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First-Line Ablation of Ventricular Tachycardia in Ischemic Cardiomyopathy: Stratification of Outcomes by Left Ventricular Function
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  • David Briceno,
  • Jorge Romero,
  • Kavisha Patel,
  • Andy Zhang,
  • Isabella Alviz,
  • Ruike Yang,
  • Daniel RodriguezOrcid,
  • Dhanunjaya Lakkireddy,
  • Domenico Della Rocca,
  • Nicola Tarantino,
  • rakesh gopinathannair,
  • Andrea Natale,
  • Luigi Di Biase
David Briceno
Montefiore Hospital and Medical Center
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Jorge Romero
Brigham and Women’s Hospital/Harvard Medical School.
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Kavisha Patel
Montefiore Hospital and Medical Center
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Andy Zhang
Montefiore Hospital and Medical Center
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Isabella Alviz
Montefiore Medical Center
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Ruike Yang
Henan Provincial People’s Hospital
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Daniel Rodriguez
Orcid
Montefiore Medical Center
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Dhanunjaya Lakkireddy
The Kansas City Heart Rhythm Institute (KCHRI) @ HCA MidWest
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Domenico Della Rocca
University Hospital of Rome
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Nicola Tarantino
Universita degli Studi di Foggia
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rakesh gopinathannair
The Kansas City Heart Rhythm Institute (KCHRI) @ HCA MidWest
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Andrea Natale
St. David's Medical Center
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Luigi Di Biase
Texas Cardiac Arrhythmia Institute at St. David's Medical Center
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Abstract

Introduction: Randomized controlled trials (RCTs) have shown improved outcomes in patients undergoing first-line catheter ablation of ventricular tachycardia/ventricular fibrillation (VT/VF) in patients with ischemic cardiomyopathy (ICM). Herein, outcomes were stratified based on left ventricular ejection fraction (LVEF). Methods: RCTs evaluating first-line ablation versus medical therapy in patients with VT and ICM were included. Risk estimates and 95% confidence intervals (CI) were measured. Results: Four RCTs with a total of 505 patients (mean age 66 ± 9 years, 89% male, 80% with previous revascularization) were included. Mean LVEF was 35 ± 8%. At a mean follow-up of 24 ± 9 months, a significant benefit in survival-free from appropriate ICD therapies was observed in all patients undergoing first-line catheter ablation compared to medical management (RR 0.70, 95% CI 0.56-0.86). In patients with moderately depressed LVEF (>30-50%), first line VT ablation was associated with a statistically significant reduction in the composite endpoint of survival-free VT/VF and appropriate ICD therapies (HR: 0.52, 95% CI: 0.36-0.76), whereas there was no difference in patients with severely depressed LVEF (30-50%).