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Journal of Geriatric Cardiology : JGC Nov 2020Catheter ablation for ventricular tachycardia (VT) in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) has significantly evolved over the past...
BACKGROUND
Catheter ablation for ventricular tachycardia (VT) in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) has significantly evolved over the past decade. However, different ablation strategies showed inconsistency in acute and long-term outcomes.
METHODS
We searched the databases of Medline, Embase and Cochrane Library through October 17, 2019 for studies describing the clinical outcomes of VT ablation in ARVC. Data including VT recurrence, all-cause mortality, acute procedural efficacy and major procedural complications were extracted. A meta-analysis with trial sequential analysis was further performed in comparative studies of endo-epicardial versus endocardial-only ablation.
RESULTS
A total of 24 studies with 717 participants were enrolled. The literatures of epicardial ablation were mainly published after 2010 with total ICD implantation of 73.7%, acute efficacy of 89.8%, major complication of 5.2%, follow-up of 28.9 months, VT freedom of 75.3%, all-cause mortality of 1.1% and heart transplantation of 0.6%. Meta-analysis of 10 comparative studies revealed that compared with endocardial-only approach, epicardial ablation significantly decreased VT recurrence (OR: 0.50; 95% CI: 0.30-0.85; = 0.010), but somehow increased major procedural complications (OR: 4.64; 95% CI: 1.28-16.92; = 0.02), with not evident improvement of acute efficacy (OR: 2.74; 95% CI: 0.98-7.65; = 0.051) or all-cause mortality (OR: 0.87; 95% CI: 0.09-8.31; = 0.90).
CONCLUSION
Catheter ablation for VT in ARVC is feasible and effective. Epicardial ablation is associated with better long-term VT freedom, but with more major complications and unremarkable survival or acute efficacy benefit.
PubMed: 33343648
DOI: 10.11909/j.issn.1671-5411.2020.11.001 -
Journal of Interventional Cardiac... Jan 2022Catheter ablation of ventricular tachycardia (VT) is associated with potential major complications, including mortality. The risk of acute complications in patients with...
BACKGROUND
Catheter ablation of ventricular tachycardia (VT) is associated with potential major complications, including mortality. The risk of acute complications in patients with ischaemic cardiomyopathy (ICM) and non-ischaemic cardiomyopathy (NICM) has not been systematically evaluated.
METHODS
PubMed was searched for studies of catheter ablation of VT published between September 2009 and September 2019. Pre-specified primary outcomes were (1) rate of major acute complications, including death, and (2) mortality rate.
RESULTS
A total of 7395 references were evaluated for relevance. From this, 50 studies with a total of 3833 patients undergoing 4319 VT ablation procedures fulfilled the inclusion criteria (mean age 59 years; male 82%; 2363 [62%] ICM; 1470 [38%] NICM). The overall major complication rate in ICM cohorts was 9.4% (95% CI, 8.1-10.7) and NICM cohorts was 7.1% (95% CI, 6.0-8.3). Reported complication rates were highly variable between studies (ICM I = 90%; NICM I = 89%). Vascular complications (ICM 2.5% [95% CI, 1.9-3.1]; NICM 1.2% [95% CI, 0.7-1.7]) and cerebrovascular events (ICM 0.5% [95% CI, 0.2-0.7]; NICM, 0.1% [95% CI, 0-0.2]) were significantly higher in ICM cohorts. Acute mortality rates in the ICM and NICM cohorts were low (ICM 0.9% [95% CI, 0.5-1.3]; NICM 0.6% [95% CI, 0.3-1.0]) with the majority of overall deaths (ICM 75%; NICM 80%) due to either recurrent VT or cardiogenic shock.
CONCLUSION
Overall acute complication rates of VT ablation are comparable between ICM and NICM patients. However, the pattern and predictors of complications vary depending on the underlying cardiomyopathy.
