ISSN 1671-5411 CN 11-5329/R

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Volume 17 Issue 11
Dec.  2020
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Article Contents
Li-Shui SHEN, Li-Min LIU, Li-Hui ZHENG, Feng HU, Zhi-Cheng HU, Shang-Yu LIU, Jin-Rui GUO, Kush Kumar Bhagat, Yan YAO. Ablation strategies for arrhythmogenic right ventricular cardiomyopathy: a systematic review and meta-analysis. J Geriatr Cardiol 2020; 17(11): 694-703. doi: 10.11909/j.issn.1671-5411.2020.11.001
Citation: Li-Shui SHEN, Li-Min LIU, Li-Hui ZHENG, Feng HU, Zhi-Cheng HU, Shang-Yu LIU, Jin-Rui GUO, Kush Kumar Bhagat, Yan YAO. Ablation strategies for arrhythmogenic right ventricular cardiomyopathy: a systematic review and meta-analysis. J Geriatr Cardiol 2020; 17(11): 694-703. doi: 10.11909/j.issn.1671-5411.2020.11.001

Ablation strategies for arrhythmogenic right ventricular cardiomyopathy: a systematic review and meta-analysis

doi: 10.11909/j.issn.1671-5411.2020.11.001
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  • Corresponding author:

    Yan YAO, MD, PhD, Arrhythmia Center, Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, 167 Beilishi Road, Xicheng, Beijing 100037, China. E-mail: ianyao@263.net.cn

  • Received Date: 2020-03-28
  • Accepted Date: 2020-11-17
  • Rev Recd Date: 2020-10-18
  • Available Online: 2020-11-28
  • Publish Date: 2020-11-28
  •  Background Catheter ablation for ventricular tachycardia (VT) in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) has significantly evolved over the past decade. However, different ablation strategies showed inconsistency in acute and long-term outcomes. Methods We searched the databases of Medline, Embase and Cochrane Library through October 17, 2019 for studies describing the clinical outcomes of VT ablation in ARVC. Data including VT recurrence, all-cause mortality, acute procedural efficacy and major procedural complications were extracted. A meta-analysis with trial sequential analysis was further performed in comparative studies of endo-epicardial versus endocardial-only ablation. Results A total of 24 studies with 717 participants were enrolled. The literatures of epicardial ablation were mainly published after 2010 with total ICD implantation of 73.7%, acute efficacy of 89.8%, major complication of 5.2%, follow-up of 28.9 months, VT freedom of 75.3%, all-cause mortality of 1.1% and heart transplantation of 0.6%. Meta-analysis of 10 comparative studies revealed that compared with endocardial-only approach, epicardial ablation significantly decreased VT recurrence (OR: 0.50; 95% CI: 0.30-0.85; P = 0.010), but somehow increased major procedural complications (OR: 4.64; 95% CI: 1.28-16.92; P= 0.02), with not evident improvement of acute efficacy (OR: 2.74; 95% CI: 0.98-7.65; P = 0.051) or all-cause mortality (OR: 0.87; 95% CI: 0.09-8.31; P = 0.90). Conclusion Catheter ablation for VT in ARVC is feasible and effective. Epicardial ablation is associated with better long-term VT freedom, but with more major complications and unremarkable survival or acute efficacy benefit.
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