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

Santangeli, Pasquale; Muser, Daniele; Maeda, Shingo; Filtz, Annalisa; Zado, Erica S.; Frankel, David S.; Dixit, Sanjay; Epstein, Andrew E.; Callans, David J.; Marchlinski, Francis E.

doi:10.1016/j.hrthm.2016.03.004

Cited by 156 publications

(97 citation statements)

References 29 publications

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“…23 In addition, in a recent pooled analysis of randomized controlled trials comparing CA versus AADs, we have shown that treatment with amiodarone was associated with increased risk of mortality. 24 Although the acute procedural end points evolved during the 15-year period of the study, the ablation approaches were uniform and always started with endocardial-only procedures, reserving adjuvant epicardial mapping and ablation in patients with VT recurrence or persistent VT inducibility after endocardial-only ablation. Of note, all of the major complications observed in our study occurred during pericardial access or epicardial mapping/ablation (Table 2).…”

Section: Discussionmentioning

confidence: 99%

Long-Term Outcome After Catheter Ablation of Ventricular Tachycardia in Patients With Nonischemic Dilated Cardiomyopathy

Muser

Santangeli

Castro

et al. 2016

Circ: Arrhythmia and Electrophysiology

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133

105

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Background— Catheter ablation (CA) of ventricular tachycardia (VT) in patients with nonischemic dilated cardiomyopathy can be challenging because of the complexity of underlying substrates. We sought to determine the long-term outcomes of endocardial and adjuvant epicardial CA in nonischemic dilated cardiomyopathy. Methods and Results— We examined 282 consecutive patients (aged 59±15 years, 80% males) with nonischemic dilated cardiomyopathy who underwent CA. Ablation was guided by activation/entrainment mapping for tolerated VT and pacemapping/targeting of abnormal electrograms for unmappable VT. Adjuvant epicardial ablation was performed for recurrent VT or persistent inducibility after endocardial–only ablation. Epicardial ablation was performed in 90 (32%) patients. Before ablation, patients failed a median of 2 antiarrhythmic drugs), including amiodarone, in 166 (59%) patients. The median follow-up after the last procedure was 48 (19–67) months. Overall, VT-free survival was 69% at 60-month follow-up. Transplant-free survival was 76% and 68% at 60- and 120-month follow-up, respectively. Among the 58 (21%) patients with VT recurrence, CA still resulted in a significant reduction of VT burden, with 31 (53%) patients having only isolated (1–3) VT episodes in 12 (4–35) months after the procedure. At the last follow-up, 128 (45%) patients were only on β-blockers or no treatment, 41 (15%) were on sotalol or class I antiarrhythmic drugs, and 62 (22%) were on amiodarone. Conclusions— In patients with nonischemic dilated cardiomyopathy and VT, endocardial and adjuvant epicardial CA is effective in achieving long-term VT freedom in 69% of cases, with a substantial improvement in VT burden in many of the remaining patients.

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Section: Discussionmentioning

confidence: 99%

Long-Term Outcome After Catheter Ablation of Ventricular Tachycardia in Patients With Nonischemic Dilated Cardiomyopathy

Muser

Santangeli

Castro

et al. 2016

Circ: Arrhythmia and Electrophysiology

Self Cite

133

105

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“…In a meta-analysis of randomized trials, both AADs and catheter ablation significantly reduced recurrent VT but without improving mortality (97). The benefit of AADs in reducing recurrent VT was mainly driven by amiodarone.…”

Section: Ventricular Arrhythmias and Scdmentioning

confidence: 99%

Arrhythmias in Patients ≥80 Years of Age

Curtis

Karki

Hattoum

et al. 2018

Journal of the American College of Cardiology

113

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Advances in medical care have led to an increase in the number of octogenarians and even older patients, forming an important and unique patient subgroup. It is clear that advancing age is an independent risk factor for the development of most arrhythmias, causing substantial morbidity and mortality. Patients ≥80 years of age have significant structural and electrical remodeling of cardiac tissue; accrue competing comorbidities; react differently to drug therapy; and may experience falls, frailty, and cognitive impairment, presenting significant therapeutic challenges. Unfortunately, very old patients are under-represented in clinical trials, leading to critical gaps in evidence to guide effective and safe treatment of arrhythmias. In this state-of-the-art review, we examine the pathophysiology of aging and arrhythmias and then present the available evidence on age-specific management of the most common arrhythmias, including drugs, catheter ablation, and cardiac implantable electronic devices.

