The efficacy of catheter ablation versus ICD for prevention of ventricular tachycardia in patients with ischemic heart disease: a systematic review and meta-analysis.

PURPOSE:Although implantable cardioverter defibrillator (ICD) could prevent the sudden death of ventricular tachycardia (VT) in patients with ischemic heart disease, it could not effectively prevent the recurrence of ventricular tachycardia. Several studies have suggested that catheter ablation may effectively decrease the incidence of ICD events, but relevant dates from randomized controlled trials were limited. METHODS:A systematic review and meta-analysis of randomized controlled trials were performed to evaluate the effect of catheter ablation for the prevention of VT in patients with ischemic heart disease. Random-effects model with inverse-variance weighting method was used to pool odds ratios. Egger method was performed to evaluate whether there was public bias in each outcome. RESULTS:Four studies enrolling a total of 605 patients were included in the present meta-analysis. Compared with the control group (ICD ± AAD), catheter ablation could significantly reduce the incidence of ICD therapy (OR, 0.49; 95% CI, 0.28 ~ 0.87), ICD shock (OR, 0.50; 95% CI, 0.28 ~ 0.87), VT storm (OR, 0.60; 95% CI, 0.40 ~ 0.90), and cardiovascular-related hospitalization (OR, 0.66; 95% CI, 0.45 ~ 0.9). But there was no significant difference among the risk of all-cause mortality (OR, 0.89; 95% CI, 0.59 ~ 1.34), cardiovascular mortality (OR, 0.76; 95% CI, 0.44 ~ 1.30), and complication (OR, 0.89; 95% CI, 0.30 ~ 2.67). CONCLUSION:These results showed that catheter ablation combined with ICD could reduce ICD therapy, ICD shock, and VT storm in patients with ischemic heart disease, but there was no improvement in all-cause mortality. Meanwhile, it also provided a basic guidance for the design of larger clinical randomized trials with longer follow-up in the future.