Prophylactic catheter ablation of ventricular tachycardia in ischemic cardiomyopathy: a systematic review and meta-analysis of randomized controlled trials

Varunsiri Atti, Venkat Vuddanda, Mohit K. Turagam, Praveen Vemula, Zubair Shah, Himakar Nagam, Srikanth Yandrapalli, Mohammad Ali Jazayeri, Scott Koerber, Juan Viles Gonzalez, Andrea Natale, Luigi Di Biase, Dhanunjaya R. Lakkireddy

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Catheter ablation is proven to be an effective strategy for drug refractory ventricular tachycardia (VT) in ischemic cardiomyopathy. However, the appropriate timing of VT ablation and identifying the group of patients that may receive the greatest benefit remains uncertain. There is limited data on the effect on prophylactic catheter ablation (PCA) in the prevention of implantable cardioverter defibrillator (ICD) therapy, electrical storm, and mortality. Methods: We performed a comprehensive literature search through November 1, 2017, for all eligible studies comparing PCA + ICD versus ICD only in eligible patients with ischemic cardiomyopathy. Clinical outcomes included all ICD therapies including ICD shocks and electrical storm. Additional outcomes included all-cause mortality, cardiovascular mortality, and complications. Results: Three randomized controlled trials (RCTs) (N = 346) met inclusion criteria. PCA was associated with a significantly lower ICD therapies (OR 0.49; CI 0.28 to 0.87; p = 0.01) including ICD shocks [OR 0.38; CI 0.22 to 0.64; p = 0.0003) and electrical storm (OR 0.55; CI 0.30 to 1.01; p = 0.05) when compared with ICD only. There was no significant difference in all-cause mortality (OR 0.77; CI 0.41 to 1.46; p = 0.42), cardiovascular mortality (OR 0.49; CI 0.16 to 1.50; p = 0.21), and major adverse events (OR 1.45; CI 0.52 to 4.01; p = 0.47) between two groups. Conclusion: These results suggest prophylactic catheter ablation decreases ICD therapies, including shocks and electrical storm with no improvement in overall mortality. There is a need for future carefully designed randomized clinical trials.

Original languageEnglish (US)
Pages (from-to)1-9
Number of pages9
JournalJournal of Interventional Cardiac Electrophysiology
DOIs
StateAccepted/In press - Apr 21 2018
Externally publishedYes

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Catheter Ablation
Implantable Defibrillators
Ventricular Tachycardia
Cardiomyopathies
Meta-Analysis
Randomized Controlled Trials
Mortality
Shock
Convulsive Therapy
Therapeutics

Keywords

  • Electrical storm
  • ICD shock
  • Ventricular tachycardia ablation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Prophylactic catheter ablation of ventricular tachycardia in ischemic cardiomyopathy : a systematic review and meta-analysis of randomized controlled trials. / Atti, Varunsiri; Vuddanda, Venkat; Turagam, Mohit K.; Vemula, Praveen; Shah, Zubair; Nagam, Himakar; Yandrapalli, Srikanth; Jazayeri, Mohammad Ali; Koerber, Scott; Viles Gonzalez, Juan; Natale, Andrea; Di Biase, Luigi; Lakkireddy, Dhanunjaya R.

In: Journal of Interventional Cardiac Electrophysiology, 21.04.2018, p. 1-9.

Research output: Contribution to journalArticle

Atti, V, Vuddanda, V, Turagam, MK, Vemula, P, Shah, Z, Nagam, H, Yandrapalli, S, Jazayeri, MA, Koerber, S, Viles Gonzalez, J, Natale, A, Di Biase, L & Lakkireddy, DR 2018, 'Prophylactic catheter ablation of ventricular tachycardia in ischemic cardiomyopathy: a systematic review and meta-analysis of randomized controlled trials', Journal of Interventional Cardiac Electrophysiology, pp. 1-9. https://doi.org/10.1007/s10840-018-0376-5
Atti, Varunsiri ; Vuddanda, Venkat ; Turagam, Mohit K. ; Vemula, Praveen ; Shah, Zubair ; Nagam, Himakar ; Yandrapalli, Srikanth ; Jazayeri, Mohammad Ali ; Koerber, Scott ; Viles Gonzalez, Juan ; Natale, Andrea ; Di Biase, Luigi ; Lakkireddy, Dhanunjaya R. / Prophylactic catheter ablation of ventricular tachycardia in ischemic cardiomyopathy : a systematic review and meta-analysis of randomized controlled trials. In: Journal of Interventional Cardiac Electrophysiology. 2018 ; pp. 1-9.
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abstract = "Background: Catheter ablation is proven to be an effective strategy for drug refractory ventricular tachycardia (VT) in ischemic cardiomyopathy. However, the appropriate timing of VT ablation and identifying the group of patients that may receive the greatest benefit remains uncertain. There is limited data on the effect on prophylactic catheter ablation (PCA) in the prevention of implantable cardioverter defibrillator (ICD) therapy, electrical storm, and mortality. Methods: We performed a comprehensive literature search through November 1, 2017, for all eligible studies comparing PCA + ICD versus ICD only in eligible patients with ischemic cardiomyopathy. Clinical outcomes included all ICD therapies including ICD shocks and electrical storm. Additional outcomes included all-cause mortality, cardiovascular mortality, and complications. Results: Three randomized controlled trials (RCTs) (N = 346) met inclusion criteria. PCA was associated with a significantly lower ICD therapies (OR 0.49; CI 0.28 to 0.87; p = 0.01) including ICD shocks [OR 0.38; CI 0.22 to 0.64; p = 0.0003) and electrical storm (OR 0.55; CI 0.30 to 1.01; p = 0.05) when compared with ICD only. There was no significant difference in all-cause mortality (OR 0.77; CI 0.41 to 1.46; p = 0.42), cardiovascular mortality (OR 0.49; CI 0.16 to 1.50; p = 0.21), and major adverse events (OR 1.45; CI 0.52 to 4.01; p = 0.47) between two groups. Conclusion: These results suggest prophylactic catheter ablation decreases ICD therapies, including shocks and electrical storm with no improvement in overall mortality. There is a need for future carefully designed randomized clinical trials.",
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T1 - Prophylactic catheter ablation of ventricular tachycardia in ischemic cardiomyopathy

