Prophylactic catheter ablation of ventricular tachycardia in ischemic cardiomyopathy: a systematic review and meta-analysis of randomized controlled trials

  • Varunsiri AttiEmail author
  • Venkat Vuddanda
  • Mohit K. Turagam
  • Praveen Vemula
  • Zubair Shah
  • Himakar Nagam
  • Srikanth Yandrapalli
  • Mohammad-Ali Jazayeri
  • Scott Koerber
  • Juan Viles Gonzalez
  • Andrea Natale
  • Luigi Di Biase
  • Dhanunjaya R. Lakkireddy



Catheter ablation is proven to be an effective strategy for drug refractory ventricular tachycardia (VT) in ischemic cardiomyopathy. However, the appropriate timing of VT ablation and identifying the group of patients that may receive the greatest benefit remains uncertain. There is limited data on the effect on prophylactic catheter ablation (PCA) in the prevention of implantable cardioverter defibrillator (ICD) therapy, electrical storm, and mortality.


We performed a comprehensive literature search through November 1, 2017, for all eligible studies comparing PCA + ICD versus ICD only in eligible patients with ischemic cardiomyopathy. Clinical outcomes included all ICD therapies including ICD shocks and electrical storm. Additional outcomes included all-cause mortality, cardiovascular mortality, and complications.


Three randomized controlled trials (RCTs) (N = 346) met inclusion criteria. PCA was associated with a significantly lower ICD therapies (OR 0.49; CI 0.28 to 0.87; p = 0.01) including ICD shocks [OR 0.38; CI 0.22 to 0.64; p = 0.0003) and electrical storm (OR 0.55; CI 0.30 to 1.01; p = 0.05) when compared with ICD only. There was no significant difference in all-cause mortality (OR 0.77; CI 0.41 to 1.46; p = 0.42), cardiovascular mortality (OR 0.49; CI 0.16 to 1.50; p = 0.21), and major adverse events (OR 1.45; CI 0.52 to 4.01; p = 0.47) between two groups.


These results suggest prophylactic catheter ablation decreases ICD therapies, including shocks and electrical storm with no improvement in overall mortality. There is a need for future carefully designed randomized clinical trials.


Ventricular tachycardia ablation ICD shock Electrical storm 



Prophylactic catheter ablation


Implantable cardiac defibrillator


Anti-arrhythmic drugs


Randomized controlled trial


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The manuscript has not been submitted or is under consideration elsewhere in any other journal. No data has been fabricated or manipulated. Consent to submit has been received explicitly from all co-authors.

Supplementary material

10840_2018_376_MOESM1_ESM.docx (28 kb)
ESM 1 (DOCX 27 kb)


