Catheter Ablation vs. Medical Therapy for Ventricular Tachycardia in Ischemic Cardiomyopathy: A Meta-Analysis and Trial Sequential Analysis of Randomized Controlled Trials.

BACKGROUND

Managing ischemic cardiomyopathy-related ventricular tachycardia (VT) remains clinically challenging since no definitive consensus exists regarding the optimal therapeutic approach. Therefore, this study aimed to assess the safety and efficacy of catheter ablation for VT in patients with ischemic cardiomyopathy.

METHODS

We systematically searched the PubMed, EMBASE, and Cochrane Library databases to identify pertinent clinical trials. We selected the relative risk (RR) and mean difference (MD) as the effect measures, which were calculated using Review Manager software. Additionally, we used trial sequential analysis to assess each outcome.

RESULTS

Our study included six randomized controlled trials with 1064 patients. Catheter ablation was found to reduce the risk of the composite endpoint (RR 0.83, 95% confidence interval (CI) 0.74-0.94; p = 0.002), cardiac hospitalizations (RR 0.82, 95% CI 0.71-0.95; p = 0.007), and adverse events (RR 0.75, 95% CI 0.62-0.91; p = 0.003). Additionally, no significant differences were observed between the two groups regarding VT recurrence (RR 0.94, 95% CI 0.83-1.06; p = 0.33), appropriate implantable cardioverter-defibrillator (ICD) shocks (RR 0.85, 95% CI 0.72-1.01; p = 0.06), or all-cause mortality (RR 0.93, 95% CI 0.73-1.18; p = 0.53).

CONCLUSIONS

Catheter ablation reduced the incidence of composite endpoints, cardiac hospitalizations, and adverse events related to VT in patients with ischemic cardiomyopathy. However, no statistically significant differences were found between the two groups for VT recurrence, appropriate ICD shocks, and all-cause mortality.

THE PROSPERO REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251011744.