Abstract
Background: Patients with post-infarct cardiomyopathy and ventricular arrhythmias (VT) necessitating implantable cardioverter defibrillators (ICD) are at risk of recurrent shocks with increased morbidity. Methods: A comprehensive search of electronic databases for all randomized clinical trials that evaluated the role of catheter ablation as a preventive strategy at the time of secondary prevention ICD implantation was performed. We calculated hazard ratios (HR) and 95% confidence intervals (CI) using random-effects model. Results: Four trials were identified with a total of 505 patients (average age 66.4 ± 9.0 years; 87.7% were male). Preventive ablation was associated with a significant reduction in appropriate device therapies (shocks and/or anti-tachycardia therapy) (HR = 0.62; 95% CI = 0.46-0.82; P <.01), sustained VT (HR = 0.74; 95% CI = 0.55-0.99; P =.04) compared to control. There were no differences in inappropriate device shocks (HR = 0.80; 95% CI = 0.38-1.71), all-cause death (HR = 0.93; 95% CI = 0.53-1.64), cardiac death (HR = 0.63; 95% CI = 0.29-1.36), arrhythmic death (HR = 0.26; 95% CI = 0.05-1.31), or cardiac hospitalization (HR = 0.79; 95% CI = 0.57-1.11) between strategies. Preventive ablation was associated with improved SF-36 physical component (mean difference = 2.81; 95% CI-0.53-5.10; P =.02), but not the mental component (mean difference = 1.30; 95% CI = -2.06-4.66). Conclusion: Among patients with post-infarct cardiomyopathy and VT, preventive catheter ablation at the time of ICD implantation is associated with a significant reduction of appropriate ICD therapy and sustained VT, and improvement in the physical component of quality-of-life, but no reduction in mortality.
Original language | English (US) |
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Pages (from-to) | 171-175 |
Number of pages | 5 |
Journal | PACE - Pacing and Clinical Electrophysiology |
Volume | 44 |
Issue number | 1 |
DOIs | |
State | Published - Jan 2021 |
Keywords
- cardiomyopathy
- catheter ablation
- implantable cardioverter defibrillators
- meta-analysis
- myocardial infarction
- shocks
- ventricular tachyarrhythmias
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine