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First-line ablation of ventricular tachycardia in ischemic cardiomyopathy: stratification of outcomes by left ventricular function

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Abstract

Purpose

First-line catheter ablation of ventricular tachycardia/ventricular fibrillation (VT/VF) in patients with ischemic cardiomyopathy (ICM) has been associated with improved outcomes; however, most benefit seems to be in patients with moderately depressed left ventricular ejection fraction (LVEF). Herein, outcomes were stratified based on LVEF.

Methods

A meta-analysis of randomized controlled trials (RCTs) evaluating first-line ablation versus medical therapy in patients with VT and ICM was performed. Risk estimates and 95% confidence intervals (CI) were measured.

Results

Four RCTs with a total of 505 patients (mean age 66 ± 9 years, 89% male, 80% with previous revascularization) were included. Mean LVEF was 35 ± 8%. At a mean follow-up of 24 ± 9 months, a significant benefit in survival-free from appropriate implantable cardioverter-defibrillator (ICD) therapies was observed in all patients undergoing first-line catheter ablation compared with medical management (RR 0.70, 95% CI 0.56–0.86). In patients with moderately depressed LVEF (> 30–50%), first-line VT ablation was associated with a statistically significant reduction in the composite endpoint of survival free from VT/VF and appropriate ICD therapies (HR 0.52, 95% CI 0.36–0.76), whereas there was no difference in patients with severely depressed LVEF (≤30%) (HR 0.56, 95% CI 0.24–1.32). Funnel plots did not show asymmetry suggesting lack of bias.

Conclusions

Patients with ICM and VT undergoing first-line ablation have a significantly lower rate of appropriate ICD therapies without a mortality difference compared with patients receiving an initial approach based on medical therapy. The beneficial effect of a first-line ablation approach was only observed in patients with moderately depressed LVEF (> 30–50%).

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Data availability

Available upon request.

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Authors and Affiliations

  1. Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA

    David F. Briceño, Jorge Romero, Kavisha Patel, Wasla Liaqat, Xiao-Dong Zhang, Isabella Alviz, Ruike Yang, Daniel Rodriguez, Nicola Tarantino & Luigi Di Biase

  2. Division of Cardiology, Department of Medicine, Henan Provincial People’s Hospital, Zhengzhou, China

    Ruike Yang

  3. Kansas City Heart Rhythm Institute, Overland Park, KS, USA

    Dhanunjaya Lakkireddy & Rakesh Gopinathannair

  4. Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX, USA

    Domenico Della Rocca, Andrea Natale & Luigi Di Biase

Authors
  1. David F. Briceño
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  2. Jorge Romero
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  3. Kavisha Patel
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  4. Wasla Liaqat
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  8. Daniel Rodriguez
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  13. Andrea Natale
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  14. Luigi Di Biase
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Corresponding author

Correspondence to Luigi Di Biase.

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Conflict of interest

Dr. Di Biase is a consultant for Biosense Webster, Boston Scientific, and St. Jude Medical and has received speaker honoraria/travel from Medtronic, Atricure, EPiEP, and Biotronik. Dr. Natale is a consultant for Biosense Webster, Stereotaxis, and St. Jude Medical and has received speaker honoraria/travel from Medtronic, Atricure, EPiEP, Biotronik, and Janssen. The remaining authors report no conflict of interest.

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Briceño, D.F., Romero, J., Patel, K. et al. First-line ablation of ventricular tachycardia in ischemic cardiomyopathy: stratification of outcomes by left ventricular function. J Interv Card Electrophysiol 62, 391–400 (2021). https://doi.org/10.1007/s10840-020-00912-w

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  • DOI: https://doi.org/10.1007/s10840-020-00912-w

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