Author + information
- Jorge Romero, MDa,
- Roberto C. Cerrud-Rodriguez, MDa,
- Luigi Di Biase, MD, PhDa,
- Juan Carlos Diaz, MDa,
- Isabella Alviz, MDa,
- Vito Grupposo, RTa,
- Luis Cerna, MDa,
- Ricardo Avendano, MDa,
- Usha Tedrow, MD, MSb,
- Andrea Natale, MDc,
- Roderick Tung, MDd and
- Saurabh Kumar, BSc(Med)/MBBS, PhDe,∗ ()
- aArrhythmia Services, Department of Medicine, Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
- bCardiac Arrhythmia Service, Heart and Vascular Center, Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts
- cTexas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, Texas
- dCenter for Arrhythmia Care, Heart and Vascular Center, Pritzker School of Medicine, The University of Chicago Medicine, Chicago, Illinois
- eDepartment of Cardiology, Westmead Applied Research Centre, University of Sydney, Sydney, New South Wales, Australia
- ↵∗Address for correspondence:
Assoc. Prof. Saurabh Kumar, Cardiology Department, Westmead Hospital, Westmead Applied Research Centre, Corner Hawkesbury and Darcy Roads, Westmead, New South Wales–2145, Australia.
Objectives This study sought to determine whether combined endocardial-epicardial (endo-epi) ablation was superior to endocardial only ablation in patients with scar-related ventricular tachycardia (VT).
Background Limited single-center studies suggest that combined endo-epi ablation strategy may be superior to endocardial ablation (endo) alone in patients with nonischemic cardiomyopathy (NICM) and arrhythmogenic right ventricular cardiomyopathy (ARVC), and ischemic cardiomyopathy (ICM).
Methods A systematic review of Medline, Cochrane, and Embase databases was performed for studies that reported outcomes comparing endo-epi with endo VT ablation alone.
Results Seventeen studies consisting of 975 patients were included (mean 56 ± 10 years of age; 79% male; NICM in 36.6%; ICM in 32.8%; and ARVC in 30.6%). After a mean follow-up of 27 ± 21 months, endo-epi ablation was associated with a 35% reduction in risk of VT recurrence compared with endocardial ablation alone (risk ratio [RR]: 0.65; 95% confidence interval [CI]: 0.55 to 0.78; p < 0.001). Sensitivity analysis showed lower risk of VT recurrence in ICM (RR: 0.43; 95% CI: 0.28 to 0.67; p = 0.0002) and ARVC (RR: 0.59; 95% CI: 0.43 to 0.82; p = 0.0002), with a nonsignificant trend in NICM (RR: 0.87; 95% CI: 0.70 to 1.08; p = 0.20). Endo-epi, compared with endo ablation, was associated with reduced all-cause mortality (RR: 0.56; 95% CI: 0.32 to 0.97; p = 0.04). Acute procedural complications were higher with the endo-epi approach (RR: 2.62; 95% CI: 0.91 to 7.52; p = 0.07).
Conclusions This meta-analysis suggests that a combined endo-epi ablation is associated with a lower risk of VT recurrence and subsequent mortality than endo only VT ablation in patients with scar-related VT. Procedural complications, however, are higher with the endo-epi approach.
- arrhythmogenic right ventricular cardiomyopathy
- catheter ablation
- endocardial ablation
- epicardial ablation
- ischemic cardiomyopathy
- nonischemic cardiomyopathy
- structural heart disease
- ventricular tachycardia
- VT recurrence
Dr. Di Biase is a consultant for Biosense Webster, Stereoataxis, Boston Scientific, and St Jude Medical; and has received speaker and travel honoraria from Medtronic, Atricure, EPiEP, and Biotronik. Dr. Tedrow is a consultant for Boston Scientific and Abbott; and has received research funding from Biosense Webster and Abbott. Dr. Grupposo is an employee of CAS Biosense Webster; and has financial relationships with Abbott, Medtronic, and Biosense Webster. Dr. Natale is a consultant for Biosense Webster, St. Jude/Abbott, Medtronic, and Biotronik. Dr Tung has received research grants from Abbott. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Francis Marchlinski, MD, served as Guest Editor for this article.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received May 14, 2018.
- Revision received August 13, 2018.
- Accepted August 15, 2018.
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