Long-term outcomes of different ablation strategies for ventricular tachycardia in patients with structural heart disease: Systematic review and meta-analysis

David F. Bricenõ, Jorge E. Romero, Pedro A. Villablanca, Alejandra Londonõ, Juan C. Diaz, Ilir Maraj, Syeda Atiqa Batul, Nidhi Madan, Jignesh Patel, Anand Jagannath, Sanghamitra Mohanty, Prasant Mohanty, Carola Gianni, Domenico Della Rocca, Ahlam Sabri, Soo G. Kim, Andrea Natale, Luigi Di Biase

Research output: Contribution to journalReview article

12 Citations (Scopus)

Abstract

To compare the long-term outcomes of standard ablation of stable ventricular tachycardia (VT) vs. substrate modification, and of complete vs. Incomplete substrate modification in patients with structural heart disease (SHD) presenting with VT. Methods and results An electronic search was performed using major databases. The main outcomes were a composite of long-term ventricular arrhythmia (VA) recurrence and all-cause mortality of standard ablation of stable VT vs. substrate modification, and long-term VA recurrence in complete vs. Incomplete substrate modification. Six studies were included for the comparison of standard ablation of stable VT vs. substrate modification, with a total of 396 patients (mean age 63 ± 10 years, 87% males), and seven studies were included to assess the impact of extensive substrate modification, with a total of 391 patients (mean age 64 ± years, 90% males). More than 70% of all the patients included had ischaemic cardiomyopathy. Substrate modification was associated with decreased composite VA recurrence/all-cause mortality compared to standard ablation of stable VTs [risk ratio (RR) 0.57, 95% confidence interval (CI) 0.40-0.81]. Complete substrate modification was associated with decreased VA recurrence as compared to incomplete substrate modification (RR 0.39, 95% CI 0.27-0.58). Conclusion In patients with SHD who had VT related mainly to ischaemic substrates, there was a significantly lower risk of the composite primary outcome of long-term VA recurrence and all-cause mortality among those undergoing substrate modification compared to standard ablation. Long-term success is improved when performing complete substrate modification.

Original languageEnglish (US)
Pages (from-to)104-115
Number of pages12
JournalEuropace
Volume20
Issue number1
DOIs
StatePublished - Jan 1 2018

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Ventricular Tachycardia
Meta-Analysis
Cardiac Arrhythmias
Heart Diseases
Recurrence
Mortality
Odds Ratio
Confidence Intervals
Cardiomyopathies
Databases

Keywords

  • Activation/entrainment mapping
  • Meta-analysis
  • Substrate modification
  • Ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Long-term outcomes of different ablation strategies for ventricular tachycardia in patients with structural heart disease : Systematic review and meta-analysis. / Bricenõ, David F.; Romero, Jorge E.; Villablanca, Pedro A.; Londonõ, Alejandra; Diaz, Juan C.; Maraj, Ilir; Batul, Syeda Atiqa; Madan, Nidhi; Patel, Jignesh; Jagannath, Anand; Mohanty, Sanghamitra; Mohanty, Prasant; Gianni, Carola; Della Rocca, Domenico; Sabri, Ahlam; Kim, Soo G.; Natale, Andrea; Di Biase, Luigi.

In: Europace, Vol. 20, No. 1, 01.01.2018, p. 104-115.

Research output: Contribution to journalReview article

Bricenõ, DF, Romero, JE, Villablanca, PA, Londonõ, A, Diaz, JC, Maraj, I, Batul, SA, Madan, N, Patel, J, Jagannath, A, Mohanty, S, Mohanty, P, Gianni, C, Della Rocca, D, Sabri, A, Kim, SG, Natale, A & Di Biase, L 2018, 'Long-term outcomes of different ablation strategies for ventricular tachycardia in patients with structural heart disease: Systematic review and meta-analysis', Europace, vol. 20, no. 1, pp. 104-115. https://doi.org/10.1093/europace/eux109
Bricenõ, David F. ; Romero, Jorge E. ; Villablanca, Pedro A. ; Londonõ, Alejandra ; Diaz, Juan C. ; Maraj, Ilir ; Batul, Syeda Atiqa ; Madan, Nidhi ; Patel, Jignesh ; Jagannath, Anand ; Mohanty, Sanghamitra ; Mohanty, Prasant ; Gianni, Carola ; Della Rocca, Domenico ; Sabri, Ahlam ; Kim, Soo G. ; Natale, Andrea ; Di Biase, Luigi. / Long-term outcomes of different ablation strategies for ventricular tachycardia in patients with structural heart disease : Systematic review and meta-analysis. In: Europace. 2018 ; Vol. 20, No. 1. pp. 104-115.
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abstract = "To compare the long-term outcomes of standard ablation of stable ventricular tachycardia (VT) vs. substrate modification, and of complete vs. Incomplete substrate modification in patients with structural heart disease (SHD) presenting with VT. Methods and results An electronic search was performed using major databases. The main outcomes were a composite of long-term ventricular arrhythmia (VA) recurrence and all-cause mortality of standard ablation of stable VT vs. substrate modification, and long-term VA recurrence in complete vs. Incomplete substrate modification. Six studies were included for the comparison of standard ablation of stable VT vs. substrate modification, with a total of 396 patients (mean age 63 ± 10 years, 87{\%} males), and seven studies were included to assess the impact of extensive substrate modification, with a total of 391 patients (mean age 64 ± years, 90{\%} males). More than 70{\%} of all the patients included had ischaemic cardiomyopathy. Substrate modification was associated with decreased composite VA recurrence/all-cause mortality compared to standard ablation of stable VTs [risk ratio (RR) 0.57, 95{\%} confidence interval (CI) 0.40-0.81]. Complete substrate modification was associated with decreased VA recurrence as compared to incomplete substrate modification (RR 0.39, 95{\%} CI 0.27-0.58). Conclusion In patients with SHD who had VT related mainly to ischaemic substrates, there was a significantly lower risk of the composite primary outcome of long-term VA recurrence and all-cause mortality among those undergoing substrate modification compared to standard ablation. Long-term success is improved when performing complete substrate modification.",
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T1 - Long-term outcomes of different ablation strategies for ventricular tachycardia in patients with structural heart disease

