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.