Substrate-Based Ablation Versus Ablation Guided by Activation and Entrainment Mapping for Ventricular Tachycardia: A Systematic Review and Meta-Analysis

Saurabh Kumar, Samuel H. Baldinger, Jorge E. Romero, Akira Fujii, Saagar N. Mahida, Usha B. Tedrow, William G. Stevenson

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Introduction: Substrate-based ablation for scar-related ventricular tachycardia (VT) has gained prominence: however, there is limited data comparing it to ablation guided predominantly by activation and entrainment mapping of inducible and hemodynamically tolerated VTs. We compared the acute procedural efficacy and outcomes of predominantly substrate-based ablation versus ablation guided predominantly by activation and entrainment mapping. Methods and Results: Database searches through April 2016 identified 6 eligible studies (enrolling 403 patients, with 1 randomized study) comparing the 2 strategies. The relative risk of VT recurrence at follow-up was assessed as the primary outcome using a random-effects meta-analysis. Secondary endpoints of acute success (based on noninducibility of VT), procedural complications, and mortality were assessed using weighted mean difference with the random effects model. At a median follow-up of 18 months, the relative risk (RR) of VT recurrence was not significantly different with substrate-based versus activation/entrainment guided VT ablation (0.72, 95% confidence interval [CI] 0.44–1.18), P = 0.2). Acute success (RR 1.02, 95% CI 0.95–1.1, P = 0.6), procedural complications (RR 0.8, 95% CI 0.35–1.82, P = 0.5) cardiovascular mortality and total mortality did not differ significantly (RR 0.83, 95% CI 0.38–1.79, P = 0.6 and RR 0.76, 95% CI 0.36–1.59, P = 0.5, respectively). Conclusions: This meta-analysis demonstrates similar acute procedural efficacy, and complications, VT recurrence and mortality rates when comparing a predominantly substrate-based ablation strategy to a strategy guided predominantly by activation and entrainment mapping of inducible and hemodynamically tolerated VTs.

Original languageEnglish (US)
Pages (from-to)1437-1447
Number of pages11
JournalJournal of Cardiovascular Electrophysiology
Volume27
Issue number12
DOIs
StatePublished - Dec 1 2016
Externally publishedYes

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Ventricular Tachycardia
Meta-Analysis
Confidence Intervals
Mortality
Recurrence
Cicatrix
Databases

Keywords

  • activation mapping
  • catheter ablation
  • entrainment mapping
  • meta-analysis
  • substrate mapping
  • ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Substrate-Based Ablation Versus Ablation Guided by Activation and Entrainment Mapping for Ventricular Tachycardia : A Systematic Review and Meta-Analysis. / Kumar, Saurabh; Baldinger, Samuel H.; Romero, Jorge E.; Fujii, Akira; Mahida, Saagar N.; Tedrow, Usha B.; Stevenson, William G.

In: Journal of Cardiovascular Electrophysiology, Vol. 27, No. 12, 01.12.2016, p. 1437-1447.

Research output: Contribution to journalArticle

Kumar, Saurabh ; Baldinger, Samuel H. ; Romero, Jorge E. ; Fujii, Akira ; Mahida, Saagar N. ; Tedrow, Usha B. ; Stevenson, William G. / Substrate-Based Ablation Versus Ablation Guided by Activation and Entrainment Mapping for Ventricular Tachycardia : A Systematic Review and Meta-Analysis. In: Journal of Cardiovascular Electrophysiology. 2016 ; Vol. 27, No. 12. pp. 1437-1447.
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abstract = "Introduction: Substrate-based ablation for scar-related ventricular tachycardia (VT) has gained prominence: however, there is limited data comparing it to ablation guided predominantly by activation and entrainment mapping of inducible and hemodynamically tolerated VTs. We compared the acute procedural efficacy and outcomes of predominantly substrate-based ablation versus ablation guided predominantly by activation and entrainment mapping. Methods and Results: Database searches through April 2016 identified 6 eligible studies (enrolling 403 patients, with 1 randomized study) comparing the 2 strategies. The relative risk of VT recurrence at follow-up was assessed as the primary outcome using a random-effects meta-analysis. Secondary endpoints of acute success (based on noninducibility of VT), procedural complications, and mortality were assessed using weighted mean difference with the random effects model. At a median follow-up of 18 months, the relative risk (RR) of VT recurrence was not significantly different with substrate-based versus activation/entrainment guided VT ablation (0.72, 95{\%} confidence interval [CI] 0.44–1.18), P = 0.2). Acute success (RR 1.02, 95{\%} CI 0.95–1.1, P = 0.6), procedural complications (RR 0.8, 95{\%} CI 0.35–1.82, P = 0.5) cardiovascular mortality and total mortality did not differ significantly (RR 0.83, 95{\%} CI 0.38–1.79, P = 0.6 and RR 0.76, 95{\%} CI 0.36–1.59, P = 0.5, respectively). Conclusions: This meta-analysis demonstrates similar acute procedural efficacy, and complications, VT recurrence and mortality rates when comparing a predominantly substrate-based ablation strategy to a strategy guided predominantly by activation and entrainment mapping of inducible and hemodynamically tolerated VTs.",
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T1 - Substrate-Based Ablation Versus Ablation Guided by Activation and Entrainment Mapping for Ventricular Tachycardia

