For patients with implantable cardioverter defibrillators (ICDs), catheter ablation and antiarrhythmic drug therapy appear to be on par for the prevention of shockable ventricular tachycardias, a meta-analysis found.
There was a similar reduction in appropriate ICD interventions following catheter ablation (odds ratio 0.45, 95% confidence interval 0.28-0.71) and antiarrhythmic drug treatment (OR 0.66, 95% CI 0.44-0.97) after more than a year of follow-up.
Of note, the benefit of antiarrhythmic drugs was driven by amiodarone (Cordarone) alone — with no impact of sotalol (Betapace, Sorine) or novel agents azimilide and celivarone — Pasquale Santangeli, MD, of the Hospital of the University of Pennsylvania in Philadelphia, and colleagues reported online in HeartRhythm.
In addition, a reduction of inappropriate ICD interventions was seen with medication (OR 0.30, 95% CI 0.14-0.62) but not with catheter ablation. Neither treatment was associated with decreased mortality over follow-up, while amiodarone was associated with greater risk of death (OR 3.36, 95% CI 1.36-8.30).
“The potential for harm associated with amiodarone use in patients with ICD and ventricular tachycardia is a new finding, and is particularly relevant in this context since amiodarone was the only agent convincingly associated with a reduction of ventricular tachycardia episodes in our pooled analysis,” the authors wrote.
Santangeli’s meta-analysis included eight randomized trials with a total of 2,268 participants evaluating antiarrhythmic drugs and six randomized trials with a total of 427 participants evaluating catheter ablation. Both sets of trials used standard medical therapy as the comparator to prevent ventricular tachycardia in patients with ICDs.
The study was funded in part by the Susan and Murray Bloom Research Fund.
The researchers reported no relevant relationships with industry.
Santangeli P, et al “Comparative effectiveness of antiarrhythmic drugs and catheter ablation for the prevention of recurrent ventricular tachycardia in patients with implantable cardioverter defibrillators: A systematic review and meta-analysis of randomized controlled trials” HeartRhythm 2016; DOI: 10.1016/j.hrthm.2016.03.004.