Catheter Ablation for the Prevention of Defibrillator Therapy: A Meta Analysis_West China Medical Journal

Authors：

TANG Yang ,  TANG Xuewen

Department of Cardiology, Ba′nan People’s Hospital of Chongqing, Chongqing 401320, P. R. China;

Corresponding?author：

TANG Xuewen, Email: t_y000@tom.com

Keywords：

室性心動過速; 導管消融; 植入式心臟轉復除顫器; Meta分析

Video：

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【摘要】　目的　評估對于曾有急性心肌梗死的室性心動過速（VT）患者，導管消融（RA）減少植入式心臟轉復除顫器（ICD）放電轉律治療的療效和安全性。　方法　計算機檢索Pubmed、EMbase、Cochrane圖書館、中國生物醫學文獻光盤數據庫、中文科技期刊全文數據庫、CNKI數字圖書館，納入RA+ICD和單獨使用ICD對比治療VT患者的隨機對照臨床試驗，對納入的研究進行質量評價和Meta分析。　結果　共納入2篇最近發表在國外一流雜志上面的臨床隨機對照研究，一篇發在《新英格蘭雜志》，另外一篇發在《柳葉刀》。RA+ICD組納入116例患者，其中有23例（20%）因為再發VT或者心室顫動（Vf）而進行了ICD放電轉律治療；ICD組納入119例患者，其中有49例（41%）因為再發VT或者Vf而進行了ICD放電轉律治療。Meta分析結果顯示，RA+ICD的組合相對于單獨運用ICD來說，需要進行ICD放電轉律治療的人數較少，OR=0.33，95%CI（0.18～0.61），P=0.000 4。　結論　目前研究認為射頻消融可能可減少需進行ICD放電轉律治療的人數，以后需要更多更大樣本量的研究進一步證實該結果。
【Abstract】　Objective　 To assess the efficacy and safety of radiofrequency catheter ablation (RA) for the prevention of defibrillator therapy with implantable cardioverter defibrillator (ICD) for patients who have had acute myocardial infarction with ventricular tachycardia (VT). 　Methods　 Randomized controlled trials on patients with VT who underwent RA and ICD versus ICD alone were searched from Pubmed, EMbase, the Cochrane Central register of controlled trials, China Biology Medicine database, Chinese Science and Technology Journal database and the CNKI digital library. Quality assessment and Meta analysis were carried out for the researches sought out from these databases.　Results　 Two randomized controlled studies published on The New England Journal of Medicine and the Lancet were included in our study. RA plus ICD were used in 116 cases, among whom 23 underwent ICD shocks due to reoccurrence of VT or ventricular fibrillation (Vf). Single ICD was used in 119 cases among whom 49 underwent ICD shocks due to reoccurrence of VT or Vf The result of Meta analysis showed that the number of patients needing ICD shocks after RA plus ICD treatment was significantly lower than that after single ICD treatment. The statistical data of the comprehensive Meta analysis were OR=0.33, 95%CI (0.18-0.61), and P=0.000 4.　Conclusion　 At present, it is believed that RA can be used for the prevention of defibrillator therapy, while the result should be confirmed by large sample research in the future.

Citation： TANG Yang,TANG Xuewen. Catheter Ablation for the Prevention of Defibrillator Therapy: A Meta Analysis. West China Medical Journal, 2011, 26(4): 535-539. doi: Copy

1.	Goldberger Z, Lampert R. Implantable cardioverter-defibrillators: expanding indications and technologies[J]. JAMA, 2006, 295(7): 809-818.
2.	Moss AJ, Zarebra W, Hall WJ, et al. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction[J]. N Engl J Med, 2002, 346(12): 877-883.
3.	Kuck KH, Cappato R, Siebels J, et al. Randomized comparison of antiarrhythmic drug therapy with implantable defibrillators in patients resuscitated from cardiac arrest. The Cardiac Arrest Study Hamburg (CASH)[J]. Circulation, 2000, 102(7): 748-754.
4.	Moss AJ, Hall WJ, Cannom DS, et al. Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. Multicentre Automatic Defibrillator Implantation Trial Investigators[J]. N Engl J Med 1996, 335(26): 1933-1940.
5.	Kamphuis HC, de Leeuw RJ, Derksen R, et al. Implantable cardioverter defibrillator recipients: quality of life in recipients with and without ICD shock delivery: a prospective study[J]. Europace, 2003, 5(4): 381-389.
6.	Sears SE Jr, Conti JB. Understanding implantable cardioverter defibrillator shocks and storms: medical and psychosocial considerations for research and clinical care[J]. Clin Cardiol, 2003, 26(3): 107-111.
7.	Bilge AK, Ozben B, Demircan S, et al. Depression and anxiety status of patients with implantable cardioverter defibrillator and precipitating factors[J]. Pacing Clin Electrophysiol, 2006, 29(6): 619-626.
8.	Irvine J, Dorian P, Baker B, et al. Quality of life in the Canadian Implantable Defibrillator Study (CIDS)[J]. Am Heart J, 2002, 144(2): 282-289.
9.	Anderson KP. Sudden cardiac death unresponsive to implantable defibrillator therapy: an urgent target for clinicians, industry and government[J]. J Interv Card Electrophysiol, 2005, 14(2): 71-78.
10.	Connolly SJ, Dorian P, Roberts RS, et al. Comparison of β-blockers, amiodarone plus β-blockers, or sotalol for prevention of shocks from implantable cardioverter defi brillators: the OPTIC study: a randomized trial[J]. JAMA, 2006, 295(2): 165-171.
11.	Calkins H, Epstein A, Packer D, et al. Catheter ablation of ventricular tachycardia in patients with structural heart disease using cooled radiofrequency energy: results of a prospective multicenter study. Cooled RF Multi Center Investigators Group[J]. J Am Coll Cardiol, 2000, 35(7): 1905-1914.
12.	Stevenson WG, Wilber DJ, Natale A, et al. Irrigated radiofrequency catheter ablation guided by electroanatomic mapping for recurrent ventricular tachycardia after myocardial infarction: the multicenter thermocool ventricular tachycardia ablation trial[J]. Circulation, 2008, 118(25): 2773-2782.
13.	Reddy VY, Reynolds MR, Neuzil P, et al. Prophylactic catheter ablation for the prevention of defibrillator therapy[J]. N Engl J Med, 2007, 357(26): 2657-2665.
14.	Kuck KH, 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[J]. Lancet, 2010, 375(9708): 31-40.
15.	Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary?[J]. Control Clin Trials, 1996, 17(1): 1-12.
16.	Hohnloser SH, Kuck KH, Dorian P, et al. Prophylactic use of an implantable cardioverter-defibrillator after acute myocardial infarction[J]. N Engl J Med, 2004, 351(24): 2481-2488.
17.	Poole JE, Johnson GW, Hellkamp AS, et al. Prognostic importance of defibrillator shocks in patients with heart failure[J]. N Engl J Med, 2008, 359(10): 1009-1017.
18.	Sweeney MO, Sherfesee L, DeGroot PJ, et al. Differences in effects of electrical therapy type for ventricular arrhythmias on mortality in implantable cardioverter-defibrillator patients[J]. Heart Rhythm, 2010, 7(3): 353-360.

