Meta-Analysis Comparing Outcomes of Catheter Ablation for Ventricular Arrhythmia in Ischemic Versus Nonischemic Cardiomyopathy

Authors

Indranill Basu-Ray
Dibbendhu Khanra
Sumit K Shah
Anindya Mukherjee
Sudhanva V Char
Bhavna Jain
T Jared Bunch
Michael Gold
Adedayo A Adeboye
Mohammad Saeed

Publication Date

1-1-2021

Journal

Pacing and Clinical Electrophysiology

DOI

10.1111/pace.14129

PMID

33216394

PMCID

PMC7984079

PubMedCentral® Posted Date

11-30-2020

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

Cardiomyopathies, Catheter Ablation, Humans, Myocardial Ischemia, Tachycardia, Ventricular

Abstract

BACKGROUND: Catheter ablation is an effective treatment for ventricular arrhythmia (VA) in ischemic cardiomyopathy (ICM). However, results in non-ICM (NICM) patients are not satisfactory, and studies comparing differences between NICM and ICM are limited. We conducted a meta-analysis of procedural characteristics and long-term outcomes of catheter ablation for VA, comparing results between ICM and NICM.

METHODS: Studies in the PubMed, EMBASE, and Cochrane databases were systematically reviewed. Four studies reporting comparison of catheter ablation of VA between ICM and NICM were examined. The Newcastle-Ottawa Scale was used to appraise study quality. A random-effects model with inverse variance method was used for comparisons.

RESULTS: Epicardial approach was significantly more undertaken for the NICM group than in the ICM group (odds ratio [OR]: 0.13; 95% confidence interval [CI]: 0.09-0.18; P < .00001). Mean ablation time (P = .54), fluoroscopy time (P = .55), and procedural time (P = .18) did not differ significantly between the ICM and NICM groups. Procedural failure rates (OR: 0.46; 95% CI: 0.24-0.89; P = .02) and VA recurrence rates (risk ratio [RR]: 0.68; 95% CI: 0.46-1.01; P = .06) were significantly higher in the NICM group than in the ICM group. However, all-cause mortality (RR: 1.37; 95% CI: 0.75-2.49; P = .31) did not differ significantly between groups.

CONCLUSIONS: Procedural failure and VA recurrence rates were significantly higher in the NICM group, despite significantly more frequent epicardial access. These highlight the limitations of catheter ablation for VA in NICM, given our current knowledge.

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