Incremental benefits of catheter ablation in patients with structural heart disease undergoing implantable cardioverter-defibrillator therapy for ventricular arrhythmias: A PRISMA compliant systematic review and meta analysis

BACKGROUND: Structural heart disease (SHD) significantly increases the risk of life-threatening ventricular arrhythmias (VAs), contributing to sudden cardiac death. Implantable cardioverter-defibrillators are the cornerstone of prevention but do not eliminate arrhythmia recurrences or reduce the arrhythmogenic substrate. Catheter ablation has emerged as a potential adjunctive therapy to reduce VA burden and implantable cardioverter-defibrillator (ICD) interventions in patients with SHD. This meta-analysis aimed to evaluate the incremental benefits of catheter ablation compared to antiarrhythmic drug (AAD) therapy or standard care in patients with SHD undergoing ICD implantation for VAs. METHODS: A systematic search was conducted till April 2025 across PubMed/MEDLINE, Cochrane, google scholar and science direct following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies included patients with SHD receiving ICD therapy, comparing catheter ablation with any alternative treatment. Outcomes assessed included mortality, arrhythmia recurrence, disease burden, and ICD interventions. Statistical analysis was performed using Review Manager, calculating odds ratios (ORs) and 95% confidence intervals (CI), with heterogeneity assessed via I2 statistics. RESULTS: Eight studies were included, encompassing 536 patients in the catheter ablation group and 560 patients in the control group. Catheter ablation did not significantly reduce all-cause mortality (OR = 0.79, 95% CI: 0.48-1.29, P = .34), cardiovascular mortality (OR = 0.73, 95% CI: 0.37-1.43, P = .36), or death (OR = 0.86, 95% CI: 0.53-1.38, P = .52). However, catheter ablation was associated with a significant reduction in recurrent ventricular tachycardia (VT) (OR = 0.42, 95% CI: 0.27-0.64, P < .001) and cardiac hospitalization (OR = 0.55, 95% CI: 0.34-0.89, P = .015). No significant differences were observed for VT storm or electrical storm. Importantly, catheter ablation significantly reduced inappropriate ICD shocks (OR = 0.36, 95% CI: 0.20-0.66, P < .001), while rates of appropriate ICD shocks and antitachycardia pacing were similar between groups. CONCLUSION: Catheter ablation offers significant benefits in reducing arrhythmia burden and inappropriate ICD shocks but does not impact overall mortality compared to antiarrhythmic therapy in patients with SHD undergoing ICD implantation.