Division of Cardiovascular Medicine, Henry Ford Health System, Detroit, MI, United States.
Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, United States; Division of Cardiovascular Medicine, Ain Shams University, Cairo, Egypt.
Int J Cardiol. 2018 Sep 15;267:107-113. doi: 10.1016/j.ijcard.2018.03.127. Epub 2018 Apr 8.
Current ventricular tachycardia (VT) management in patients with ischemic cardiomyopathy (ICM) includes optimal medical therapy, ICDs device therapy, and antiarrhythmic medications. Data about outcomes of catheter ablation (CA) in these patients is scarce. We aimed to perform a meta-analysis of RCTs to compare outcomes of CA vs conventional management of VT in ICM patients who had ICD.
A systematic review and meta-analysis of published RCTs between January 1970 and December 2016 were performed. Random effects DerSimonian-Laird risk ratios (RR) were calculated. Sensitivity analyses using fixed-effects summary odds ratios (OR) were performed using Peto model. Outcomes of interest were: all-cause mortality (ACM), cardiovascular death (CVD), CV disease-related hospitalization, VT storms, and ICD shocks.
4 RCTs were identified (521 patients (261 had CA), mean age: 66.4 ± 1.7 years, 91.5% male, mean follow-up: 19 months). No difference observed between VT ablation and conventional management regarding ACM (RR 0.94, 95% CI, 0.66-1.32, p = 0.70) or CVD (RR 0.82, 95% CI, 0.52-1.29, p = 0.39). VT ablation was associated with less CV disease-related hospitalization (RR 0.72, 95% CI, 0.54-0.96, p = 0.02), VT storms (RR 0.71, 95% CI, 0.52-0.97, p = 0.03), and trend towards reducing ICD shocks (RR 0.59, 95% CI, 0.34-1.05, p = 0.07). In sensitivity analysis using fixed-effects OR, CA was associated with significant reduction in ICD shocks.
In patients with ICM, VT ablation reduced CV disease-related hospitalization, VT storms, and ICD shocks when compared to conventional management with no mortality benefit over a relatively short mean follow-up period.
目前，缺血性心肌病（ICM）患者的室性心动过速（VT）管理包括最佳药物治疗、ICD 设备治疗和抗心律失常药物治疗。关于这些患者导管消融（CA）结果的数据很少。我们旨在对 RCT 进行荟萃分析，以比较在有 ICD 的 ICM 患者中，CA 与 VT 的常规治疗结果。
对 1970 年 1 月至 2016 年 12 月发表的 RCT 进行了系统回顾和荟萃分析。使用随机效应 DerSimonian-Laird 风险比（RR）进行计算。使用 Peto 模型进行固定效应汇总优势比（OR）的敏感性分析。主要观察终点为全因死亡率（ACM）、心血管死亡率（CVD）、与 CV 疾病相关的住院治疗、VT 风暴和 ICD 电击。
确定了 4 项 RCT（521 例患者（261 例接受 CA），平均年龄 66.4±1.7 岁，91.5%为男性，平均随访时间 19 个月）。与常规治疗相比，VT 消融在 ACM（RR 0.94，95%CI，0.66-1.32，p=0.70）或 CVD（RR 0.82，95%CI，0.52-1.29，p=0.39）方面无差异。VT 消融与与 CV 疾病相关的住院治疗（RR 0.72，95%CI，0.54-0.96，p=0.02）、VT 风暴（RR 0.71，95%CI，0.52-0.97，p=0.03）减少相关，并且趋势表明可减少 ICD 电击（RR 0.59，95%CI，0.34-1.05，p=0.07）。在使用固定效应 OR 的敏感性分析中，CA 与 ICD 电击显著减少相关。
在 ICM 患者中，与常规治疗相比，VT 消融可减少与 CV 疾病相关的住院治疗、VT 风暴和 ICD 电击，但在相对较短的平均随访期间没有死亡率获益。
