title: Substrate-Based Ablation Versus Ablation Guided by Activation and Entrainment Mapping for Ventricular Tachycardia: A Systematic Review and Meta-Analysis.
abstract: Substrate-based ablation for scar-related ventricular tachycardia (VT) has gained prominence: however, there is limited data comparing it to ablation guided predominantly by activation and entrainment mapping of inducible and hemodynamically tolerated VTs. We compared the acute procedural efficacy and outcomes of predominantly substrate-based ablation versus ablation guided predominantly by activation and entrainment mapping.
  
  
  
  Database searches through April 2016 identified 6 eligible studies (enrolling 403 patients, with 1 randomized study) comparing the 2 strategies. The relative risk of VT recurrence at follow-up was assessed as the primary outcome using a random-effects meta-analysis. Secondary endpoints of acute success (based on noninducibility of VT), procedural complications, and mortality were assessed using weighted mean difference with the random effects model. At a median follow-up of 18 months, the relative risk (RR) of VT recurrence was not significantly different with substrate-based versus activation/entrainment guided VT ablation (0.72, 95% confidence interval [CI] 0.44-1.18), P = 0.2). Acute success (RR 1.02, 95% CI 0.95-1.1, P = 0.6), procedural complications (RR 0.8, 95% CI 0.35-1.82, P = 0.5) cardiovascular mortality and total mortality did not differ significantly (RR 0.83, 95% CI 0.38-1.79, P = 0.6 and RR 0.76, 95% CI 0.36-1.59, P = 0.5, respectively).
  
  
  
  This meta-analysis demonstrates similar acute procedural efficacy, and complications, VT recurrence and mortality rates when comparing a predominantly substrate-based ablation strategy to a strategy guided predominantly by activation and entrainment mapping of inducible and hemodynamically tolerated VTs.
authors: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors: Saurabh
authors: S
authors: Kumar
authors: Bern University Hospital and University of Bern, Bern, Switzerland.
authors: Samuel H
authors: SH
authors: Baldinger
authors: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors: Jorge
authors: J
authors: Romero
authors: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors: Akira
authors: A
authors: Fujii
authors: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors: Saagar N
authors: SN
authors: Mahida
authors: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors: Usha B
authors: UB
authors: Tedrow
authors: Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors: William G
authors: WG
authors: Stevenson
mesh_terms: D000200:Action Potentials; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D016009:Chi-Square Distribution; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006339:Heart Rate; D006352:Heart Ventricles / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D012008:Recurrence; D012307:Risk Factors; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: activation mapping; catheter ablation; entrainment mapping; meta-analysis; substrate mapping; ventricular tachycardia