Department of Cardiology; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China.
Chongqing Key Laboratory of Pediatrics, Chongqing, China.
J Interv Card Electrophysiol. 2021 Sep;61(3):435-443. doi: 10.1007/s10840-020-00848-1. Epub 2021 Mar 15.
Although implantable cardioverter defibrillator (ICD) could prevent the sudden death of ventricular tachycardia (VT) in patients with ischemic heart disease, it could not effectively prevent the recurrence of ventricular tachycardia. Several studies have suggested that catheter ablation may effectively decrease the incidence of ICD events, but relevant dates from randomized controlled trials were limited.
A systematic review and meta-analysis of randomized controlled trials were performed to evaluate the effect of catheter ablation for the prevention of VT in patients with ischemic heart disease. Random-effects model with inverse-variance weighting method was used to pool odds ratios. Egger method was performed to evaluate whether there was public bias in each outcome.
Four studies enrolling a total of 605 patients were included in the present meta-analysis. Compared with the control group (ICD ± AAD), catheter ablation could significantly reduce the incidence of ICD therapy (OR, 0.49; 95% CI, 0.28 ~ 0.87), ICD shock (OR, 0.50; 95% CI, 0.28 ~ 0.87), VT storm (OR, 0.60; 95% CI, 0.40 ~ 0.90), and cardiovascular-related hospitalization (OR, 0.66; 95% CI, 0.45 ~ 0.9). But there was no significant difference among the risk of all-cause mortality (OR, 0.89; 95% CI, 0.59 ~ 1.34), cardiovascular mortality (OR, 0.76; 95% CI, 0.44 ~ 1.30), and complication (OR, 0.89; 95% CI, 0.30 ~ 2.67).
These results showed that catheter ablation combined with ICD could reduce ICD therapy, ICD shock, and VT storm in patients with ischemic heart disease, but there was no improvement in all-cause mortality. Meanwhile, it also provided a basic guidance for the design of larger clinical randomized trials with longer follow-up in the future.
尽管植入式心脏复律除颤器（ICD）可预防缺血性心脏病患者室性心动过速（VT）的猝死，但不能有效预防 VT 的复发。几项研究表明，导管消融术可能有效降低 ICD 事件的发生率，但相关随机对照试验的数据有限。
对评估导管消融术预防缺血性心脏病患者 VT 的效果的随机对照试验进行系统评价和荟萃分析。采用逆方差加权法的随机效应模型来汇总优势比。采用 Egger 法评估每个结局是否存在发表偏倚。
本荟萃分析纳入了 4 项共纳入 605 例患者的研究。与对照组（ICD ± AAD）相比，导管消融术可显著降低 ICD 治疗（OR，0.49；95%CI，0.280.87）、ICD 电击（OR，0.50；95%CI，0.280.87）、VT 风暴（OR，0.60；95%CI，0.400.90）和心血管相关住院（OR，0.66；95%CI，0.450.9）的发生率。但全因死亡率（OR，0.89；95%CI，0.591.34）、心血管死亡率（OR，0.76；95%CI，0.441.30）和并发症发生率（OR，0.89；95%CI，0.30~2.67）之间无显著差异。
这些结果表明，导管消融术联合 ICD 可降低缺血性心脏病患者 ICD 治疗、ICD 电击和 VT 风暴的发生率，但不能改善全因死亡率。同时，这也为未来设计具有更长随访时间的更大规模的临床随机试验提供了基本指导。