T2 - A Systematic Review and Meta-Analysis

AU - Kumar, Saurabh

AU - Baldinger, Samuel H.

AU - Romero, Jorge E.

AU - Fujii, Akira

AU - Mahida, Saagar N.

AU - Tedrow, Usha B.

AU - Stevenson, William G.

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Y1 - 2016/12/1

N2 - Introduction: Substrate-based ablation for scar-related ventricular tachycardia (VT) has gained prominence: however, there is limited data comparing it to ablation guided predominantly by activation and entrainment mapping of inducible and hemodynamically tolerated VTs. We compared the acute procedural efficacy and outcomes of predominantly substrate-based ablation versus ablation guided predominantly by activation and entrainment mapping. Methods and Results: Database searches through April 2016 identified 6 eligible studies (enrolling 403 patients, with 1 randomized study) comparing the 2 strategies. The relative risk of VT recurrence at follow-up was assessed as the primary outcome using a random-effects meta-analysis. Secondary endpoints of acute success (based on noninducibility of VT), procedural complications, and mortality were assessed using weighted mean difference with the random effects model. At a median follow-up of 18 months, the relative risk (RR) of VT recurrence was not significantly different with substrate-based versus activation/entrainment guided VT ablation (0.72, 95% confidence interval [CI] 0.44–1.18), P = 0.2). Acute success (RR 1.02, 95% CI 0.95–1.1, P = 0.6), procedural complications (RR 0.8, 95% CI 0.35–1.82, P = 0.5) cardiovascular mortality and total mortality did not differ significantly (RR 0.83, 95% CI 0.38–1.79, P = 0.6 and RR 0.76, 95% CI 0.36–1.59, P = 0.5, respectively). Conclusions: This meta-analysis demonstrates similar acute procedural efficacy, and complications, VT recurrence and mortality rates when comparing a predominantly substrate-based ablation strategy to a strategy guided predominantly by activation and entrainment mapping of inducible and hemodynamically tolerated VTs.

AB - Introduction: Substrate-based ablation for scar-related ventricular tachycardia (VT) has gained prominence: however, there is limited data comparing it to ablation guided predominantly by activation and entrainment mapping of inducible and hemodynamically tolerated VTs. We compared the acute procedural efficacy and outcomes of predominantly substrate-based ablation versus ablation guided predominantly by activation and entrainment mapping. Methods and Results: Database searches through April 2016 identified 6 eligible studies (enrolling 403 patients, with 1 randomized study) comparing the 2 strategies. The relative risk of VT recurrence at follow-up was assessed as the primary outcome using a random-effects meta-analysis. Secondary endpoints of acute success (based on noninducibility of VT), procedural complications, and mortality were assessed using weighted mean difference with the random effects model. At a median follow-up of 18 months, the relative risk (RR) of VT recurrence was not significantly different with substrate-based versus activation/entrainment guided VT ablation (0.72, 95% confidence interval [CI] 0.44–1.18), P = 0.2). Acute success (RR 1.02, 95% CI 0.95–1.1, P = 0.6), procedural complications (RR 0.8, 95% CI 0.35–1.82, P = 0.5) cardiovascular mortality and total mortality did not differ significantly (RR 0.83, 95% CI 0.38–1.79, P = 0.6 and RR 0.76, 95% CI 0.36–1.59, P = 0.5, respectively). Conclusions: This meta-analysis demonstrates similar acute procedural efficacy, and complications, VT recurrence and mortality rates when comparing a predominantly substrate-based ablation strategy to a strategy guided predominantly by activation and entrainment mapping of inducible and hemodynamically tolerated VTs.

KW - activation mapping

KW - catheter ablation

KW - entrainment mapping

KW - meta-analysis

KW - substrate mapping

KW - ventricular tachycardia

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