Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Prevention of Recurrent Ventricular Tachycardia in Patients With Implantable Cardioverter Defibrillators—A Network Meta-analysis

Malik, Aaqib H. MD, MPH*; Aronow, Wilbert S. MD, FACC, FAHA

doi: 10.1097/MJT.0000000000000928
Systematic Review
Buy
SDC

Background: The optimal management for the prevention of recurrent ventricular tachycardia in patients with implantable cardioverter-defibrillators (ICDs) offers a challenge with no set guidelines regarding which therapy offers a best safety and efficacy profile.

Study Question: Which therapeutic strategy, among antiarrhythmic drugs and catheter ablation (CA), offers the most effective and safe approach in patients with ICDs?

Data Sources: Randomized controlled trials (RCTs) comparing the efficacy and safety of antiarrhythmic drugs or CA against a placebo group. RCTs were identified from a comprehensive search in PubMed, Embase, and Cochrane library.

Study Design: Our outcomes of interest were reductions in appropriate ICD shocks, inappropriate ICD shocks, and overall mortality. We used the event rates in both groups, and then using a frequentist approach employing a graph theory methodology, we constructed a network meta-analysis model.

Results: Fourteen RCTs with 3815 participants and 6 different interventions treatments were included in our network meta-analysis. The most effective treatment for the prevention of recurrent ventricular tachycardia after ICD is amiodarone followed by CA. Amiodarone is most effective in the reduction of appropriate and inappropriate ICD shocks with an odds ratio (OR) of 0.29 [95% confidence interval (CI), 0.11–0.74] and 0.15 (95% CI, 0.04–0.60), respectively. CA was effective in the reduction of appropriate ICD shocks (OR, 0.41; 95% CI, 0.20–0.87), whereas sotalol was effective in the reduction of inappropriate ICD shocks (OR, 0.46; 95% CI, 0.22–0.95). There was no significant reduction in the overall mortality from any therapy. There was a trend of increased mortality associated with amiodarone therapy (OR, 2.40; 95% CI, 0.92–6.26).

Conclusions: Amiodarone remains the most efficacious therapy for the reduction of appropriate and inappropriate shocks in patients with ICD. No therapy resulted in mortality reduction, but amiodarone showed a trend toward increased mortality.

Division of Cardiology, Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY.

Address for correspondence: Department of Medicine, Westchester Medical Center, New York Medical College, 100 woods road Valhalla, NY 10595. E-mail: aaqib2012@aya.yale.edu

The authors have no conflicts of interest to declare.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.americantherapeutics.com).

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.