# Outcomes of catheter ablation for ventricular tachycardia in structural heart disease: a meta-analysis and quality appraisal of trials

## TL;DR

Catheter ablation for ventricular tachycardia in patients with heart disease may not reduce overall mortality but can lower VT recurrence and hospitalizations.

## Contribution

A meta-analysis of RCTs clarifies the effectiveness of catheter ablation for ventricular tachycardia in structural heart disease.

## Key findings

- Catheter ablation significantly reduced cardiovascular hospitalizations and ventricular tachycardia recurrence.
- No significant reduction in all-cause or cardiovascular mortality was observed.
- Appropriate ICD therapy and VT storm incidence were also reduced with ablation.

## Abstract

Catheter ablation (CA) of ventricular tachycardia (VT) in patients with structural heart disease is usually reserved for those with recurrent implantable cardioverter defibrillator (ICD) shocks or intolerant to anti-arrhythmic drugs. This meta-analysis synthesizes available trial evidence on CA for VT to clarify the role of this approach.

MEDLINE, PubMed, EMBASE and Cochrane were searched for randomized controlled trials (RCTs) of patients with structural heart disease allocated to receive either CA or standard treatment. Outcomes of interest were: all-cause and cardiovascular (CV) mortality, VT recurrence, incidence of appropriate ICD therapy, CV hospitalizations and VT storm. Evidence was appraised using the risk of bias tool and the grading of recommendations assessment, development and evaluation (GRADE) approach. Trial-level pairwise meta-analyses were conducted for all outcomes. Reconstructed time-to-event data meta-analysis was also performed for all-cause mortality 13 RCTs (n = 1735 patients) were included in the meta-analysis with a follow-up duration of 6–52 months. No significant reduction in all-cause mortality was observed at trial level meta-analysis (risk ratio [RR] 0.87, 95% confidence interval [CI] 0.70–1.08, heterogeneity [I2] = 0%), or reconstructed individual patient data meta-analysis [hazard ratio (HR) 0.79, 95%CI 0.57–1.11 at 3 years]. However, our pooled estimates, observed effect size and GRADE assessments suggest a potential mortality reduction in the ablation group. Patients who underwent CA experienced a significant reduction in CV hospitalizations (RR 0.78, 95%CI 0.65–0.94, I2 = 41%), VT storm (RR 0.78, 95%CI 0.63–0.97; I2 = 5%), VT recurrence (RR 0.83, 95%CI 0.72–0.95, I2 = 21%), and appropriate ICD therapy (RR 0.74, 95%CI 0.61–0.89, I2 = 32.5%) compared to control groups.

A potential all-cause mortality reduction by catheter ablation requires further confirmation in a properly powered RCT. No reduction in cardiovascular mortality was found. VT recurrence, CV hospitalizations, VT storm and ICD therapy were all significantly reduced by catheter ablation in patients with structural heart disease.

We examined the effectiveness of catheter ablation (CA) for treating ventricular tachycardia (VT) in patients with structural heart disease, particularly those facing recurrent implantable cardioverter defibrillator shocks or unable to tolerate medications by analysing several randomized controlled trials. The findings suggest that while CA may not significantly reduce overall mortality, it can lead to fewer recurrences of VT and hospitalizations related to cardiovascular problems.

Graphical Abstract