Catheter ablation versus medical therapy for ventricular tachycardia in patients with ischemic heart disease: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND

Ventricular tachycardia (VT) is a common chronic complication of ischemic heart disease (IHD), even in the era of contemporary coronary intervention. The use of implantable cardioverter-defibrillators (ICDs) has reduced mortality, but ICD shocks can be painful and traumatizing. Catheter ablation has been posited to reduce VT incidence and is commonly used in IHD patients when antiarrhythmic drugs do not suppress VT.

PURPOSE: We aim to review the clinical efficacy and safety of catheter ablation vs medical therapy in patients with IHD.

METHODS

We conducted comprehensive searches across PubMed, CENTRAL, Web of Science, Scopus, and Embase until May 2024. Pooled data were reported using risk ratio (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes. This systematic review and meta-analysis was registered with PROSPERO ID: CRD42024551760.

RESULTS

We included eight RCTs with a total of 1252 patients. Patients who underwent catheter ablation had a lower risk of VT storms compared to those who received medical therapy alone [RR: 0.74 with 95 % CI: (0.60, 0.91), P = 0.005), Compared to medical therapy, the catheter ablation group also required less appropriate ICD therapy [RR: 0.72 with 95 % CI: (0.57, 0.90), P = 0.005), and fewer appropriate ICD shocks [RR: 0.75 with 95 % CI: (0.57, 0.99), P = 0.04). However, there was no significant difference in Ventricular tachycardia/Ventricular fibrillation (VT/VF) recurrence [RR: 0.94 with 95 % CI: (0.83, 1.06), P = 0.33) and all-cause mortality [RR: 0.87 with 95 % CI: (0.70, 1.09), P = 0.22).

CONCLUSION

Catheter ablation is associated with a significant reduction in ventricular storms, appropriate ICD therapy, and appropriate ICD shocks while demonstrating similar safety in managing VT in IHD patients compared to medical therapy alone.