Abstract 4347326: Catheter Ablation Versus Antiarrhythmic Drug Therapy for Ventricular Tachycardia in Structural Heart Disease: A Meta-Analysis of Randomized Controlled Trials

Background: Ventricular tachycardia (VT) is a life-threatening arrhythmia often seen in patients with structural heart disease. While antiarrhythmic drugs (AADs) have long been standard therapy, catheter ablation has emerged as a preferred treatment strategy. The comparative efficacy and safety of ablation versus AADs as first-line therapy remain uncertain. Methods: A systematic literature search was conducted across multiple databases, including PubMed, Embase, and Web of Science, to identify randomized controlled trials (RCTs) comparing catheter ablation to AAD therapy in adults with structural heart disease and sustained ventricular tachycardia. The primary outcome was VT reoccurrence. Secondary outcomes included all-cause mortality, VT storm, hospitalizations, and major adverse cardiovascular events (MACE). Results: Six randomized controlled trials were selected comprising 1,072 patients that met the inclusion criteria. 552 patients were treated with catheter ablation, and 520 received AAD therapy. Antiarrhythmic drugs used were amiodarone, sotalol, mexiletine, and procainamide, with earlier studies using a wide array of therapies and later often using only amiodarone and sotalol. The average follow-up duration was 24.8 months, with an average age of 65 years and approximately 89.5% of male patients. Catheter ablation was associated with a significant reduction in recurrent VT (OR: 0.69; 95% CI: 0.50–0.95; P = 0.02), VT storm (OR: 0.62; 95% CI: 0.47–0.80; P = 0.0003), hospitalizations (OR: 0.74; 95% CI: 0.56–0.98; P = 0.03), and a trend toward reduced MACE (OR: 0.76; 95% CI: 0.54–1.07; P = 0.12). No significant difference was observed in all-cause mortality (OR: 0.91; 95% CI: 0.66–1.26; P = 0.58). Conclusion: Catheter ablation significantly reduces the risk of VT recurrence, VT storm, and hospitalizations compared to AAD therapy in patients with structural heart disease. Although no mortality benefit was observed, these findings support catheter ablation as a potentially superior initial strategy for VT management in this population. More high-quality studies are warranted to clarify the long-term safety and effectiveness of this procedure.