Abstract 4366761: Catheter Ablation versus Antiarrhythmic Drugs for Ventricular Tachycardia: A Systematic Review and Meta-Analysis

Background: Sustained ventricular tachycardia (VT) and fibrillation-related sudden cardiac death (SCD) account for nearly 450,000 deaths annually in the United States. Catheter ablation (CA) and antiarrhythmic drugs (AADs) are commonly used to manage VT recurrence; however, their comparative efficacy and safety remain uncertain. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing CA and AADs in patients with ischemic cardiomyopathy and implantable cardioverter-defibrillators (ICDs). PubMed, Embase, and Cochrane CENTRAL Library were searched up to February 15, 2025. Primary outcomes included all-cause mortality, cardiovascular mortality, VT storm, and appropriate ICD shock. Secondary outcomes included inappropriate ICD shock, appropriate antitachycardia pacing (ATP), heart failure hospitalization, stroke/transient ischemic attack (TIA), and myocardial infarction (MI). Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Results: Three RCTs encompassing 587 patients (287 CA, 300 AADs) were included. No significant differences were found between CA and AADs in all-cause mortality (RR 0.88, 95% CI: 0.63–1.22; p=0.43), cardiovascular mortality (RR 1.23, 95% CI: 0.77–1.98; p=0.39), VT storm (RR 0.76, 95% CI: 0.39–1.46; p=0.41), or appropriate ICD shock (RR 0.87, 95% CI: 0.69–1.10; p=0.24). Secondary outcomes, including inappropriate ICD shock, ATP, heart failure hospitalization, stroke/TIA, and MI, were also comparable between the two groups. Conclusions: CA and AADs demonstrated comparable efficacy and safety in patients with VT. Larger high-quality trials are warranted to confirm these findings and further define the role of CA as a potential first-line therapy.