Catheter Ablation for Ventricular Tachycardia After MI: A Reconstructed Individual Patient Data Meta-analysis of Randomised Controlled Trials.

Autor:	Reddy RK; National Heart and Lung Institute, Imperial College London London, UK., Howard JP; National Heart and Lung Institute, Imperial College London London, UK., Ahmad Y; Section of Cardiovascular Medicine, Yale University New Haven, CT, US., Shun-Shin MJ; National Heart and Lung Institute, Imperial College London London, UK., Simader FA; National Heart and Lung Institute, Imperial College London London, UK., Miyazawa AA; National Heart and Lung Institute, Imperial College London London, UK., Saleh K; National Heart and Lung Institute, Imperial College London London, UK., Naraen A; National Heart and Lung Institute, Imperial College London London, UK., Samways JW; National Heart and Lung Institute, Imperial College London London, UK., Katritsis G; National Heart and Lung Institute, Imperial College London London, UK., Mohal JS; National Heart and Lung Institute, Imperial College London London, UK., Kaza N; National Heart and Lung Institute, Imperial College London London, UK., Porter B; National Heart and Lung Institute, Imperial College London London, UK., Keene D; National Heart and Lung Institute, Imperial College London London, UK., Linton NW; Biomedical Engineering Department, Imperial College London London, UK., Francis DP; National Heart and Lung Institute, Imperial College London London, UK., Whinnett ZI; National Heart and Lung Institute, Imperial College London London, UK., Luther V; National Heart and Lung Institute, Imperial College London London, UK., Kanagaratnam P; National Heart and Lung Institute, Imperial College London London, UK., Arnold AD; National Heart and Lung Institute, Imperial College London London, UK.
Jazyk:	angličtina
Zdroj:	Arrhythmia & electrophysiology review [Arrhythm Electrophysiol Rev] 2023 Nov 22; Vol. 12, pp. e26. Date of Electronic Publication: 2023 Nov 22 (Print Publication: 2023).
DOI:	10.15420/aer.2023.07
Abstrakt:	Background: 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. Methods: 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. Results: 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 2 =0%). Catheter ablation significantly reduced VT recurrence, defibrillator shocks and hospitalisations compared with medical therapy. Sensitivity analyses were consistent with the primary analyses. Conclusion: In patients with postinfarct VT, catheter ablation reduces mortality. Competing Interests: Disclosures: PK is on the editorial board of Arrhythmia & Electrophysiology Review; this did not influence peer review. All other authors have no conflicts of interest to declare. Author contributions: Conceptualisation: RKR, JPH, ADA, ZIW; data curation: FAS, AAM, AN, JWS, JSM, NK, BP, DK, NWFL; formal analysis: RKR, JPH, MJSS; funding acquisition: ADA; investigation: RKR, JPH, YA, MJSS, DPF, ZIW, VL, PK, ADA; methodology: RKR, JPH, YA, MJSS, ADA; project administration: RKR, ADA; resources: FAS, AAM, AN, JWS, JSM, NK, BP, DK, NWFL; software: RKR, JPH, MJSS; supervision: ADA, PK, VL, ZIW, DPF, NWFL, DK, BP; validation: ADA; visualisation: RKR, JPH, MJSS; writing – original draft preparation: RKR, ADA; writing – review and editing: JPH, YA, MJSS, FAS, AAM, KS, AN, JWS, JSM, NK, BP, DK, NWFL, DPF, ZIW, ZL, PK. (Copyright © The Author(s), 2023. Published by Radcliffe Group Ltd.)
Databáze:	MEDLINE
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