{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T20:39:51Z","timestamp":1791319191664,"version":"4.3.1"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T00:00:00Z","timestamp":1750291200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Ventricular tachycardia (VT) ablation has been shown to reduce the recurrence of VT episodes, but the timing of performing VT ablation (early; at the time of implantable cardioverter defibrillator implantation) or (deferred: after the patient has received ICD shocks) remains controversial. The objective is to conduct a systematic review and meta-analysis of published data from randomized controlled trials (RCTs) in patients with ischaemic cardiomyopathy (ICM) with the aim of comparing outcome of VT ablation stratified by procedural timing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>We conducted a meta-analysis of seven landmark RCTs which included patients with ICM who were either at a high risk of VT or experienced VT\/ICD shocks. The primary outcome of VT recurrence was compared according to the timing of performing VT ablation (early vs. deferred). In addition, we also compared the secondary outcome of cardiac mortality. Following a comprehensive search strategy, a total of seven RCTs were included within the final analysis. Based on a pooled analysis, early VT ablation was associated with a significant reduction in the primary outcome [pooled odds ratio (OR) of 0.72, 95% confidence interval (CI): 0.55\u20130.95, P &amp;lt; 0.05] in comparison with a \u2018deferred VT ablation\u2019 strategy. The cumulative absolute risk reduction (ARR) for the primary outcome was 0.21, and number needed to treat (NNT) to prevent the outcome of VT recurrence was 4.81. Furthermore, the effect size of early VT ablation compared to a deferred VT ablation approach was more pronounced in reduction of ICD shocks in the subgroup of patients with LVEF &amp;gt; 30% vs. those with LVEF &amp;lt; 30% (pooled OR of 0.65, 95% CI of 0.54\u20130.79, P = 0.01). For the secondary outcomes, we observed that an earlier timing of VT ablation was also associated with both a decrease in cardiac mortality (pooled OR of 0.59, 95% CI of 0.43\u20130.82) and in the subsequent risk of VT storm (pooled OR of 0.63, 95% CI of 0.51\u20130.78) when compared with a deferred timing. The cumulative ARR for cardiac mortality was 0.07 and NNT was 15.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The findings from this pooled analysis of seven major RCTs suggest that performing early VT ablation may be beneficial in reducing recurrent VT, ICD shocks, and electrical storm and could also improve cardiac mortality. The benefit of performing early VT ablation was greater in patients with LVEF of &amp;gt;30% amongst this ICM cohort.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjopen\/oeaf076","type":"journal-article","created":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T07:59:08Z","timestamp":1750319948000},"source":"Crossref","is-referenced-by-count":8,"title":["Early vs. deferred catheter ablation of ventricular tachycardia in patients of ischaemic substrate: systematic review and meta-analysis of clinical outcomes"],"prefix":"10.1093","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1241-4054","authenticated-orcid":false,"given":"Abhishek","family":"Maan","sequence":"first","affiliation":[{"name":"Department of Cardiac Electrophysiology , 3000 Arlington Avenue, Toledo, OH 43604 ,","place":["USA"]},{"name":"Department of Health Policy and Economics, London School of Economics & Political Sciences , Houghton Street, London WC2A 2AE ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3876-9192","authenticated-orcid":false,"given":"Maaz","family":"Waseem","sequence":"additional","affiliation":[{"name":"Department of Biological Sciences , CW405, Edmonton, AB ,","place":["Canada T6G 2E9"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex","family":"Carter","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Economics, London School of Economics & Political Sciences , Houghton Street, London WC2A 2AE ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirtivardhan","family":"Vashishtha","sequence":"additional","affiliation":[{"name":"Icahn School of Medicine, Mount Sinai Hospital , 1450 Madison Ave, New York, NY, 10029 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5806-8567","authenticated-orcid":false,"given":"Tarvinder","family":"Dhanjal","sequence":"additional","affiliation":[{"name":"Division of Biomedical Sciences, Warwick Medical School , Coventry CV4 7 AL ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2221-8372","authenticated-orcid":false,"given":"Jacob","family":"Koruth","sequence":"additional","affiliation":[{"name":"Icahn School of Medicine, Mount Sinai Hospital , 1450 Madison Ave, New York, NY, 10029 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5605-4724","authenticated-orcid":false,"given":"E Kevin","family":"Heist","sequence":"additional","affiliation":[{"name":"Massachusetts General Hospital, Harvard Medical School , 55 Fruit Street, Boston, MA 02114 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,6,19]]},"reference":[{"key":"2025081804511145600_oeaf076-B1","doi-asserted-by":"crossref","first-page":"3997","DOI":"10.1093\/eurheartj\/ehac262","article-title":"2022 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death","volume":"43","author":"Zeppenfeld","year":"2022","journal-title":"Eur Heart J"},{"key":"2025081804511145600_oeaf076-B2","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1016\/j.hrthm.2017.10.009","article-title":"Impact of ventricular tachycardia ablation on health care utilization","volume":"15","author":"Winterfield","year":"2018","journal-title":"Heart Rhythm"},{"key":"2025081804511145600_oeaf076-B3","doi-asserted-by":"crossref","first-page":"2591","DOI":"10.1161\/01.CIR.0000145610.64014.E4","article-title":"Prospective randomized multicenter trial of empirical antitachycardia pacing versus shocks for spontaneous rapid ventricular tachycardia in patients with implantable cardioverter-defibrillators: pacing fast ventricular tachycardia reduces shock therapies (PainFREE Rx II) trial results","volume":"110","author":"Wathen","year":"2004","journal-title":"Circulation"},{"key":"2025081804511145600_oeaf076-B4","doi-asserted-by":"crossref","first-page":"e007600","DOI":"10.1161\/CIRCEP.119.007600","article-title":"Antiarrhythmic drugs or catheter ablation in the management of ventricular tachyarrhythmias in patients with implantable cardioverter defibrillators: a systematic review and meta-analysis of randomized controlled trials","volume":"12","author":"Kheiri","year":"2019","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"2025081804511145600_oeaf076-B5","doi-asserted-by":"crossref","first-page":"808","DOI":"10.1016\/j.jacep.2023.01.030","article-title":"Ventricular tachycardia and ICD therapy burden with catheter ablation versus escalated antiarrhythmic drug therapy","volume":"9","author":"Samuel","year":"2023","journal-title":"JACC Clin Electrophysiol"},{"key":"2025081804511145600_oeaf076-B6","first-page":"169","article-title":"Health care utilization after ventricular tachycardia ablation: a propensity score-matched cohort study","volume":"35","author":"Porta-S\u00e1nchez","year":"2019","journal-title":"Can J Cardiol"},{"key":"2025081804511145600_oeaf076-B7","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.hrthm.2017.08.022","article-title":"Successful ventricular tachycardia ablation in patients with electrical storm reduces recurrences and improves survival","volume":"15","author":"Vergara","year":"2018","journal-title":"Heart Rhythm"},{"key":"2025081804511145600_oeaf076-B8","doi-asserted-by":"crossref","first-page":"1850","DOI":"10.1161\/CIRCULATIONAHA.122.059730","article-title":"Can early ablation of ventricular tachycardia improve survival?","volume":"145","author":"Kanagasundram","year":"2022","journal-title":"Circulation"},{"key":"2025081804511145600_oeaf076-B9","doi-asserted-by":"crossref","first-page":"b2700","DOI":"10.1136\/bmj.b2700","article-title":"The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration","volume":"339","author":"Liberati","year":"2009","journal-title":"BMJ"},{"key":"2025081804511145600_oeaf076-B10","doi-asserted-by":"crossref","first-page":"d5928","DOI":"10.1136\/bmj.d5928","article-title":"The Cochrane Collaboration's tool for assessing risk of bias in randomised trials","volume":"343","author":"Higgins","year":"2011","journal-title":"BMJ"},{"key":"2025081804511145600_oeaf076-B11","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1016\/j.jclinepi.2010.07.017","article-title":"GRADE guidelines: 4. Rating the quality of evidence\u2014study limitations (risk of bias)","volume":"64","author":"Guyatt","year":"2011","journal-title":"J Clin Epidemiol"},{"key":"2025081804511145600_oeaf076-B12","doi-asserted-by":"crossref","first-page":"I5342","DOI":"10.1136\/bmj.l5342","article-title":"A guide to prospective meta-analysis","volume":"367","author":"Seidler","year":"2019","journal-title":"BMJ"},{"key":"2025081804511145600_oeaf076-B13","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/0197-2456(86)90046-2","article-title":"Meta-analysis