  1. 1.
    Koplan BA, Stevenson WG. Ventricular tachycardia and sudden cardiac death. Mayo Clin Proc. 2009;84(3):289–97.CrossRefGoogle Scholar
  2. 2.
    MacIntyre CJ, Sapp JL. Treatment of persistent ventricular tachycardia: drugs or ablation? Trends Cardiovasc Med. 2017;27(7):506–13.CrossRefGoogle Scholar
  3. 3.
    Dunbar SB, Dougherty CM, Sears SF, et al. Educational and psychological interventions to improve outcomes for recipients of implantable cardioverter defibrillators and their families: a scientific statement from the American Heart Association. Circulation. 2012;126(17):2146–72.CrossRefGoogle Scholar
  4. 4.
    Antiarrhythmics versus Implantable Defibrillators (AVID) Investigators. A comparison of antiarrhythmic-drug therapy with implantable defibrillators in patients resuscitated from near-fatal ventricular arrhythmias. N Engl J Med. 1997;337(22):1576–83.CrossRefGoogle Scholar
  5. 5.
    Moss AJ, Zareba W, Hall WJ, et al. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction. N Engl J Med. 2002;346(12):877–83.CrossRefGoogle Scholar
  6. 6.
    Daubert JP, Zareba W, Cannom DS, et al. Inappropriate implantable cardioverter-defibrillator shocks in MADIT II: frequency, mechanisms, predictors, and survival impact. J Am Coll Cardiol. 2008;51(14):1357–65.CrossRefGoogle Scholar
  7. 7.
    Poole JE, Johnson GW, Hellkamp AS, et al. Prognostic importance of defibrillator shocks in patients with heart failure. N Engl J Med. 2008;359(10):1009–17.CrossRefGoogle Scholar
  8. 8.
    Connolly SJ, Dorian P, Roberts RS, et al. Comparison of beta-blockers, amiodarone plus beta-blockers, or sotalol for prevention of shocks from implantable cardioverter defibrillators: the OPTIC study: a randomized trial. JAMA. 2006;295(2):165–71.CrossRefGoogle Scholar
  9. 9.
    Aliot EM, Stevenson WG, Almendral-Garrote JM, et al. EHRA/HRS expert consensus on catheter ablation of ventricular arrhythmias: developed in a partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology (ESC), and the Heart Rhythm Society (HRS); in collaboration with the American College of Cardiology (ACC) and the American Heart Association (AHA). Europace. 2009;11(6):771–817.CrossRefGoogle Scholar
  10. 10.
    Pedersen CT, Kay GN, Kalman J, et al. EHRA/HRS/APHRS expert consensus on ventricular arrhythmias. Heart Rhythm. 2014;11(10):e166-e196.CrossRefGoogle Scholar
  11. 11.
    Liang JJ, Santangeli P, Callans DJ. Long-term outcomes of ventricular tachycardia ablation in different types of structural heart disease. Arrhythm Electrophysiol Rev. 2015;4(3):177–83.CrossRefGoogle Scholar
  12. 12.
    Dinov B, Arya A, Bertagnolli L, Schirripa - Circulation: … V, 2014. Early referral for ablation of scar-related ventricular tachycardia is associated with improved acute and long term outcomes: results from the heart center of …. Am Heart Assoc. 2014.
  13. 13.
    Frankel DS, Mountantonakis SE, Robinson MR, Zado ES, Callans DJ, Marchlinski FE. Ventricular tachycardia ablation remains treatment of last resort in structural heart disease: argument for earlier intervention. J Cardiovasc Electrophysiol. 2011;22(10):1123–8.CrossRefGoogle Scholar
  14. 14.
    Romero J, Di Biase L, Diaz JC, et al. Early versus late referral for catheter ablation of ventricular tachycardia in patients with structural heart disease: a systematic review and meta-analysis of clinical outcomes. JACC: Clin Electrophysiol. 2018;4(3):374–82.Google Scholar
  15. 15.
    Mukherjee RK, O’Neill L, O’Neill MD. Prophylactic catheter ablation for ventricular tachycardia: are we there yet? Arrhythm Electrophysiol Rev. 2017;6(3):125–8.CrossRefGoogle Scholar
  16. 16.
    Reddy VY, Reynolds MR, Neuzil P, et al. Prophylactic catheter ablation for the prevention of defibrillator therapy. N Engl J Med. 2007;357(26):2657–65.CrossRefGoogle Scholar
  17. 17.
    Kuck K-H, Schaumann A, Eckardt L, et al. Catheter ablation of stable ventricular tachycardia before defibrillator implantation in patients with coronary heart disease (VTACH): a multicentre randomised controlled trial. Lancet. 2010;375(9708):31–40.CrossRefGoogle Scholar
  18. 18.
    Kuck K-H, Tilz RR, Deneke T, et al. Impact of substrate modification by catheter ablation on implantable cardioverter-defibrillator interventions in patients with unstable ventricular arrhythmias and coronary artery disease: results from the multicenter randomized controlled SMS (substrate modification study). Circ Arrhythm Electrophysiol. 2017;10(3)
  19. 19.
    Pokorney SD, Friedman DJ, Calkins H, et al. Catheter ablation of ventricular tachycardia: lessons learned from past clinical trials and implications for future clinical trials. Heart Rhythm. 2016;13(8):1748–54.CrossRefGoogle Scholar
  20. 20.
    Moher D, Liberati A, Tetzlaff J, Altman DG. PRISMA group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264–9. W64CrossRefGoogle Scholar
  21. 21.
    DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials. 1986;7(3):177–88.CrossRefGoogle Scholar
  22. 22.
    Higgins JPT, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.CrossRefGoogle Scholar
  23. 23.
    Go AS, Mozaffarian D, Roger VL, et al. Heart disease and stroke statistics—2014 update: a report from the American Heart Association. Circulation. 2014;129(3):e28–e292.PubMedGoogle Scholar
  24. 24.
    Lo R, Chia KKM, Hsia HH. Ventricular tachycardia in ischemic heart disease. Card Electrophysiol Clin. 2017;9(1):25–46.CrossRefGoogle Scholar
  25. 25.
