Catheter Ablation versus Antiarrhythmic Drugs for Ventricular Tachycardia: A Systematic Review and Meta-Analysis
Abstract Body (Do not enter title and authors here): Background: Sustained ventricular tachycardia (VT) and fibrillation-related sudden cardiac death (SCD) account for nearly 450,000 deaths annually in the United States. Catheter ablation (CA) and antiarrhythmic drugs (AADs) are commonly used to manage VT recurrence; however, their comparative efficacy and safety remain uncertain.
Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing CA and AADs in patients with ischemic cardiomyopathy and implantable cardioverter-defibrillators (ICDs). PubMed, Embase, and Cochrane CENTRAL Library were searched up to February 15, 2025. Primary outcomes included all-cause mortality, cardiovascular mortality, VT storm, and appropriate ICD shock. Secondary outcomes included inappropriate ICD shock, appropriate antitachycardia pacing (ATP), heart failure hospitalization, stroke/transient ischemic attack (TIA), and myocardial infarction (MI). Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using a random-effects model.
Results: Three RCTs encompassing 587 patients (287 CA, 300 AADs) were included. No significant differences were found between CA and AADs in all-cause mortality (RR 0.88, 95% CI: 0.63–1.22; p=0.43), cardiovascular mortality (RR 1.23, 95% CI: 0.77–1.98; p=0.39), VT storm (RR 0.76, 95% CI: 0.39–1.46; p=0.41), or appropriate ICD shock (RR 0.87, 95% CI: 0.69–1.10; p=0.24). Secondary outcomes, including inappropriate ICD shock, ATP, heart failure hospitalization, stroke/TIA, and MI, were also comparable between the two groups.
Conclusions: CA and AADs demonstrated comparable efficacy and safety in patients with VT. Larger high-quality trials are warranted to confirm these findings and further define the role of CA as a potential first-line therapy.
Patel, Palak
( New York Medical College
, Newark
, New Jersey
, United States
)
Shahid, Sufyan
( Khawaja Muhammad Safdar Medical College
, Sialkot
, Punjab
, Pakistan
)
Tabassum, Shehroze
( The Wright Center for GME
, Scranton
, Pennsylvania
, United States
)
Ali, Muhammad Abdullah
( Khyber Medical College, Peshawar
, Peshawar
, Pakistan
)
Ejaz, Zoya
( Allama Iqbal Medical College
, Lahore
, Pakistan
)
Iqbal, Minahil
( Allama Iqbal Medical College
, Lahore
, Pakistan
)
Jain, Hritvik
( AIIMS Jodhpur
, Jodhpur
, India
)
Khalid, Salman
( Oklahoma Heart Hospital
, Oklahoma
, Oklahoma
, United States
)
Author Disclosures:
Palak Patel:DO NOT have relevant financial relationships
| Sufyan Shahid:DO NOT have relevant financial relationships
| Shehroze Tabassum:DO NOT have relevant financial relationships
| Muhammad Abdullah Ali:DO NOT have relevant financial relationships
| Umama Alam:No Answer
| Zoya Ejaz:No Answer
| Minahil Iqbal:DO NOT have relevant financial relationships
| Hritvik Jain:DO NOT have relevant financial relationships
| Salman Khalid:No Answer
Rasool Muhammad Mujtaba, Cheema Shamikha, Murtaza Muhammad, Kamran Haneen, . Abdullah, Khan Misha, Majeed Uzair, Raza Muhammad Ahmed, Zaeem Muhammad, Ali Muhammad Abdullah, Alam Umama
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