in clinical trials","volume":"7","author":"DerSimonian","year":"1986","journal-title":"Control Clin Trials"},{"key":"2025081804511145600_oeaf076-B14","doi-asserted-by":"crossref","first-page":"2657","DOI":"10.1056\/NEJMoa065457","article-title":"Prophylactic catheter ablation for the prevention of defibrillator therapy","volume":"357","author":"Reddy","year":"2007","journal-title":"N Engl J Med"},{"key":"2025081804511145600_oeaf076-B15","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/S0140-6736(09)61755-4","article-title":"Catheter ablation of stable ventricular tachycardia before defibrillator implantation in patients with coronary heart disease (VTACH): a multicentre randomised controlled trial","volume":"375","author":"Kuck","year":"2010","journal-title":"Lancet"},{"key":"2025081804511145600_oeaf076-B16","doi-asserted-by":"crossref","first-page":"e004422","DOI":"10.1161\/CIRCEP.116.004422","article-title":"Impact of substrate modification by catheter ablation on implantable cardioverter-defibrillator interventions in patients with unstable ventricular arrhythmias and coronary artery disease: results from the multicenter randomized controlled SMS (substrate modification study)","volume":"10","author":"Kuck","year":"2017","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"2025081804511145600_oeaf076-B17","doi-asserted-by":"crossref","first-page":"1829","DOI":"10.1161\/CIRCULATIONAHA.122.059598","article-title":"Does timing of ventricular tachycardia ablation affect prognosis in patients with an implantable cardioverter defibrillator? Results from the multicenter randomized PARTITA trial","volume":"145","author":"Della Bella","year":"2022","journal-title":"Circulation"},{"key":"2025081804511145600_oeaf076-B18","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1161\/CIRCULATIONAHA.119.043400","article-title":"Preventive or deferred ablation of ventricular tachycardia in patients with ischemic cardiomyopathy and implantable defibrillator (BERLIN VT): a multicenter randomized trial","volume":"141","author":"Willems","year":"2020","journal-title":"Circulation"},{"key":"2025081804511145600_oeaf076-B19","doi-asserted-by":"crossref","first-page":"1839","DOI":"10.1161\/CIRCULATIONAHA.122.060039","article-title":"First-line catheter ablation of monomorphic ventricular tachycardia in cardiomyopathy concurrent with defibrillator implantation: the PAUSE-SCD randomized trial","volume":"145","author":"Tung","year":"2022","journal-title":"Circulation"},{"key":"2025081804511145600_oeaf076-B20","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1056\/NEJMoa2409501","article-title":"Catheter ablation or antiarrhythmic drugs for ventricular tachycardia","volume":"392","author":"Sapp","year":"2025","journal-title":"N Engl J Med"},{"key":"2025081804511145600_oeaf076-B21","doi-asserted-by":"crossref","first-page":"1010","DOI":"10.1111\/pace.13149","article-title":"Impact of timing of recurrence following catheter ablation of scar-related ventricular tachycardia on subsequent mortality","volume":"40","author":"Muser","year":"2017","journal-title":"Pacing Clin Electrophysiol"},{"key":"2025081804511145600_oeaf076-B22","doi-asserted-by":"crossref","first-page":"e004432","DOI":"10.1161\/CIRCEP.116.004432","article-title":"Prognostic impact of the timing of recurrence of infarct-related ventricular tachycardia after catheter ablation","volume":"9","author":"Siontis","year":"2016","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"2025081804511145600_oeaf076-B23","doi-asserted-by":"crossref","first-page":"1442","DOI":"10.1002\/joa3.13175","article-title":"Predictors of long-term success after high-density mapping-guided substrate ablation procedures for ventricular tachycardia in patients with ischemic cardiomyopathy","volume":"40","author":"Balt","year":"2024","journal-title":"J Arrhythm"},{"key":"2025081804511145600_oeaf076-B24","doi-asserted-by":"crossref","first-page":"e010279","DOI":"10.1161\/CIRCEP.121.010279","article-title":"Substrate characterization and outcome of catheter ablation of ventricular tachycardia in patients with nonischemic cardiomyopathy and isolated epicardial scar","volume":"14","author":"Liuba","year":"2021","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"2025081804511145600_oeaf076-B25","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1016\/j.jacep.2015.07.006","article-title":"Scar extension measured by magnetic resonance-based signal intensity mapping predicts ventricular tachycardia recurrence after substrate ablation in patients with previous myocardial