Introduction:
Randomized controlled trials (RCTs) have shown improved outcomes in patients undergoing first-line catheter ablation of ventricular tachycardia/ventricular fibrillation (VT/VF) in patients with ischemic cardiomyopathy (ICM). Nonetheless, the impact of Left ventricular ejection fraction (LVEF) on the outcomes after catheter ablation (CA) have not been studied.
Hypothesis:
LVEF has a strong impact on the outcome after CA for VT in patients with ICM.
Methods:
RCTs evaluating first-line ablation versus medical therapy in patients with VT and ICM were included. Risk estimates and 95% confidence intervals (CI) were measured.
Results:
Four RCTs with a total of 505 patients (mean age 66 ± 9 years, 89% male, 80% with previous revascularization) were included. Mean LVEF was 35 ± 8%. At a mean follow-up of 24 ± 9 months, a significant benefit in survival-free from appropriate ICD therapies was observed in all patients undergoing first-line catheter ablation compared to medical management (RR 0.70, 95% CI 0.56-0.86). In patients with moderately depressed LVEF (>30-50%), first line VT ablation was associated with a statistically significant reduction in the composite endpoint of survival-free VT/VF and appropriate ICD therapies (HR: 0.52, 95% CI: 0.36-0.76), whereas there was no difference in patients with severely depressed LVEF (</=30%) (HR: 0.56, 95% CI: 0.24-1.32). Funnel plots did not show asymmetry suggesting lack of bias.
Conclusions:
Patients with ICM and VT undergoing first-line ablation have a significant lower rate of appropriate ICD therapies without a mortality difference compared to patients receiving an initial approach based on medical therapy. The beneficial effect was only observed in patients with moderately depressed LVEF (>30-50%).
Persistent ventricular dysrhythmia follow in general anesthesia for tonsillectomy