Topics: Cardiomyopathies; Catheter Ablation; Humans; Male; Middle Aged; Myocardial Ischemia; Tachycardia, Ventricular
PubMed: 33512605
DOI: 10.1007/s10840-021-00948-6 -
Cureus Dec 2021The presence of mitral valve prolapse (MVP) varies from asymptomatic to life-threatening arrhythmias. Catheter ablation (CA) is widely used to treat ventricular... (Review)
Review
The presence of mitral valve prolapse (MVP) varies from asymptomatic to life-threatening arrhythmias. Catheter ablation (CA) is widely used to treat ventricular arrhythmias (VAs) associated with MVP. Despite having high procedural success, outcome data after CA is limited, especially in a long-term setting. Therefore, this systematic review and meta-analysis were performed. Literature searching was conducted in Pubmed, EuropePMC, Proquest, and Ebsco from inception to December 2020 using keywords: ventricular arrhythmia, premature ventricular complex, ventricular tachycardia, ventricular fibrillation, mitral valve prolapse, and catheter ablation. A total of 407 potential articles were retrieved for further review. The final review resulted in six articles for systematic review and meta-analysis. The study was registered in PROSPERO (CRD42020219144). The most common origin of VAs was papillary muscle. The acute success rate of CA in the MVP group varies between 66% and 94%. Follow-up studies reported a higher percentage of VAs recurrence after CA in the MVP group (22.22%) compared with the non-MVP group (11.38%). However, the difference is not significant (P-value = 0.16). Other studies reported a 12.5%-36% rate and 40% of repeat ablation in the medium term and the long term, respectively. Episodes of sudden cardiac death during exertion could still occur following CA in patients with MVP. Distinct origin of VAs was observed during repeated ablation procedures, which may explain arrhythmic substrate progression. Diffuse left ventricular fibrosis around papillary muscle rather than local fibrosis was observed among older patients. Furthermore, the presence of mitral annular disjunction (MAD) and Filamin C mutation might increase the risk of recurrent VAs. CAn has been done as the treatment of VAs associated with MVP. The acute success rate of CA varies between studies and the number of patients requiring repeat CA varied from 12.5% to 40%. Sudden cardiac death could still occur after CA. Older age during CA, genetic predisposition, deep arrhythmic foci, multifocal VAs origin, diffuse fibrosis, and the presence of MAD may contribute to the recurrence of VAs. Further studies, stratification, and evaluation are needed to prevent fatal outcomes in VA associated with MVP, even after CA.
PubMed: 35024259
DOI: 10.7759/cureus.20310 -
Frontiers in Cardiovascular Medicine 2022To perform a systematic review and meta-analysis of available trials regarding the outcomes of ventricular tachycardia (VT) ablation in patients with non-ischemic...
OBJECTIVE
To perform a systematic review and meta-analysis of available trials regarding the outcomes of ventricular tachycardia (VT) ablation in patients with non-ischemic dilated cardiomyopathy (NIDCM).
METHODS
A comprehensive database search of large four electronic databases, including PubMed, Cochrane, Scopus, and Institute for Scientific Information network meta-analysis, identified five studies enrolling 666 patients for patients with idiopathic dilated cardiomyopathy (IDCM) underwent catheter ablation (CA) for VT. The short-term outcomes assessed included procedural success, VT non-inducibility and procedural complications, whereas the long-term outcomes assessed included VT recurrence, heart transplantation, antiarrhythmic drugs (AAD) use after ablation and death.
RESULTS
A total of 5 observational studies reported outcomes in 666 patients with NIDCM undergoing VT CA. The complete procedural success was moderately high; 65.5% of the patients (95% CI 0.402- 0.857, < 0.001) and the procedural complications occurred in 5.8% of the patients (95% CI 0.040-0.076, = 0.685). Epicardial mapping and ablation were performed among 61.5% and 37% of patients with NIDCM respectively. During a follow up period of 12 to 45 months, there were VT recurrence in 34.2% of the patients (95% CI 0.301-0.465, < 0.080), death in 20.2% of the patients (95% CI 0.059-0.283, < 0.017) and heart transplantation in 12.9% of the patients (95% CI -0.026-0.245, < 0.012).