infarction","volume":"1","author":"\u00c1vila","year":"2015","journal-title":"JACC Clin Electrophysiol"},{"key":"2025081804511145600_oeaf076-B26","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1161\/CIRCHEARTFAILURE.110.957480","article-title":"A systematic assessment of causes of death after heart failure onset in the community: impact of age at death, time period, and left ventricular systolic dysfunction","volume":"4","author":"Lee","year":"2011","journal-title":"Circ Heart Fail"},{"key":"2025081804511145600_oeaf076-B27","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1016\/j.hrthm.2013.04.011","article-title":"Electrocardiographic left ventricular scar burden predicts clinical outcomes following infarct-related ventricular tachycardia ablation","volume":"10","author":"Kojodjojo","year":"2013","journal-title":"Heart Rhythm"},{"key":"2025081804511145600_oeaf076-B28","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1016\/j.jacep.2022.11.004","article-title":"Early mortality after VT ablation: \u201cthe remedy worse than the disease\u201d?","volume":"9","author":"Eckardt","year":"2023","journal-title":"JACC Clin Electrophysiol"},{"key":"2025081804511145600_oeaf076-B29","doi-asserted-by":"crossref","first-page":"824","DOI":"10.1016\/j.jacep.2022.10.024","article-title":"Causes of early mortality after ventricular tachycardia ablation in patients with reduced ejection fraction","volume":"9","author":"Lee","year":"2023","journal-title":"JACC Clin Electrophysiol"},{"key":"2025081804511145600_oeaf076-B30","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1161\/CIRCRESAHA.123.321553","article-title":"Mechanism of ventricular tachycardia occurring in chronic myocardial infarction scar","volume":"134","author":"Donahue","year":"2024","journal-title":"Circ Res"},{"key":"2025081804511145600_oeaf076-B31","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1161\/01.CIR.77.3.589","article-title":"Reentry as a cause of ventricular tachycardia in patients with chronic ischemic heart disease: electrophysiologic and anatomic correlation","volume":"77","author":"de Bakker","year":"1988","journal-title":"Circulation"},{"key":"2025081804511145600_oeaf076-B32","doi-asserted-by":"crossref","first-page":"830","DOI":"10.1038\/s41467-022-28418-1","article-title":"Heterogeneous repolarization creates ventricular tachycardia circuits in healed myocardial infarction scar","volume":"13","author":"Kelemen","year":"2022","journal-title":"Nat Commun"},{"key":"2025081804511145600_oeaf076-B33","doi-asserted-by":"crossref","first-page":"2158","DOI":"10.1016\/j.jacep.2024.06.016","article-title":"Evolution of substrate for ventricular arrhythmias early postinfarction: insights from a porcine ischemia-reperfusion model","volume":"10","author":"Bhaskaran","year":"2024","journal-title":"JACC Clin Electrophysiol"},{"key":"2025081804511145600_oeaf076-B34","doi-asserted-by":"crossref","first-page":"173","DOI":"10.15420\/aer.2019.31.3","article-title":"Preventive ventricular tachycardia ablation in patients with ischaemic cardiomyopathy: meta-analysis of randomised trials","volume":"8","author":"Tilz","year":"2019","journal-title":"Arrhythm Electrophysiol Rev"},{"key":"2025081804511145600_oeaf076-B35","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1016\/j.hroo.2020.08.001","article-title":"Preventive versus deferred catheter ablation of myocardial infarct-associated ventricular tachycardia: a meta-analysis","volume":"1","author":"Kampaktsis","year":"2020","journal-title":"Heart Rhythm O2"}],"container-title":["European Heart Journal Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjopen\/advance-article-pdf\/doi\/10.1093\/ehjopen\/oeaf076\/63528647\/oeaf076.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjopen\/article-pdf\/5\/4\/oeaf076\/63528647\/oeaf076.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjopen\/article-pdf\/5\/4\/oeaf076\/63528647\/oeaf076.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,18]],"date-time":"2025-08-18T08:51:21Z","timestamp":1755507081000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjopen\/article\/doi\/10.1093\/ehjopen\/oeaf076\/8169431"}},"subtitle":[],"editor":[{"given":"Frieder","family":"Braunschweig","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,6,19]]},"references-count":35,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2025,7,4]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjopen\/oeaf076","relation":{},"ISSN":["2752-4191"],"issn-type":[{"value":"2752-4191","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,7]]},"published":{"date-parts":[[2025,6,19]]},"article-number":"oeaf076"}}