Comparative Efficacy of Catheter Ablation Versus Antiarrhythmic Drugs in Reducing Ventricular Tachycardia and Related Complications in Ischemic Heart Disease: A Meta-Analysis

Objectives Ventricular tachycardia (VT) in ischemic heart disease (IHD) carries a high risk of sudden cardiac death. Treatment typically involves catheter ablation or antiarrhythmic drugs (AADs), but the optimal approach is uncertain. This meta-analysis compared the safety of these treatments for VT in IHD patients. Methods This meta-analysis included all studies comparing catheter ablation with AADs in IHD patients with symptomatic VT. Databases searched included PubMed, Google Scholar, Embase, and Cochrane Library up to June 9, 2024. Primary outcomes analyzed were recurrent VT, mortality, and heart failure; secondary outcomes included hospitalizations for VT, VT storm, and appropriate anti-tachycardia pacing (AATP). Risk ratios (RR) with 95% confidence intervals (CI) were calculated using a random-effects model. Quality and bias were assessed using the Cochrane ROB 2 tool, and heterogeneity with Higgins I² statistic. Results Three studies with 430 participants were included. No significant difference was found between ablation and AADs for recurrent VT (RR = 1.08; 95%CI = 0.70–1.65; p = 0.74; I²=0%), mortality (RR = 0.98; 95%CI = 0.67–1.42; p = 0.90; I²=0%), and AATP (RR = 1.00; 95%CI = 0.84–1.20; p = 0.97; I²=0%).Heart failure (RR = 0.75; 95%CI = 0.50–1.11; p = 0.15; I²=0%), VT storm (RR = 0.77; 95%CI = 0.55–1.09; p = 0.14; I²=0%), and hospitalizations for VT (RR = 0.59; 95% CI = 0.30–1.15; p = 0.12; I²=62%) were lower with ablation but not significantly. Conclusion While no significant differences emerged, ablation showed a trend toward reducing heart failure and hospitalizations, suggesting potential advantages in managing VT-related complications in IHD. Further large-scale studies are needed to confirm these benefits.