CONCLUSION
Ventricular tachycardia CA is effective and safe approach for management of patients with NIDCM with the epicardial approach to be considered as initial strategy especially in presence of ECG and CMR findings suggestive of epicardial substrate. A multicenter randomized trial is crucial to look at the short- and long-term outcomes of VT ablation in NIDCM especially with the advances in mapping and ablation techniques and predictors of success.
PubMed: 36440030
DOI: 10.3389/fcvm.2022.1007392 -
Journal of Interventional Cardiac... Jun 2012Remote magnetic navigation (RMN) is considered to be a solution for mapping and ablation of several arrhythmias. In this systematic review we aimed to assess the safety... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Remote magnetic navigation (RMN) is considered to be a solution for mapping and ablation of several arrhythmias. In this systematic review we aimed to assess the safety and efficacy of RMN in ablation of ventricular tachycardia (VT).
METHODS
The National Library of Medicine's PubMed database was searched for articles containing any of a predetermined set of search terms that were published prior to November 1, 2011. Quality of evidence was rated using the GRADE system.
RESULTS
The database search resulted in 11 relevant articles evaluating the usefulness of RMN. Three groups of VTs were studied: VT in patients with ischemic cardiomyopathy (ICMP), non-ischemic cardiomyopathy (NICMP) and structurally normal hearts (SNH). The use of RMN in patients with ICMP has been associated with success rates ranging from 71 to 80%. RMN has been shown to be a feasible and effective method for ablation of VT in NICMP and SNH patients. Success rates between 50% and 100% have been reported in NICMP populations. Rates ranging from 86% to 100% have been reported for SNH patients. The lowest rates of arrhythmia recurrence are reported for SNH patients (0-17%). In ICMP and NICMP, recurrence rates of 0-30% and 14-50%, respectively, have been reported. One patient experienced total heart block, and one patient experienced a thromboembolic event after RMN catheter ablation procedures.
CONCLUSIONS
RMN has been shown to be an effective and safe method for ablation of VT in various patient populations with low recurrence and complication rates. However, more comparative and randomized studies are necessary, and therefore the true value of RMN for VT ablation remains still unknown.
Topics: Catheter Ablation; Humans; Imaging, Three-Dimensional; Prevalence; Robotics; Treatment Outcome; Ventricular Fibrillation
PubMed: 22180126
DOI: 10.1007/s10840-011-9645-2 -
Heart Rhythm O2 Dec 2022Sex differences have diversely affected cardiac diseases. Little is known whether these differences impact outcomes of catheter ablation of ventricular tachycardia (VT).
BACKGROUND
Sex differences have diversely affected cardiac diseases. Little is known whether these differences impact outcomes of catheter ablation of ventricular tachycardia (VT).
OBJECTIVES
To assess the impact of sex differences on outcomes of catheter ablation of VT.
METHODS
Databases were searched from inception through December 2021. Effect estimates from individual studies were extracted and combined using the random-effects, generic inverse variance method of DerSimonian and Laird. The outcomes of interest included VT recurrence rates, all-cause mortality, and composite outcomes of mortality, left ventricular assistant device use, and heart transplantation following VT ablation.
RESULTS
Our analysis included 22 observational studies. There were 10,206 patients, of which 12.8% were women. We found no statistical difference between sexes for VT recurrence rate (pooled hazard ratio [HR] 1.04, .57, = 14.9%). Similarly, there was statistical difference in neither all-cause mortality nor composite outcomes (pooled HR 0.93, .75, = 59.1% and pooled HR 0.9, .33, = 0%, respectively). There was a trend toward an increase in women undergoing VT ablation in the recent registries ( .071).
