Catheter ablation of
ventricular tachycardia (VT) aims to treat the underlying
arrhythmia substrate to prevent ICD
therapies. The aim of this meta-analysis was to assess the safety and efficacy of VT ablation prior to or at the time of
secondary prevention ICD implantation in patients with
coronary artery disease, as compared with deferred VT ablation. Based on a systematic literature search, three randomised trials were considered eligible for inclusion in this analysis, and data on the number of patients with appropriate ICD shocks, appropriate ICD
therapy, arrhythmic storm, death and major complications were extracted from each study. On pooled analysis, there was a significant reduction of appropriate ICD shocks (OR 2.58; 95% CI [1.54-4.34]; p<0.001) and appropriate ICD
therapies (OR 2.04; 95% CI [1.15-3.61]; p=0.015) in patients undergoing VT ablation at the time of ICD implantation without significant differences with respect to complications (OR 1.39; 95% CI [0.43-4.51]; p=0.581). Mortality did not differ between both groups (OR 1.30; 95% CI [0.60-2.45]; p=0.422). Preventive
catheter ablation of VT in patients with
coronary heart disease at the time of
secondary prevention ICD implantation results in a significant reduction of appropriate ICD shocks and any appropriate ICD
therapy compared with patients without or with deferred VT ablation. No significant difference with respect to complications or mortality was observed between both treatment strategies.