Abstract 17116: Substrate-based Ablation Strategies Versus Standard Ablation of Ventricular Tachycardia in Patients With Structural Heart Disease: A Meta-analysis
Background: Catheter ablation of ventricular tachycardia (VT) reduces ventricular arrhythmia recurrence in patients with structural heart disease (SHD), however the most effective catheter ablation technique is unknown. We sought to evaluate what is the best approach for VT ablation in patients with SHD.
Hypothesis: Substrate-based (SU) ablation is superior to standard (ST) ablation of VT.
Methods: An electronic search was performed using major databases. Studies comparing SU versus ST ablation of VT in patients with SHD were included. Primary outcomes were ventricular arrhythmia recurrence and all-cause mortality. Secondary outcomes included procedure, radiofrequency, and fluoroscopy times. Odds ratios (OR) and 95% confidence intervals (CI) were computed using the Mantel-Haenszel method. Summary estimates and 95% CI for continuous variables were reported as standardized difference in means (SDM).
Results: Seven studies were included (n=563 patients). The mean follow-up was 26 months. SU was associated with decreased ventricular arrhythmia recurrence and all-cause mortality compared to ST (OR 0.29, 95% CI 0.16-0.55; OR 0.54, 95% CI 0.29-0.99, respectively), without difference in procedure, radiofrequency, and fluoroscopy times (SDM 2.68, 95% CI -41.27 to 46.63, p=0.9; SDM 13.49, 95% CI -1.16 to 28.15, p=0.07; SDM 2.19, 95% CI -3.26 to 7.65, p=0.43, respectively). No evidence of significant publication bias was found.
Conclusions: This is the first meta-analysis comparing SU vs. ST ablation of VT. SU is associated with decreased long-term ventricular arrhythmia recurrence and all-cause mortality compared to ST.
Author Disclosures: D.F. Briceno: None. P. Villablanca: None. F. Lupercio: None. A. Jagannath: None. J. Patel: None. A. Londono: None. F. Kargoli: None. S. Mohanty: None. P. Mohanty: None. C. Gianni: None. H. Ramakrishna: None. S.G. Kim: None. A. Natale: Honoraria; Modest; Boston Scientific, Biosense Webster, St. Jude Medical, Biotronik and Medtronic. Consultant/Advisory Board; Modest; Biosense Webster St Jude Medical and Janssen. L. Di Biase: Honoraria; Modest; Boston Scientific ,Medtronic, Janssen, Pfizer, Bristol Meyers, EPiEP and Biotronik. Consultant/Advisory Board; Modest; Biosense Webster, Stereotaxis and St Jude Medical.
- © 2016 by American Heart Association, Inc.