1. 　Goldberger Z, Lampert R. Implantable cardioverter-defibrillators: expanding indications and technologies[J]. JAMA, 2006, 295(7): 809-818.
2. 　Moss AJ, Zarebra W, Hall WJ, et al. Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction[J]. N Engl J Med, 2002, 346(12): 877-883.
3. 　Kuck KH, Cappato R, Siebels J, et al. Randomized comparison of antiarrhythmic drug therapy with implantable defibrillators in patients resuscitated from cardiac arrest. The Cardiac Arrest Study Hamburg (CASH)[J]. Circulation, 2000, 102(7): 748-754.
4. 　Moss AJ, Hall WJ, Cannom DS, et al. Improved survival with an implanted defibrillator in patients with coronary disease at high risk for ventricular arrhythmia. Multicentre Automatic Defibrillator Implantation Trial Investigators[J]. N Engl J Med 1996, 335(26): 1933-1940.
5. 　Kamphuis HC, de Leeuw RJ, Derksen R, et al. Implantable cardioverter defibrillator recipients: quality of life in recipients with and without ICD shock delivery: a prospective study[J]. Europace, 2003, 5(4): 381-389.
6. 　Sears SE Jr, Conti JB. Understanding implantable cardioverter defibrillator shocks and storms: medical and psychosocial considerations for research and clinical care[J]. Clin Cardiol, 2003, 26(3): 107-111.
7. 　Bilge AK, Ozben B, Demircan S, et al. Depression and anxiety status of patients with implantable cardioverter defibrillator and precipitating factors[J]. Pacing Clin Electrophysiol, 2006, 29(6): 619-626.
8. 　Irvine J, Dorian P, Baker B, et al. Quality of life in the Canadian Implantable Defibrillator Study (CIDS)[J]. Am Heart J, 2002, 144(2): 282-289.
9. 　Anderson KP. Sudden cardiac death unresponsive to implantable defibrillator therapy: an urgent target for clinicians, industry and government[J]. J Interv Card Electrophysiol, 2005, 14(2): 71-78.
10. 　Connolly SJ, Dorian P, Roberts RS, et al. Comparison of β-blockers, amiodarone plus β-blockers, or sotalol for prevention of shocks from implantable cardioverter defi brillators: the OPTIC study: a randomized trial[J]. JAMA, 2006, 295(2): 165-171.
11. 　Calkins H, Epstein A, Packer D, et al. Catheter ablation of ventricular tachycardia in patients with structural heart disease using cooled radiofrequency energy: results of a prospective multicenter study. Cooled RF Multi Center Investigators Group[J]. J Am Coll Cardiol, 2000, 35(7): 1905-1914.
12. 　Stevenson WG, Wilber DJ, Natale A, et al. Irrigated radiofrequency catheter ablation guided by electroanatomic mapping for recurrent ventricular tachycardia after myocardial infarction: the multicenter thermocool ventricular tachycardia ablation trial[J]. Circulation, 2008, 118(25): 2773-2782.
13. 　Reddy VY, Reynolds MR, Neuzil P, et al. Prophylactic catheter ablation for the prevention of defibrillator therapy[J]. N Engl J Med, 2007, 357(26): 2657-2665.
14. 　Kuck KH, 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[J]. Lancet, 2010, 375(9708): 31-40.
15. 　Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary?[J]. Control Clin Trials, 1996, 17(1): 1-12.
16. 　Hohnloser SH, Kuck KH, Dorian P, et al. Prophylactic use of an implantable cardioverter-defibrillator after acute myocardial infarction[J]. N Engl J Med, 2004, 351(24): 2481-2488.
17. 　Poole JE, Johnson GW, Hellkamp AS, et al. Prognostic importance of defibrillator shocks in patients with heart failure[J]. N Engl J Med, 2008, 359(10): 1009-1017.
18. 　Sweeney MO, Sherfesee L, DeGroot PJ, et al. Differences in effects of electrical therapy type for ventricular arrhythmias on mortality in implantable cardioverter-defibrillator patients[J]. Heart Rhythm, 2010, 7(3): 353-360.

West China Medical Journal

Catheter Ablation for the Prevention of Defibrillator Therapy: A Meta Analysis

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