense Webster and Abbott. KY received an educational and research grant from the Turkish Society of Cardiology. All other authors have no conflicts of interest to declare.