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“…In a recent meta-analysis of randomized-controlled trials, we found a 1.5-fold reduction of appropriate ICD interventions with AADs compared to standard medical therapy with also a significant reduction of inappropriate ICD interventions. However, pooled analysis did not show a significant impact of AADs on all-cause mortality compared to standard medical therapy[11]. The choice of a particular drug and its dose should take into account its efficacy in controlling VA but also potential pro-arrhythmic effects as well as other side effects.…”

Section: Antiarrhythmic Drug Therapymentioning

confidence: 99%

“…Importantly, amiodarone may increase defibrillation thresholds in patients with ICDs[25] and the risks and benefits of long-term administration of amiodarone should be carefully weighed because of its several side effects including liver dysfunction (elevated AST/ALT levels in up to 30% of patients but hepatitis requiring drug discontinuation in < 3% of the cases), thyroid disorders (hypothyroidism in up to 22%, hyperthyroidism in up to 12%), pulmonary fibrosis (2%), corneal deposits (> 90%, usually of no clinical importance), optic neuropathy (< 1%) and pro-arrhythmic effect (< 1%)[26]. A recent pooled analysis of randomized controlled trials comparing CA vs AADs demonstrated an association between amiodarone and increased mortality[11]. Furthermore, among patients undergoing CA for VT in the setting of structural heart disease, we have recently shown that higher amiodarone dose at discharge after CA was associated with increased mortality, suggesting that discontinuation or dose reduction of amiodarone should be considered in certain patients after successful CA[27].…”

Section: Antiarrhythmic Drug Therapymentioning

confidence: 99%

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Management of ventricular tachycardia storm in patients with structural heart disease

Muser¹,

Santangeli²,

Liang³

2017

WJC

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Electrical storm (ES) is a medical emergency characterized by repetitive episodes of sustained ventricular arrhythmias (VAs) in a limited amount of time (at least 3 within a 24-h period) leading to repeated appropriate implantable cardioverter defibrillator therapies. The occurrence of ES represents a major turning point in the natural history of patients with structural heart disease being associated with poor short- and long-term survival particularly in those with compromised left ventricular ejection fraction (LVEF) that can develop hemodynamic decompensation and multi-organ failure. Management of ES is challenging with limited available evidence coming from small retrospective series and a substantial lack of randomized-controlled trials. In general, a multidisciplinary approach including medical therapies such as anti-arrhythmic drugs, sedation, as well as interventional approaches like catheter ablation, may be required. Accurate patient risk stratification at admission for ES is pivotal and should take into account hemodynamic tolerability of VAs as well as comorbidities like low LVEF, advanced NYHA class and chronic pulmonary disease. In high risk patients, prophylactic mechanical circulatory support with left ventricular assistance devices or extracorporeal membrane oxygenation should be considered as bridge to ablation and recovery. In the present manuscript we review the available strategies for management of ES and the evidence supporting them.

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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

Cited by 156 publications

References 29 publications

Long-Term Outcome After Catheter Ablation of Ventricular Tachycardia in Patients With Nonischemic Dilated Cardiomyopathy

Long-Term Outcome After Catheter Ablation of Ventricular Tachycardia in Patients With Nonischemic Dilated Cardiomyopathy

Arrhythmias in Patients ≥80 Years of Age

Management of ventricular tachycardia storm in patients with structural heart disease

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