Abstract 15765: A Meta-analysis of Catheter Ablation versus Medical Therapy in Ventricular Tachycardia
Background: Catheter ablation (CA) is an effective treatment strategy when compared to medical therapy (MT) for ventricular tachycardia (VT) in ischemic cardiomyopathy. However, its effect on mortality remains unclear. We aimed to perform a meta-analysis from eligible studies to analyze the true impact of CA versus MT with regard to implantable cardioverter defibrillator (ICD) shocks, VT storm and mortality.
Methods: We performed a comprehensive literature search through May 30, 2016 comparing CA versus MT for VT in ischemic cardiomyopathy in Pubmed, Ebsco and google scholar databases. A total of 9 eligible studies [7 randomized controlled trials (RCT), 1 prospective observational and 1 retrospective] consisting of 1,484 patients (CA group - 500 patients and MT group- 984) were included in the meta-analysis. Follow-up duration for the studies ranged from 6 months to 5 years.
Results: ICD shocks were reported in 7 studies (all RCTs), mortality in 8 studies (6 RCTs) and VT storm in 3 studies (all RCTs) respectively. Low-moderate degree of heterogeneity among studies was demonstrated by Cochrane q-statistic. CA group had significantly lower episodes of ICD shocks when compared with MT [(38% vs. 49%, HR 0.53, 95% CI (0.33-0.85), p=0.009]. CA showed a trend towards lower episodes of VT storm [30% vs. 37%, HR 0.68, 95% CI (0.34-1.4, p=0.3)] and a significantly lower mortality when compared with MT [17% versus 39%, HR 0.65, 95% CI (0.43-1.0), p=0.05]. The effect on mortality was largely driven by the study by Bunch et al. No mortality benefit was seen between CA versus MT if that study was excluded from analysis (15% vs. 18%, HR 0.87, 95% CI (0.57-1.33)].
Conclusion: CA significantly decreased ICD shocks and mortality by 47% and 35% but not VT storm when compared with MT.
Author Disclosures: M. Turagam: None. P. Velagapudi: None. M. Lavu: None. S. Iskandar: None. D. Atkins: None. L. Di Biase: None. A. Natale: None. M. Reddy: None. D. Lakkireddy: None.
- © 2016 by American Heart Association, Inc.