    de Bakker JMT, van Capflle FJL, Janse MJ, et al. Macroreentry in the infarcted human heart: the mechanism of ventricular tachycardias with a “focal” activation pattern. J Am Coll Cardiol. 1991;18(4):1005–14.CrossRefGoogle Scholar
  26. 26.
    Palaniswamy C, Kolte D, Harikrishnan P, et al. Catheter ablation of postinfarction ventricular tachycardia: ten-year trends in utilization, in-hospital complications, and in-hospital mortality in the United States. Heart Rhythm. 2014;11(11):2056–63.CrossRefGoogle Scholar
  27. 27.
    Haqqani HM, Roberts-Thomson KC. Radiofrequency catheter ablation for ventricular tachycardia. Heart Lung Circ. 2012;21(6-7):402–12.CrossRefGoogle Scholar
  28. 28.
    Liang JJ, Muser D, Santangeli P. Ventricular tachycardia ablation clinical trials. Card Electrophysiol Clin. 2017;9(1):153–65.CrossRefGoogle Scholar
  29. 29.
    Tung R, Vaseghi M, Frankel DS, et al. Freedom from recurrent ventricular tachycardia after catheter ablation is associated with improved survival in patients with structural heart disease: an International VT Ablation Center Collaborative Group study. Heart Rhythm. 2015;12(9):1997–2007.CrossRefGoogle Scholar
  30. 30.
    Sapp JL, Wells GA, Parkash R, et al. Ventricular tachycardia ablation versus escalation of antiarrhythmic drugs. N Engl J Med. 2016;375(2):111–21.CrossRefGoogle Scholar
  31. 31.
    Suzuki A, Yoshida A, Takei A, et al. Prophylactic catheter ablation of ventricular tachycardia before cardioverter-defibrillator implantation in patients with non-ischemic cardiomyopathy: clinical outcomes after a single endocardial ablation. J Arrhythm. 2015;31(3):122–9.CrossRefGoogle Scholar
  32. 32.
    Irvine J, Dorian P, Baker B, et al. Quality of life in the Canadian implantable defibrillator study (CIDS). Am Heart J. 2002;144(2):282–9.CrossRefGoogle Scholar
  33. 33.
    Soejima K, Suzuki M, Maisel WH, et al. Catheter ablation in patients with multiple and unstable ventricular tachycardias after myocardial infarction: short ablation lines guided by reentry circuit isthmuses and sinus rhythm mapping. Circulation. 2001;104(6):664–9.CrossRefGoogle Scholar
  34. 34.
    Marchlinski FE, Callans DJ, Gottlieb CD, Zado E. Linear ablation lesions for control of unmappable ventricular tachycardia in patients with ischemic and nonischemic cardiomyopathy. Circulation. 2000;101(11):1288–96.CrossRefGoogle Scholar
  35. 35.
    Tung R, Josephson ME, Reddy V, Reynolds MR, SMASH-VT Investigators. Influence of clinical and procedural predictors on ventricular tachycardia ablation outcomes: an analysis from the substrate mapping and ablation in Sinus Rhythm to Halt Ventricular Tachycardia Trial (SMASH-VT). J Cardiovasc Electrophysiol. 2010;21(7):799–803.PubMedGoogle Scholar
  36. 36.
    Muser D, Liang JJ, Pathak RK, et al. Long-term outcomes of catheter ablation of electrical storm in nonischemic dilated cardiomyopathy compared with ischemic cardiomyopathy. JACC: Clin Electrophysiol. 2017;3(7):767–78.Google Scholar
  37. 37.
    Di Biase L, Burkhardt JD, Lakkireddy D, et al. Ablation of stable VTs versus substrate ablation in ischemic cardiomyopathy: the VISTA randomized multicenter trial. J Am Coll Cardiol. 2015;66(25):2872–82.CrossRefGoogle Scholar
  38. 38.
    Silberbauer J, Oloriz T, Maccabelli G, et al. Noninducibility and late potential abolition: a novel combined prognostic procedural end point for catheter ablation of postinfarction ventricular tachycardia. Circ Arrhythm Electrophysiol. 2014;7(3):424–35.CrossRefGoogle Scholar
  39. 39.
    Mizuno H. Mapping of ventricular tachycardia in patients with structural heart disease. J Arrhythmia. 2014;30(4):283–91.CrossRefGoogle Scholar
  40. 40.
    Yoshiga Y, Mathew S, Wissner E, et al. Correlation between substrate location and ablation strategy in patients with ventricular tachycardia late after myocardial infarction. Heart Rhythm. 2012;9(8):1192–9.CrossRefGoogle Scholar
  41. 41.
    Sacher F, Roberts-Thomson K, Maury P, et al. Epicardial ventricular tachycardia ablation a multicenter safety study. J Am Coll Cardiol. 2010;55(21):2366–72.CrossRefGoogle Scholar
  42. 42.
    Di Biase L, Santangeli P, Burkhardt DJ, et al. Endo-epicardial homogenization of the scar versus limited substrate ablation for the treatment of electrical storms in patients with ischemic cardiomyopathy. J Am Coll Cardiol. 2012;60(2):132–41.CrossRefGoogle Scholar
  43. 43.
    Santangeli P, Muser D, Maeda S, 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. Heart Rhythm. 2016;13(7):1552–9.CrossRefGoogle Scholar
  44. 44.
    Carbucicchio C, Santamaria M, Trevisi N, et al. Catheter ablation for the treatment of electrical storm in patients with implantable cardioverter-defibrillators. Circulation. 2008;117(4):462–9.CrossRefGoogle Scholar
  45. 45.
    Sesselberg HW, Moss AJ, McNitt S, et al. Ventricular arrhythmia storms in postinfarction patients with implantable defibrillators for primary prevention indications: a MADIT-II substudy. Heart Rhythm. 2007;4(11):1395–402.CrossRefGoogle Scholar
  46. 46.
    Winterfield JR, Kent AR, Karst E, et al. Impact of ventricular tachycardia ablation on health care utilization. Heart Rhythm. 2017; Scholar
  47. 47.
    Preventive aBlation of vEntricular tachycaRdia in Patients With myocardiaL INfarction - Full Text View - Accessed 26 Nov 2017.
  48. 48.
    Does Timing of VT Ablation Affect Prognosis in Patients With an Implantable Cardioverter-defibrillator? - Full Text View - Accessed 26 Nov 2017.

