First-line ablation of ventricular tachycardia in ischemic cardiomyopathy: stratification of outcomes by left ventricular function

David F. Briceño, Jorge Romero, Kavisha Patel, Wasla Liaqat, Xiao Dong Zhang, Isabella Alviz, Ruike Yang, Daniel Rodriguez, Dhanunjaya Lakkireddy, Domenico Della Rocca, Nicola Tarantino, Rakesh Gopinathannair, Andrea Natale, Luigi Di Biase

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: First-line catheter ablation of ventricular tachycardia/ventricular fibrillation (VT/VF) in patients with ischemic cardiomyopathy (ICM) has been associated with improved outcomes; however, most benefit seems to be in patients with moderately depressed left ventricular ejection fraction (LVEF). Herein, outcomes were stratified based on LVEF. Methods: A meta-analysis of randomized controlled trials (RCTs) evaluating first-line ablation versus medical therapy in patients with VT and ICM was performed. Risk estimates and 95% confidence intervals (CI) were measured. Results: Four RCTs with a total of 505 patients (mean age 66 ± 9 years, 89% male, 80% with previous revascularization) were included. Mean LVEF was 35 ± 8%. At a mean follow-up of 24 ± 9 months, a significant benefit in survival-free from appropriate implantable cardioverter-defibrillator (ICD) therapies was observed in all patients undergoing first-line catheter ablation compared with medical management (RR 0.70, 95% CI 0.56–0.86). In patients with moderately depressed LVEF (> 30–50%), first-line VT ablation was associated with a statistically significant reduction in the composite endpoint of survival free from VT/VF and appropriate ICD therapies (HR 0.52, 95% CI 0.36–0.76), whereas there was no difference in patients with severely depressed LVEF (≤30%) (HR 0.56, 95% CI 0.24–1.32). Funnel plots did not show asymmetry suggesting lack of bias. Conclusions: Patients with ICM and VT undergoing first-line ablation have a significantly lower rate of appropriate ICD therapies without a mortality difference compared with patients receiving an initial approach based on medical therapy. The beneficial effect of a first-line ablation approach was only observed in patients with moderately depressed LVEF (> 30–50%).

Original languageEnglish (US)
JournalJournal of Interventional Cardiac Electrophysiology
DOIs
StateAccepted/In press - 2020

Keywords

  • Catheter ablation
  • Heart failure
  • Ischemic cardiomyopathy
  • Ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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