Serviço de Cardiologia, Departamento de Coração e Vasos, CHULN Hospital de Santa Maria, Av Prof. Egas Moniz, 1649-028, Lisbon, Portugal.
Cardiac Rhythm Abnormalities Unit, Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Av Prof. Egas Moniz, 1649-028, Lisbon, Portugal.
J Interv Card Electrophysiol. 2020 Dec;59(3):603-616. doi: 10.1007/s10840-020-00870-3. Epub 2020 Sep 19.
Ventricular tachycardia (VT) is a frequent cause of mortality and morbidity in patients with ischemic heart disease (IHD). We aim to perform a systematic review and meta-analysis of randomized controlled trials (RCT) of radiofrequency catheter ablation (RCA) of VT in patients with IHD and to discuss its appropriate timing and limitations.
Literature searches of MEDLINE, CENTRAL, the Cochrane Database of Systematic Reviews, Health Technology Assessment, and PsycINFO were performed in February 2020. RCTs comparing RCA vs conventional management for VT in patients with IHD and previous or planned implantable cardioverter defibrillator (ICD) were identified. Clinical outcomes included all-cause mortality, cardiovascular mortality, cardiovascular hospitalization, VT storm, recurrent VT/ventricular fibrillation (VF), appropriate ICD therapies, and appropriate ICD shocks. Using a random-effects model, relative risk (RR) and 95% confidence intervals (CI) were calculated for each outcome.
A total of 6 RCTs (N = 791) met inclusion criteria. RCA was associated with significantly lower VT storm (RR 0.70; CI 0.51 to 0.94, p = 0.02) and appropriate ICD therapies (RR 0.69; CI 0.54 to 0.88, p = 0.003), including appropriate ICD shocks (RR 0.66; CI 0.47 to 0.92, p = 0.02). There was no significant difference in all-cause or cardiovascular mortality, cardiovascular hospitalization, and recurrent VT/VF.
Radiofrequency catheter ablation for VT in patients with IHD was associated with a reduced risk of VT storm, ICD therapies, and ICD shocks. There is a need for future carefully designed RCTs that incorporate improved RCA procedural aspects.
室性心动过速（VT）是缺血性心脏病（IHD）患者死亡和发病的常见原因。我们旨在对 IHD 患者 VT 的射频导管消融（RCA）的随机对照试验（RCT）进行系统评价和荟萃分析，并讨论其适当的时机和局限性。
于 2020 年 2 月对 MEDLINE、CENTRAL、Cochrane 系统评价数据库、卫生技术评估和 PsycINFO 进行文献检索。确定了比较 RCA 与 IHD 患者 VT 的常规治疗的 RCT，这些患者既往或计划植入植入式心脏复律除颤器（ICD）。临床结局包括全因死亡率、心血管死亡率、心血管住院、VT 风暴、复发性 VT/室颤（VF）、适当的 ICD 治疗和适当的 ICD 电击。使用随机效应模型，计算每个结局的相对风险（RR）和 95%置信区间（CI）。
共有 6 项 RCT（N=791）符合纳入标准。RCA 与 VT 风暴显著降低相关（RR 0.70；CI 0.51 至 0.94，p=0.02）和适当的 ICD 治疗（RR 0.69；CI 0.54 至 0.88，p=0.003），包括适当的 ICD 电击（RR 0.66；CI 0.47 至 0.92，p=0.02）。全因死亡率、心血管死亡率、心血管住院和复发性 VT/VF 无显著差异。
射频导管消融治疗 IHD 患者的 VT 与降低 VT 风暴、ICD 治疗和 ICD 电击的风险有关。需要未来精心设计的 RCT，纳入改进的 RCA 程序方面。
