{"id":"c1c983b9212f","type":"article","url":"https://hartvaat.nl/2026/06/02/vroege-katheterablatie-even-effectief-als-antiaritmica-bij-ischemische-ventricul/","title":"Vroege katheterablatie even effectief als antiaritmica bij ischemische ventriculaire tachycardie — meta-analyse","title_en":"Early catheter ablation vs. antiarrhythmic drugs in treatment-naïve ischaemic ventricular tachyarrhythmias: a meta-analysis of randomized controlled trials.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euag073","source_url":"https://doi.org/10.1093/europace/euag073","authors":["Tiago Moura Façanha","Anna Isabelle Gomes Pereira","Maria Fernanda Carvalho Garcia","Enzo Tunala Mendonça","João Vitor Jacobsen Ramos","Leonardo Antunes Mesquita"],"significance":6,"published":"2026-08-12","source_date":"2026-06-02","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/esc-richtlijn-af-2024/","https://hartvaat.nl/kennis/ritmestoornissen/katheterablatie-vt/"],"congress":"","summary_en":"A meta-analysis of three randomized controlled trials (n=618) evaluated early catheter ablation versus antiarrhythmic drugs as initial therapy for ventricular tachycardia in patients with prior myocardial infarction. Both strategies demonstrated comparable efficacy for all-cause mortality, appropriate ICD therapies, and VT storm, while ablation showed a trend toward fewer hospitalizations and adverse events, though largely driven by a single study. These results support considering early ablation as a first-line option in selected patients, pending further confirmation in larger trials.","created":"2026-08-05T01:07:47Z","updated":"2026-08-10T10:36:02Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Een meta-analyse van drie gerandomiseerde trials (n=618) vergeleek vroege katheterablatie met antiaritmische medicatie als eerste behandeling bij patiënten met een voorgeschiedenis van myocardinfarct en ventriculaire tachycardie. Er waren geen significante verschillen in sterfte, ICD-therapieën of VT-storm tussen beide strategieën, hoewel ablatie gepaard ging met minder ziekenhuisopnames en bijwerkingen, zij het grotendeels gedreven door één trial. Deze bevindingen ondersteunen overweging van ablatie als eerste-linjetherapie bij geselecteerde patiënten, mits rekening wordt gehouden met de heterogeniteit in de onderliggende data.","abstract_original":"INTRODUCTION: Antiarrhythmic drugs (AADs) have traditionally been used as first-line therapy for ventricular tachycardia (VT) but are frequently associated with systemic toxicities and drug interactions. Therefore, we performed a meta-analysis comparing early catheter ablation (CA) with AAD therapy as initial treatment for VT in patients with prior myocardial infarction. METHODS AND RESULTS: PubMed, Embase, and the Cochrane Library were searched for randomized controlled trials comparing CA vs. AAD in patients naïve to both strategies. Meta-analysis was performed using Review Manager. Three randomized trials including 618 patients were analysed. No significant differences were observed in all-cause mortality, appropriate implantable cardioverter-defibrillator (ICD) therapies (including shocks and antitachycardia pacing), ventricular arrhythmia storm, hospitalizations, or adverse events between strategies. Leave-one-out sensitivity analysis identified one trial as the primary contributor to between-study heterogeneity. CONCLUSION: Early catheter ablation provides similar efficacy to first-line antiarrhythmic drug therapy for major arrhythmic and survival outcomes, with reductions in hospitalizations and treatment-related adverse events, although largely driven by one trial. These findings support consideration of CA as a first-line therapeutic strategy in selected patients with ischaemic VT."}