title: Catheter ablation for ventricular tachycardia (VT) in patients with ischemic heart disease: a systematic review and a meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  Patients with ischemic heart disease may have implantable cardioverter defibrillators (ICDs) implanted for primary or secondary prevention of sudden cardiac death. Although ICD shocks can be life saving, in some patients, they have been associated with increased mortality and/or morbidity. Several studies have suggested that catheter ablation may be superior to non-ablative strategies at preventing ICD shocks delivered for ventricular arrhythmias; however, this is still controversial.
  
  
  METHODS
  We performed a meta-analysis of randomized controlled trials (RCTs) comparing catheter ablation with non-ablative strategies in treatment of ventricular tachycardia (VT) in patients with ischemic heart disease and an ICD. The primary endpoints of interest were recurrent episodes of VT and death. We used a binary random effects method to calculate the cumulative odds ratios (OR) for recurrent VT and deaths.
  
  
  RESULTS
  Of a total of 643 potential citations, our search yielded three citations that met our inclusion and exclusion criteria. In the three trials, a total of 262 patients were randomized to ablation (n = 129) or non-ablative interventions (beta-blockers ± use of antiarrhythmics) (n = 133) group. The cumulative OR for recurrent VT was 0.471 (95% confidence interval (CI) = 0.176-1.257) for catheter ablation compared with non-ablative strategies, and for death, it was 0.766 (95% CI = 0.351-1.674). Excluding one study for being appreciably smaller than the other two, the OR for recurrent VT was 0.298 (95% CI = 0.164-0.543).
  
  
  CONCLUSIONS
  In this meta-analysis, the rate of recurrent VT was lower with VT catheter ablation compared with non-ablative strategies. There was not a significant difference in rate of death among patients receiving catheter ablation versus non-ablative strategies for management of VT. Given the lack of adequately powered RCTs comparing ablation versus medical management of VT in patients with ischemic heart disease and an ICD, larger studies with longer follow-up are needed.
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, NC, USA.
authors.forename: Divyang
authors.initials: D
authors.lastname: Patel
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, PO Box 17969, Durham, NC, 27715, USA.
authors.forename: Vic
authors.initials: V
authors.lastname: Hasselblad
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, NC, USA.|Duke Clinical Research Institute, Duke University Medical Center, PO Box 17969, Durham, NC, 27715, USA.
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Jackson
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, NC, USA.|Duke Clinical Research Institute, Duke University Medical Center, PO Box 17969, Durham, NC, 27715, USA.
authors.forename: Sean D
authors.initials: SD
authors.lastname: Pokorney
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, NC, USA.|Duke Clinical Research Institute, Duke University Medical Center, PO Box 17969, Durham, NC, 27715, USA.
authors.forename: James P
authors.initials: JP
authors.lastname: Daubert
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, NC, USA. alkha001@dm.duke.edu.|Duke Clinical Research Institute, Duke University Medical Center, PO Box 17969, Durham, NC, 27715, USA. alkha001@dm.duke.edu.
authors.forename: Sana M
authors.initials: SM
authors.lastname: Al-Khatib
mesh_terms: D000368:Aged; D017115:Catheter Ablation / Q000401:mortality* / Q000706:statistics & numerical data; D015897:Comorbidity; D019317:Evidence-Based Medicine; D006801:Humans; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000401:mortality* / Q000517:prevention & control*; D015995:Prevalence; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D015996:Survival Rate; D017180:Tachycardia, Ventricular / Q000401:mortality* / Q000601:surgery*; D016896:Treatment Outcome
keywords: Ablation; Implantable cardioverter defibrillator; Ischemic heart disease; Meta-analysis; Ventricular tachycardia