CONCLUSION
Our contemporary analysis suggests that sex may have no impact on clinical outcomes of catheter ablation of VT in patients with structural heart disease, though women are the underrepresented. However, recent VT ablation registries have involved more women in their studies. Future studies with a higher proportion of women are encouraged to verify the current perception.
PubMed: 36588991
DOI: 10.1016/j.hroo.2022.09.009 -
Journal of Interventional Cardiac... Sep 2021Although implantable cardioverter defibrillator (ICD) could prevent the sudden death of ventricular tachycardia (VT) in patients with ischemic heart disease, it could... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
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.
METHODS
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.
RESULTS
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).
CONCLUSION
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.
Topics: Catheter Ablation; Defibrillators, Implantable; Humans; Myocardial Ischemia; Tachycardia, Ventricular; Treatment Outcome
PubMed: 33723693
DOI: 10.1007/s10840-020-00848-1 -
Frontiers in Cardiovascular Medicine 2022Catheter ablation (CA) for ventricular tachycardia (VT) can improve outcomes in patients with ischemic cardiomyopathy. Data on patients with non-ischemic cardiomyopathy...
Outcomes of early catheter ablation for ventricular tachycardia in adult patients with structural heart disease and implantable cardioverter-defibrillator: An updated systematic review and meta-analysis of randomized trials.
AIMS
Catheter ablation (CA) for ventricular tachycardia (VT) can improve outcomes in patients with ischemic cardiomyopathy. Data on patients with non-ischemic cardiomyopathy are scarce. The purpose of this systematic review and meta-analysis is to compare early CA for VT to deferred or no ablation in patients with ischemic or non-ischemic cardiomyopathy.
METHODS AND RESULTS
Studies were selected according to the following PICOS criteria: patients with structural heart disease and an implantable cardioverter-defibrillator (ICD) for VT, regardless of the antiarrhythmic drug treatment; intervention-early CA; comparison-no or deferred CA; outcomes-any appropriate ICD therapy, appropriate ICD shocks, all-cause mortality, VT storm, cardiovascular mortality, cardiovascular hospitalizations, complications, quality of life; published randomized trials with follow-up ≥12 months. Random-effect meta-analysis was performed. Outcomes were assessed using aggregate study-level data and reported as odds ratio (OR) or mean difference with 95% confidence intervals (CIs). Stratification by left ventricular ejection fraction (LVEF) was also done. Eight trials ( = 1,076) met the criteria. Early ablation was associated with reduced incidence of ICD therapy (OR 0.53, 95% CI 0.33-0.83, = 0.005), shocks (OR 0.52, 95% CI 0.35-0.77, = 0.001), VT storm (OR 0.58, 95% CI 0.39-0.85, = 0.006), and cardiovascular hospitalizations (OR 0.67, 95% CI 0.49-0.92, = 0.01). All-cause and cardiovascular mortality, complications, and quality of life were not different. Stratification by LVEF showed a reduction of ICD therapy only with higher EF (high EF OR 0.40, 95% CI 0.20-0.80, = 0.01 vs. low EF OR 0.62, 95% CI 0.34-1.12, = 0.11), while ICD shocks (high EF OR 0.54, 95% CI 0.25-1.15, = 0.11 vs. low EF OR 0.50, 95% CI 0.30-0.83, = 0.008) and hospitalizations (high EF OR 0.95, 95% CI 0.58-1.58, = 0.85 vs. low EF OR 0.58, 95% CI 0.40-0.82, = 0.002) were reduced only in patients with lower EF.
CONCLUSION
Early CA for VT in patients with structural heart disease is associated with reduced incidence of ICD therapy and shocks, VT storm, and hospitalizations. There is no impact on mortality, complications, and quality of life. (The review protocol was registered with INPLASY on June 19, 2022, #202260080).
SYSTEMATIC REVIEW REGISTRATION
[https://inplasy.com/], identifier [202260080].
