Background: Ventricular tachycardia (VT) is a common chronic complication of ischemic heart disease (IHD), even in the era of contemporary coronary intervention. The use of implantable cardioverter-defibrillators (ICDs) has reduced mortality, but ICD shocks can be painful and traumatizing. Catheter ablation has been posited to reduce VT incidence and is commonly used in IHD patients when antiarrhythmic drugs do not suppress VT.
Purpose: We aim to review the clinical efficacy and safety of catheter ablation vs medical therapy in patients with IHD.
Methods: We conducted comprehensive searches across PubMed, CENTRAL, WOS, Scopus, and EMBASE until Feb 2024. Pooled data were reported using risk ratio (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes. This systematic review and meta-analysis was registered with PROSPERO ID: CRD42024551760.
Results: We included Eight RCTs with a total of 1,252 patients. Patients who underwent ablation had a lower risk of VT storm compared to those who received medical therapy [RR: 0.74 with 95% CI: (0.60, 0.91), P =0.005), Compared to medical treatment, the catheter ablation group also required less appropriate ICD therapy [RR: 0.72 with 95% CI (0.57, 0.90), P < 0.01), and fewer appropriate ICD shocks [RR: 0.75 with 95% CI (0.57, 0.0.99), P = 0.04). However, there was no significant difference in VT/VF recurrence [RR: 0.94 with 95% CI (0.83, 1.04), P = 0.33) and all-cause mortality [RR: 0.87 with 95% CI (0.70, 1.09), P = 0.22).
Conclusion: Catheter ablation is associated with a reduction in ventricular storms, ICD therapy, and ICD shocks while demonstrating similar safety in managing VT in IHD patients compared to medical therapy alone.
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