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.

Copyright © 2011 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1

Flow diagram of literature search and study selection process.

Figure 2

A) Forest plot of relative risk of VT recurrences after catheter ablation versus medical therapy, all studies included. B) Forest plot of relative risk of VT recurrences after catheter ablation versus medical therapy, randomized controlled trials only. C) Forest plot of relative risk of mortality after catheter ablation versus medical therapy. Relative risks in this figure were calculated using the fixed effects Mantel-Haenszel method.