PubMed: 36531738
DOI: 10.3389/fcvm.2022.1063147 -
Indian Pacing and Electrophysiology... 2022This review aims to determine if patients who undergo atrial fibrillation (AF) ablation with heart failure with preserved ejection fraction (HFpEF) do better, or worse...
A comparison of clinical outcomes following atrial fibrillation ablation for heart failure patients with preserved or reduced left ventricular function: A systematic review and meta-analysis.
BACKGROUND
This review aims to determine if patients who undergo atrial fibrillation (AF) ablation with heart failure with preserved ejection fraction (HFpEF) do better, or worse or the same compared to patients with heart failure with reduced ejection fraction (HFrEF).
METHODS
A search of MEDLINE and EMBASE was performed using the search terms: "atrial fibrillation", "ablation" and terms related to HFpEF and HFrEF in order to identify studies that evaluated one or more of i) AF recurrence, ii) periprocedural complications and iii) adverse outcomes at follow up for patients with HFpEF and HFrEF who underwent AF ablation. Data was extracted from included studies and statistically pooled to evaluate adverse events and AF recurrence.
RESULTS
5 studies were included in this review and the sample size of the studies ranged from 91 to 521 patients with heart failure. There was no significant difference in the pooled rate for no AF or symptom recurrence after AF ablation comparing patients with HFpEF vs HFrEF (RR 1.07 95%CI 0.86-1.33, p = 0.15). The most common complications were access site complications/haematoma/bleeding which occurred in similar proportion in each group; HFpEF (3.1%) and HFrEF (3.1%). In terms of repeat ablations, two studies were pooled to yield a rate of 78/455 (17.1%) for HFpEF vs 24/279 (8.6%) for HFrEF (p = 0.001.
CONCLUSIONS
Heart failure patients with preserved or reduced ejection fraction have similar risk of AF or symptom recurrence after AF ablation but two studies suggest that patients with HFpEF are more likely to have repeat ablations.
PubMed: 34624479
DOI: 10.1016/j.ipej.2021.09.002 -
American Heart Journal Plus :... Dec 2022Hypertrophic cardiomyopathy (HCM) is a genetic disease that can cause left ventricular outflow tract (LVOT) obstruction. This study analyzed the efficacy of... (Review)
Review
STUDY OBJECTIVE
Hypertrophic cardiomyopathy (HCM) is a genetic disease that can cause left ventricular outflow tract (LVOT) obstruction. This study analyzed the efficacy of radiofrequency ablation (RA) in improving clinical and hemodynamic factors in patients receiving obstructive HCM refractory treatment. This evaluation was necessary because of the small number of studies on the effectiveness of this technique for obstructive HCM in the existing literature.
DESIGN
We used the PubMed, Embase, and Science Direct databases to identify randomized clinical trials and observational studies addressing the clinical and hemodynamic outcomes before and after RA in patients with HCM.
PARTICIPANTS
We selected six articles published between 2011 and 2022, comprising 304 patients (mean age: 45 years).
INTERVENTIONS
We performed a bias assessment using the ROBINS I tool, and meta-analysis processing was performed using the STATA program (v.16.0).
RESULTS
The left ventricular outflow tract (LVOT) gradient at rest and with stimulation decreased by 58.78 mmHg ( = 0.001) and 70.38 mmHg (total effect Z = 21.62; < 0.0001), respectively. Additionally, the New York Heart Association (NYHA) functional class decreased by 0.43 ( = 0.001), indicating symptomatic and hemodynamic improvements. Furthermore, we observed a significant reduction in septal thickness (by 4 mm; = 0.001).
CONCLUSIONS
RA improved the NYHA functional class and LVOT gradient at rest and with stimulation and reduced septal thickness. These results suggest that RA is effective in patients refractory to pharmacological therapy and unsuitable for alcohol septal ablation or myectomy. However, more studies, including randomized clinical trials, should be conducted to define the role of RA in interventional therapies.
PubMed: 38560638
DOI: 10.1016/j.ahjo.2022.100229