Meta‐analysis of catheter ablation in patients with post‐infarct cardiomyopathy undergoing defibrillator implantation. Issue 1 (13th November 2020) - Kheiri, Babikir
Abstract: Background: Patients with post‐infarct cardiomyopathy and ventricular arrhythmias (VT) necessitating implantable cardioverter defibrillators (ICD) are at risk of recurrent shocks with increased morbidity. Methods: A comprehensive search of electronic databases for all randomized clinical trials that evaluated the role of catheter ablation as a preventive strategy at the time of secondary prevention ICD implantation was performed. We calculated hazard ratios (HR) and 95% confidence intervals (CI) using random‐effects model. Results: Four trials were identified with a total of 505 patients (average age 66.4 ± 9.0 years; 87.7% were male). Preventive ablation was associated with a significant reduction in appropriate device therapies (shocks and/or anti‐tachycardia therapy) (HR = 0.62; 95% CI = 0.46‐0.82; P < .01), sustained VT (HR = 0.74; 95% CI = 0.55‐0.99; P = .04) compared to control. There were no differences in inappropriate device shocks (HR = 0.80; 95% CI = 0.38‐1.71), all‐cause death (HR = 0.93; 95% CI = 0.53‐1.64), cardiac death (HR = 0.63; 95% CI = 0.29‐1.36), arrhythmic death (HR = 0.26; 95% CI = 0.05‐1.31), or cardiac hospitalization (HR = 0.79; 95% CI = 0.57‐1.11) between strategies. Preventive ablation was associated with improved SF‐36 physical component (mean difference = 2.81; 95% CI‐0.53‐5.10; P = .02), but not the mental component (mean difference = 1.30; 95% CI = ‐2.06‐4.66). Conclusion: Among patients with post‐infarct cardiomyopathy and VT, preventive catheter ablation at the time of ICD implantation is associated with a significant reduction of appropriate ICD therapy and sustained VT, and improvement in the physical component of quality‐of‐life, but no reduction in mortality.