Early vs. deferred catheter ablation of ventricular tachycardia in patients of ischaemic substrate: systematic review and meta-analysis of clinical outcomes
Notice bibliographique
Résumé
Abstract Aims 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 implantable cardioverter defibrillator implantation) or (deferred: after the patient has received ICD shocks) remains controversial. The objective is to conduct a systematic review and meta-analysis of published data from randomized controlled trials (RCTs) in patients with ischaemic cardiomyopathy (ICM) with the aim of comparing outcome of VT ablation stratified by procedural timing. Methods and results We conducted a meta-analysis of seven 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. Following a comprehensive search strategy, a total of seven 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 odds ratio (OR) of 0.72, 95% confidence interval (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) when compared with a deferred timing. The cumulative ARR for cardiac mortality was 0.07 and NNT was 15. Conclusion The findings from this pooled analysis of seven 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.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,007 | 0,003 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».