title: Comparative effectiveness of antiarrhythmic drugs and catheter ablation for the prevention of recurrent ventricular tachycardia in patients with implantable cardioverter-defibrillators: A systematic review and meta-analysis of randomized controlled trials.
abstract: Treatment strategies to prevent ventricular tachycardia (VT) in patients with an implantable cardioverter-defibrillator (ICD) include antiarrhythmic drugs (AADs) and catheter ablation (CA).
  
  
  
  The purpose of this study was to systematically compare the efficacy of AADs and CA for the prevention of VT in patients with ICDs.
  
  
  
  Major databases were searched (October 2015) for randomized trials evaluating AADs or CA vs standard medical therapy to prevent VT in ICD patients. Primary outcome was the number of VT episodes leading to appropriate ICD interventions.
  
  
  
  Eight trials (n = 2268, follow-up 15 ± 6 months) evaluated AADs, and 6 trials (n = 427, follow-up 14 ± 8 months) evaluated CA. A significant reduction in appropriate ICD interventions was found with both CA (odds ratio [OR] 0.45, 95% confidence interval [CI] 0.28-0.71, P = .001) and AADs (OR 0.66, 95% CI 0.44-0.97, P = .037), with no significant difference between the 2 treatment strategies. The benefit of AADs was driven by amiodarone and not confirmed with other AADs. A reduction of inappropriate ICD interventions was found with AADs (OR 0.30, P = .001) but not with CA. Both CA and AADs were not associated with decreased mortality over follow-up. Amiodarone appeared to increase the risk of death (OR 3.36, 95% CI 1.36-8.30, P = .009).
  
  
  
  In patients with an ICD, both AADs (amiodarone) and CA reduce the risk of recurrent VT compared to control medical therapy, with no significant difference between the 2 treatments. AADs are also associated with a reduction of inappropriate ICD therapies. The significant reduction of recurrent VT episodes does not appear to result in a mortality benefit, with a potential for increased mortality with amiodarone.
authors.affiliation: Electrophysiology Section, Cardiovascular Division-Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: pasquale.santangeli@uphs.upenn.edu.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Santangeli
authors.affiliation: Electrophysiology Section, Cardiovascular Division-Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Daniele
authors.initials: D
authors.lastname: Muser
authors.affiliation: Electrophysiology Section, Cardiovascular Division-Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Shingo
authors.initials: S
authors.lastname: Maeda
authors.affiliation: Electrophysiology Section, Cardiovascular Division-Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Annalisa
authors.initials: A
authors.lastname: Filtz
authors.affiliation: Electrophysiology Section, Cardiovascular Division-Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Erica S
authors.initials: ES
authors.lastname: Zado
authors.affiliation: Electrophysiology Section, Cardiovascular Division-Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: David S
authors.initials: DS
authors.lastname: Frankel
authors.affiliation: Electrophysiology Section, Cardiovascular Division-Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Dixit
authors.affiliation: Electrophysiology Section, Cardiovascular Division-Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Epstein
authors.affiliation: Electrophysiology Section, Cardiovascular Division-Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: David J
authors.initials: DJ
authors.lastname: Callans
authors.affiliation: Electrophysiology Section, Cardiovascular Division-Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Francis E
authors.initials: FE
authors.lastname: Marchlinski
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000494:pharmacology*; D017115:Catheter Ablation / Q000379:methods / Q000706:statistics & numerical data; D057186:Comparative Effectiveness Research; D017147:Defibrillators, Implantable / Q000009:adverse effects; D004554:Electric Countershock / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D055502:Secondary Prevention / Q000379:methods*; D017180:Tachycardia, Ventricular / Q000517:prevention & control*
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: Antiarrhythmic drugs; Catheter ablation; Comparative effectiveness; Implantable cardioverter-defibrillator; Ventricular tachycardia