Introduction
In patients with post-infarct cardiomyopathy who develop ventricular
tachycardia (VT) or ventricular fibrillation (VF), implantable
cardioverter defibrillators (ICDs) are an effective therapy to reduce
the risk of sudden cardiac death.1 However, ICDs do
not prevent recurrent arrhythmias and subsequent ICD discharges (shocks)
are associated with increased morbidity and mortality, and significantly
affect quality of life. Current guidelines recommend anti-arrhythmic
drugs (AADs) as a first-line therapy for prevention of recurrent VT/VF
leading to ICD shocks (Class I). In cases where AADs are ineffective,
poorly tolerated, or contraindicated- catheter ablation is recommended
(Class I). In patients in whom AADs are undesirable for other reasons,
catheter ablation may be considered (Class IIa).1
Given the potential benefits of avoiding recurrent ICD discharges and
chronic AAD side-effects, several randomized trials have evaluated the
efficacy of preventative catheter ablation, but without consensus.
Therefore, we conducted this meta-analysis to evaluate the role of
catheter ablation as a preventive strategy at the time of secondary
prevention ICD implantation in patients with post-infarct cardiomyopathy
and VT.