T2 - Systematic review and meta-analysis

AU - Bricenõ, David F.

AU - Romero, Jorge E.

AU - Villablanca, Pedro A.

AU - Londonõ, Alejandra

AU - Diaz, Juan C.

AU - Maraj, Ilir

AU - Batul, Syeda Atiqa

AU - Madan, Nidhi

AU - Patel, Jignesh

AU - Jagannath, Anand

AU - Mohanty, Sanghamitra

AU - Mohanty, Prasant

AU - Gianni, Carola

AU - Della Rocca, Domenico

AU - Sabri, Ahlam

AU - Kim, Soo G.

AU - Natale, Andrea

AU - Di Biase, Luigi

PY - 2018/1/1

Y1 - 2018/1/1

N2 - To compare the long-term outcomes of standard ablation of stable ventricular tachycardia (VT) vs. substrate modification, and of complete vs. Incomplete substrate modification in patients with structural heart disease (SHD) presenting with VT. Methods and results An electronic search was performed using major databases. The main outcomes were a composite of long-term ventricular arrhythmia (VA) recurrence and all-cause mortality of standard ablation of stable VT vs. substrate modification, and long-term VA recurrence in complete vs. Incomplete substrate modification. Six studies were included for the comparison of standard ablation of stable VT vs. substrate modification, with a total of 396 patients (mean age 63 ± 10 years, 87% males), and seven studies were included to assess the impact of extensive substrate modification, with a total of 391 patients (mean age 64 ± years, 90% males). More than 70% of all the patients included had ischaemic cardiomyopathy. Substrate modification was associated with decreased composite VA recurrence/all-cause mortality compared to standard ablation of stable VTs [risk ratio (RR) 0.57, 95% confidence interval (CI) 0.40-0.81]. Complete substrate modification was associated with decreased VA recurrence as compared to incomplete substrate modification (RR 0.39, 95% CI 0.27-0.58). Conclusion In patients with SHD who had VT related mainly to ischaemic substrates, there was a significantly lower risk of the composite primary outcome of long-term VA recurrence and all-cause mortality among those undergoing substrate modification compared to standard ablation. Long-term success is improved when performing complete substrate modification.

AB - To compare the long-term outcomes of standard ablation of stable ventricular tachycardia (VT) vs. substrate modification, and of complete vs. Incomplete substrate modification in patients with structural heart disease (SHD) presenting with VT. Methods and results An electronic search was performed using major databases. The main outcomes were a composite of long-term ventricular arrhythmia (VA) recurrence and all-cause mortality of standard ablation of stable VT vs. substrate modification, and long-term VA recurrence in complete vs. Incomplete substrate modification. Six studies were included for the comparison of standard ablation of stable VT vs. substrate modification, with a total of 396 patients (mean age 63 ± 10 years, 87% males), and seven studies were included to assess the impact of extensive substrate modification, with a total of 391 patients (mean age 64 ± years, 90% males). More than 70% of all the patients included had ischaemic cardiomyopathy. Substrate modification was associated with decreased composite VA recurrence/all-cause mortality compared to standard ablation of stable VTs [risk ratio (RR) 0.57, 95% confidence interval (CI) 0.40-0.81]. Complete substrate modification was associated with decreased VA recurrence as compared to incomplete substrate modification (RR 0.39, 95% CI 0.27-0.58). Conclusion In patients with SHD who had VT related mainly to ischaemic substrates, there was a significantly lower risk of the composite primary outcome of long-term VA recurrence and all-cause mortality among those undergoing substrate modification compared to standard ablation. Long-term success is improved when performing complete substrate modification.

KW - Activation/entrainment mapping

KW - Meta-analysis

KW - Substrate modification

KW - Ventricular tachycardia

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