Outcomes following catheter ablation for ventricular tachycardia in adult patients with structural heart disease and implantable cardioverter-defibrillator: protocol for an updated systematic review and meta-analysis of randomized studies

Abstract

Review question / Objective: Does catheter ablation for scar-related monomorphic ventricular tachycardia improve outcomes (defined as any appropriate ICD therapy, appropriate ICD shocks, all-cause mortality, VT storm, cardiovascular mortality, cardiovascular hospitalizations, complications) in adult patients with ischemic or non-ischemic cardiomyopathy and implantable cardioverter-defibrillator? Condition being studied: Ventricular tachycardia in patients with structural heart disease is usually an arrhythmia using the myocardial scar as a substrate for reentry. It poses a risk of syncope and sudden cardiac death, especially in patients with reduced ejection fraction. Most antiarrhythmic drugs are of little value and their use is restricted in patients with LV systolic dysfunction. Catheter ablation is a viable option for the treatment of ventricular tachycardia. In patients with previous myocardial infarction the arrhythmogenic scar is located most frequently subendocardially and is readily accessible using endocardial approach, while in non-ischemic cardiomyopathy the scar is frequently located in the midmyocardial or subepicardial layers. This is the reason endocardial catheter ablation to be less effective in those patients and to more often necessitate epicardial approach.