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Varunsiri Atti
    • 1
    Email author
  • Venkat Vuddanda
    • 2
  • Mohit K. Turagam
    • 3
  • Praveen Vemula
    • 4
  • Zubair Shah
    • 5
  • Himakar Nagam
    • 6
  • Srikanth Yandrapalli
    • 7
  • Mohammad-Ali Jazayeri
    • 8
  • Scott Koerber
    • 9
  • Juan Viles Gonzalez
    • 10
  • Andrea Natale
    • 11
  • Luigi Di Biase
    • 3
  • Dhanunjaya R. Lakkireddy
    • 8
  1. 1.Department of Internal MedicineMichigan State UniversityEast LansingUSA
  2. 2.Department of Cardiovascular DiseaseHarvard Medical SchoolBostonUSA
  3. 3.Helmsley Electrophysiology CenterMount Sinai School of MedicineNew YorkUSA
  4. 4.Department of Internal MedicineSparrow HospitalLansingUSA
  5. 5.Department of Cardiovascular DiseasesUniversity of UtahSalt Lake CityUSA
  6. 6.University of CaliforniaBerkeleyUSA
  7. 7.Department of Cardiovascular DiseasesNew York Medical CollegeValhallaUSA
  8. 8.Cardiovascular Research InstituteKansas University HospitalKansas CityUSA
  9. 9.Department of Cardiac ElectrophysiologyMedical University of South CarolinaColumbiaUSA
  10. 10.Heart and Vascular InstituteTulane University School of MedicineNew OrleansUSA
  11. 11.Texas Cardiac Arrhythmia CenterAustinUSA

Personalised recommendations