T2 - a systematic review and meta-analysis of randomized controlled trials

AU - Atti, Varunsiri

AU - Vuddanda, Venkat

AU - Turagam, Mohit K.

AU - Vemula, Praveen

AU - Shah, Zubair

AU - Nagam, Himakar

AU - Yandrapalli, Srikanth

AU - Jazayeri, Mohammad Ali

AU - Koerber, Scott

AU - Viles Gonzalez, Juan

AU - Natale, Andrea

AU - Di Biase, Luigi

AU - Lakkireddy, Dhanunjaya R.

PY - 2018/4/21

Y1 - 2018/4/21

N2 - Background: Catheter ablation is proven to be an effective strategy for drug refractory ventricular tachycardia (VT) in ischemic cardiomyopathy. However, the appropriate timing of VT ablation and identifying the group of patients that may receive the greatest benefit remains uncertain. There is limited data on the effect on prophylactic catheter ablation (PCA) in the prevention of implantable cardioverter defibrillator (ICD) therapy, electrical storm, and mortality. Methods: We performed a comprehensive literature search through November 1, 2017, for all eligible studies comparing PCA + ICD versus ICD only in eligible patients with ischemic cardiomyopathy. Clinical outcomes included all ICD therapies including ICD shocks and electrical storm. Additional outcomes included all-cause mortality, cardiovascular mortality, and complications. Results: Three randomized controlled trials (RCTs) (N = 346) met inclusion criteria. PCA was associated with a significantly lower ICD therapies (OR 0.49; CI 0.28 to 0.87; p = 0.01) including ICD shocks [OR 0.38; CI 0.22 to 0.64; p = 0.0003) and electrical storm (OR 0.55; CI 0.30 to 1.01; p = 0.05) when compared with ICD only. There was no significant difference in all-cause mortality (OR 0.77; CI 0.41 to 1.46; p = 0.42), cardiovascular mortality (OR 0.49; CI 0.16 to 1.50; p = 0.21), and major adverse events (OR 1.45; CI 0.52 to 4.01; p = 0.47) between two groups. Conclusion: These results suggest prophylactic catheter ablation decreases ICD therapies, including shocks and electrical storm with no improvement in overall mortality. There is a need for future carefully designed randomized clinical trials.

AB - Background: Catheter ablation is proven to be an effective strategy for drug refractory ventricular tachycardia (VT) in ischemic cardiomyopathy. However, the appropriate timing of VT ablation and identifying the group of patients that may receive the greatest benefit remains uncertain. There is limited data on the effect on prophylactic catheter ablation (PCA) in the prevention of implantable cardioverter defibrillator (ICD) therapy, electrical storm, and mortality. Methods: We performed a comprehensive literature search through November 1, 2017, for all eligible studies comparing PCA + ICD versus ICD only in eligible patients with ischemic cardiomyopathy. Clinical outcomes included all ICD therapies including ICD shocks and electrical storm. Additional outcomes included all-cause mortality, cardiovascular mortality, and complications. Results: Three randomized controlled trials (RCTs) (N = 346) met inclusion criteria. PCA was associated with a significantly lower ICD therapies (OR 0.49; CI 0.28 to 0.87; p = 0.01) including ICD shocks [OR 0.38; CI 0.22 to 0.64; p = 0.0003) and electrical storm (OR 0.55; CI 0.30 to 1.01; p = 0.05) when compared with ICD only. There was no significant difference in all-cause mortality (OR 0.77; CI 0.41 to 1.46; p = 0.42), cardiovascular mortality (OR 0.49; CI 0.16 to 1.50; p = 0.21), and major adverse events (OR 1.45; CI 0.52 to 4.01; p = 0.47) between two groups. Conclusion: These results suggest prophylactic catheter ablation decreases ICD therapies, including shocks and electrical storm with no improvement in overall mortality. There is a need for future carefully designed randomized clinical trials.

KW - Electrical storm

KW - ICD shock

KW - Ventricular tachycardia ablation

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