Reddy Rohin K, Howard James P, Ahmad Yousif, Shun-Shin Matthew J, Simader Florentina A, Miyazawa Alejandra A, Saleh Keenan, Naraen Akriti, Samways Jack W, Katritsis George, Mohal Jagdeep S, Kaza Nandita, Porter Bradley, Keene Daniel, Linton Nicholas Wf, Francis Darrel P, Whinnett Zachary I, Luther Vishal, Kanagaratnam Prapa, Arnold Ahran D
National Heart and Lung Institute, Imperial College London London, UK.
Section of Cardiovascular Medicine, Yale University New Haven, CT, US.
Arrhythm Electrophysiol Rev. 2023 Nov 22;12:e26. doi: 10.15420/aer.2023.07. eCollection 2023.
The prognostic impact of ventricular tachycardia (VT) catheter ablation is an important outstanding research question. We undertook a reconstructed individual patient data meta-analysis of randomised controlled trials comparing ablation to medical therapy in patients developing VT after MI.
We systematically identified all trials comparing catheter ablation to medical therapy in patients with VT and prior MI. The prespecified primary endpoint was reconstructed individual patient assessment of all-cause mortality. Prespecified secondary endpoints included trial-level assessment of all-cause mortality, VT recurrence or defibrillator shocks and all-cause hospitalisations. Prespecified subgroup analysis was performed for ablation approaches involving only substrate modification without VT activation mapping. Sensitivity analyses were performed depending on the proportion of patients with prior MI included.
Eight trials, recruiting a total of 874 patients, were included. Of these 874 patients, 430 were randomised to catheter ablation and 444 were randomised to medical therapy. Catheter ablation reduced all-cause mortality compared with medical therapy when synthesising individual patient data (HR 0.63; 95% CI [0.41-0.96]; p=0.03), but not in trial-level analysis (RR 0.91; 95% CI [0.67-1.23]; p=0.53; I=0%). Catheter ablation significantly reduced VT recurrence, defibrillator shocks and hospitalisations compared with medical therapy. Sensitivity analyses were consistent with the primary analyses.
In patients with postinfarct VT, catheter ablation reduces mortality.
室性心动过速（VT）导管消融的预后影响是一个重要的悬而未决的研究问题。我们对心肌梗死后发生VT的患者进行了一项重建个体患者数据的随机对照试验荟萃分析，比较消融与药物治疗。
我们系统地识别了所有比较VT患者和既往心肌梗死患者导管消融与药物治疗的试验。预先设定的主要终点是对全因死亡率进行重建个体患者评估。预先设定的次要终点包括全因死亡率、VT复发或除颤器电击以及全因住院的试验水平评估。对仅涉及基质改良而无VT激动标测的消融方法进行预先设定的亚组分析。根据纳入的既往心肌梗死患者比例进行敏感性分析。
纳入八项试验，共招募874名患者。在这874名患者中，430名被随机分配至导管消融组，444名被随机分配至药物治疗组。在综合个体患者数据时，导管消融与药物治疗相比降低了全因死亡率（HR 0.63；95%CI[0.41-0.96]；p=0.03），但在试验水平分析中未降低（RR 0.91；95%CI[0.67-1.23]；p=0.53；I=0%）。与药物治疗相比，导管消融显著降低了VT复发、除颤器电击和住院率。敏感性分析与主要分析结果一致。
在心肌梗死后VT患者中，导管消融可降低死亡率。
