Radiofrequency catheter ablation of ventricular tachycardia in ischemic heart disease in light of current practice: a sy
- PDF / 1,109,467 Bytes
- 14 Pages / 595.276 x 790.866 pts Page_size
- 21 Downloads / 183 Views
REVIEWS
Radiofrequency catheter ablation of ventricular tachycardia in ischemic heart disease in light of current practice: a systematic review and meta-analysis of randomized controlled trials Gustavo Lima da Silva 1,2 Daniel Caldeira 1,3,4
&
Afonso Nunes-Ferreira 1,3 & Nuno Cortez-Dias 1,2 & João de Sousa 1,2 & Fausto J. Pinto 1,2,3 &
Received: 21 June 2020 / Accepted: 10 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Ventricular tachycardia (VT) is a frequent cause of mortality and morbidity in patients with ischemic heart disease (IHD). We aim to perform a systematic review and meta-analysis of randomized controlled trials (RCT) of radiofrequency catheter ablation (RCA) of VT in patients with IHD and to discuss its appropriate timing and limitations. Methods Literature searches of MEDLINE, CENTRAL, the Cochrane Database of Systematic Reviews, Health Technology Assessment, and PsycINFO were performed in February 2020. RCTs comparing RCA vs conventional management for VT in patients with IHD and previous or planned implantable cardioverter defibrillator (ICD) were identified. Clinical outcomes included all-cause mortality, cardiovascular mortality, cardiovascular hospitalization, VT storm, recurrent VT/ventricular fibrillation (VF), appropriate ICD therapies, and appropriate ICD shocks. Using a random-effects model, relative risk (RR) and 95% confidence intervals (CI) were calculated for each outcome. Results A total of 6 RCTs (N = 791) met inclusion criteria. RCA was associated with significantly lower VT storm (RR 0.70; CI95% 0.51 to 0.94, p = 0.02) and appropriate ICD therapies (RR 0.69; CI95% 0.54 to 0.88, p = 0.003), including appropriate ICD shocks (RR 0.66; CI95% 0.47 to 0.92, p = 0.02). There was no significant difference in all-cause or cardiovascular mortality, cardiovascular hospitalization, and recurrent VT/VF. Conclusions Radiofrequency catheter ablation for VT in patients with IHD was associated with a reduced risk of VT storm, ICD therapies, and ICD shocks. There is a need for future carefully designed RCTs that incorporate improved RCA procedural aspects. Keywords Catheter ablation . Ischemic heart disease . Meta-analysis . Systematic review . Ventricular tachycardia Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10840-020-00870-3) contains supplementary material, which is available to authorized users. * Gustavo Lima da Silva [email protected]
Abbreviations AAD Antiarrhythmic drug CI Confidence interval ICD Implantable cardioverter defibrillator IHD Ischemic heart disease RCA Radiofrequency catheter ablation RCT Randomized controlled trial RR Relative risk VF Ventricular fibrillation VT Ventricular tachycardia
1
Serviço de Cardiologia, Departamento de Coração e Vasos, CHULN Hospital de Santa Maria, Av Prof. Egas Moniz, 1649-028 Lisbon, Portugal
2
Cardiac Rhythm Abnormalities Unit, Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Av P
Data Loading...
