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Background: Catheter ablation is recommended for patients with drug-refractory VT. We performed a meta-analysis combining all prospective randomized controlled trials to determine the magnitude of benefit from catheter ablation.
Methods: Systematic literature search was performed in MEDLINE, Pubmed, EMBASE, the Cochrane Central Register of Controlled Trials and Web of Science for published randomized controlled trials of patients undergoing VT ablation compared with medical therapy with and without AADs.
Results: Seven randomized trials (3 in abstract, 4 in manuscript form) including 686 patients (365 patients in the ablation group and 321 in the control group) were included (98% with post-infarction VT; EF 31±10%; 91% Male, mean follow up 20 months). Catheter ablation conferred reduction in risk of VT recurrence compared to medical therapy (P=0.0007; Figure 1). Procedural complications included pericardial bleeding (1%), transient or persistent conduction block (1%) and stroke or transient ischemic attack (0.008%). All-cause and cardiac-specific mortality did not differ (P=0.65, P=0.34 respectively).
Conclusions: Catheter ablation has a demonstrable benefit in reducing VT recurrence as compared with medical therapy (with or without AADs) in populations who almost exclusively have post-infarction VT. No overall mortality benefit is noted. Whether this benefit is seen in non-ischemic substrate remains unclear and needs further investigation.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Atrial Fibrillation and VT: Incorporating Novel Risks Toward Decision Making
Abstract Category: 8. Arrhythmias and Clinical EP: Supraventricular/Ventricular Arrhythmias
Presentation Number: 1280-100
- 2017 American College of Cardiology Foundation