Catheter ablation to reduce cardiovascular hospitalizations in patients with ventricular arrhythmias: a systematic review and meta-analysis of randomized controlled trials
M Grine, R Bertao Ventura, G Ferraz-Costa, C Saleiro, P Alves, J Ferreira, N Antonio, P A Sousa, L GoncalvesAbstract
Background
Patients with structural heart disease and ventricular arrhythmias experience high rates of cardiovascular (CV) hospitalizations, reflecting both arrhythmic instability and disease progression. Catheter ablation (CA) has been proposed as a strategy to reduce arrhythmic burden and subsequent CV admissions, but randomized evidence remains fragmented.
Objective
To evaluate the effect of catheter ablation on CV hospitalizations in patients with structural heart disease and documented ventricular arrhythmias.
Methods
We performed a systematic review and meta-analysis of randomized controlled trials comparing CA with conventional medical management in adult patients with structural heart disease and ventricular arrhythmias. The primary outcome was CV hospitalization. Secondary outcomes included electrical storm, appropriate implantable cardioverter-defibrillator (ICD) shocks, all-cause mortality, and CV mortality. Trials with insufficient event reporting were excluded. Pooled risk ratios (RRs) were estimated using a random-effects model with Wald-type confidence intervals.
Results
Nine eligible RCTs comprising 1435 patients were included in the primary outcome analysis. CV hospitalization occurred in 238/706 CA patients and in 300/729 Control patients. Catheter ablation was associated with a significant reduction in CV hospitalizations compared with standard therapy [RR = 0.79 (95% CI 0.63–0.98); p = 0.03; I² = 48%]. CA also reduced the occurrence of electrical storm (RR = 0.77, 95% CI 0.62–0.95; p = 0.02; I² = 0%) and appropriate ICD shocks [RR = 0.66 (95% CI 0.51–0.85); p = 0.001; I² = 48%]. No significant differences were observed in all-cause or CV mortality. In analyses restricted to trials enrolling patients with ischemic cardiomyopathy, the effect on CV hospitalization remained consistent [RR = 0.77 (95% CI 0.61–0.99); p = 0.04; I² = 55%].
Conclusions
In patients with structural heart disease and ventricular arrhythmias, catheter ablation significantly reduces CV hospitalizations and arrhythmic events compared with conventional management, without a demonstrable effect on mortality. These findings highlight the role of catheter ablation as an effective strategy to reduce CV healthcare utilization in this high-risk population.