title: Meta-analysis of catheter ablation as an adjunct to medical therapy for treatment of ventricular tachycardia in patients with structural heart disease.
abstract: BACKGROUND
  Most studies of catheter ablation for the treatment of ventricular tachycardia (VT) are relatively small observational trials.
  
  
  OBJECTIVE
  The purpose of this study was to define the relative risk of VT recurrence in patients undergoing catheter ablation as an adjunct to medical therapy versus medical therapy alone in a pooled analysis of controlled studies.
  
  
  METHODS
  Randomized and nonrandomized controlled trials of patients who underwent adjunctive catheter ablation of VT versus medical therapy alone were sought. MEDLINE, EMBASE, the Cochrane central register of controlled trials (CENTRAL), and Web of Science were searched from 1965 to July 2010. Supplemental searches included Internet resources, reference lists, and reports of arrhythmia experts. Three authors independently reviewed and extracted the data regarding baseline characteristics, ablation methodology, medical therapy, complications, VT recurrences, mortality, and study quality.
  
  
  RESULTS
  Five studies were included totaling 457 participants with structural heart disease. Adjunctive catheter ablation was performed in 58% of participants, whereas 42% received medical therapy alone for VT. Complications of catheter ablation included death (1%), stroke (1%), cardiac perforation (1%), and complete heart block (1.6%). Using a random-effects model, a statistically significant 35% reduction in the number of patients with VT recurrence was noted with adjunctive catheter ablation (P<.001). There was no statistically significant difference in mortality.
  
  
  CONCLUSIONS
  Catheter ablation as an adjunct to medical therapy reduces VT recurrences in patients with structural heart disease and has no impact on mortality.
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Jaya
authors.initials: J
authors.lastname: Mallidi
authors.forename: Girish N
authors.initials: GN
authors.lastname: Nadkarni
authors.forename: Ronald D
authors.initials: RD
authors.lastname: Berger
authors.forename: Hugh
authors.initials: H
authors.lastname: Calkins
authors.forename: Saman
authors.initials: S
authors.lastname: Nazarian
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D017115:Catheter Ablation / Q000379:methods*; D006339:Heart Rate; D006801:Humans; D017180:Tachycardia, Ventricular / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents