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Prophylactic Catheter Ablation of Ventricular Tachycardia in Ischemic Cardiomyopathy: a systematic review and meta-analysis of randomized controlled trials. Electrophysiology Collaborative Consortium for Metaanalysis – ELECTRAM Investigators

Aims: Catheter ablation is an effective strategy for drug-refractory ventricular tachycardia (VT) in ischemic cardiomyopathy. We aimed to perform a systematic review and meta-analysis of outcomes of prophylactic catheter ablation (PCA) of Ventricular Tachycardia (VT) in ischemic cardiomyopathy patients Methods We performed a comprehensive literature search through February 10, 2020,for all eligible randomized controlled trials that compared “PCA”versus“No PCA”for VT. Primary efficacy outcomes included - appropriate ICD therapy (composite of anti-tachycardia pacing and ICD shock),appropriate ICD shocks, electrical storm,cardiac mortality, and all-cause mortality.The primary safety outcome was any adverse events. Results. Four randomized controlled trials (N = 505) met inclusion criteria. Prophylactic catheter ablation was associated significant reduction in appropriate ICD therapies (RR 0.70; 95% CI 0.55 - 0.89, p = 0.004), appropriate ICD shocks (RR 0.57 95% CI 0.40 - 0.80, p = 0.001) with a trend towards reduced risk of electrical storm (RR 0.64; CI 0.39 - 1.05; p = 0.075) compared to “No PCA”. There was no significant difference incardiac mortality (RR 0.66, 95% CI 0.31 – 1.43, p = 0.29) and all-cause mortality (RR 0.98, 95% CI 0.52 – 1.82, p = 0.94) with similar adverse events (RR 1.46, 95% CI 0.73 – 2.95, p = 0.29) between two groups. Conclusion.Prophylactic catheter ablation in ischemic cardiomyopathy patients was associated with a lower risk of ICD therapies, including ICD shocks and VT storm with no difference in cardiac and all-cause mortality.

Credits: Kuldeep Shah MD,Mohit Turagam MD, Brijesh Patel DO FACC, Andrea Natale MD FHRS FACC FESC, Dhanunjaya Lakkireddy MD FACC FHRS, Jalaj Garg MD FACC FESC

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