Early vs. deferred catheter ablation of ventricular tachycardia in patients of ischemic substrate: systematic review and meta-analysis of clinical outcomes

Maan, Abhishek, Waseem, Maaz, Carter, Alex ORCID: 0000-0003-3793-407X, Vashishtha, Kirtivardhan, Dhanjal, Tarvinder, Koruth, Jacob and Heist, E Kevin (2025) Early vs. deferred catheter ablation of ventricular tachycardia in patients of ischemic substrate: systematic review and meta-analysis of clinical outcomes. European Heart Journal Open. ISSN 2752-4191 (In Press)

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Abstract

Background Ventricular tachycardia (VT) ablation has been shown to reduce the recurrence of VT episodes, but the timing of performing VT ablation (early; at the time of ICD implantation) or (deferred: after the patient has received ICD shocks), remains controversial. Objective To conduct a systematic review and meta-analysis of published data from randomized controlled trials (RCTs) in patients with ischemic cardiomyopathy (ICM) with the aim of comparing outcome of VT ablation stratified by procedural timing. Methods We conducted a meta-analysis of 7 landmark RCTs which included patients with ICM who were either at a high risk of VT or experienced VT/ICD shocks. The primary outcome of VT recurrence was compared according to the timing of performing VT ablation (early vs. deferred). In addition, we also compared the secondary outcome of cardiac mortality. Results Following a comprehensive search strategy, a total of 7 RCTs were included within the final analysis. Based on a pooled analysis, early VT ablation was associated with a significant reduction in the primary outcome (pooled OR of 0.72, 95% CI: 0.55-0.95, p< 0.05) in comparison with a “deferred VT ablation” strategy. The cumulative absolute risk-reduction (ARR) for the primary outcome was 0.21, and number needed to treat (NNT) to prevent the outcome of VT recurrence was 4.81. Furthermore, the effect size of early VT ablation compared to a deferred VT ablation approach was more pronounced in reduction of ICD shocks in the subgroup of patients with LVEF > 30% vs. those with LVEF < 30% (pooled OR of 0.65, 95% CI of 0.54-0.79, p = 0.01). For the secondary outcomes, we observed that an earlier timing of VT ablation was also associated with both a decrease in cardiac mortality (pooled OR of 0.59, 95% CI of 0.43-0.82) and in the subsequent risk of VT storm (pooled OR of 0.63, 95% CI of 0.51- 0.78) as compared to a deferred timing. The cumulative ARR for cardiac mortality was 0.07 and NNT was 15. Conclusions The findings from this pooled analysis of 7 major RCTs suggest that performing early VT ablation may be beneficial in reducing recurrent VT, ICD shocks and electrical storm and could also improve cardiac mortality. The benefit of performing early VT ablation was greater in patients with LVEF of > 30% amongst this ICM cohort.

Item Type:	Article
Additional Information:	© 2025 The Author(s)
Divisions:	Health Policy
Subjects:	R Medicine > RC Internal medicine
Date Deposited:	07 Jul 2025 13:09
Last Modified:	07 Jul 2025 13:09
URI:	http://eprints.lse.ac.uk/id/eprint/128659

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