Outcomes in endocardial versus endo-epicardial catheter ablation in patients with arrhythmogenic right ventricular cardiomyopathy: a systematic review and meta analysis

Both endocardial and combined endo-epicardial ventricular tachycardia (VT) ablation approaches have been utilized in patients with ARVC. Although there are data from single-center studies on both these approaches, there is paucity of data on direct comparison of these 2 ablation approaches.

We searched major electronic databases for studies that had compared endocardial ablation to combined endo-epicardial VT ablation in patients with ARVC. The outcomes were pooled using a random-effects model, and the results were expressed as risk ratios (RR) with corresponding 95% confidence intervals (CI). Statistical heterogeneity was assessed using the I2 statistic and all analyses were conducted using RStudio.

Primary outcomes:

VT/VF recurrence

Secondary/safety outcomes:

Major complications

From the 11 studies utilized in our meta-analysis, a total of 633 patients were included. Endo-epicardial ablation was associated with a 30% relative risk reduction (RRR) in ventricular arrhythmia (VA) recurrence when compared with endocardial ablation alone (risk ratio [RR], 0.70; 95% confidence interval [CI], 0.53-0.93; P < .0001). There was also an absolute risk reduction (ARR) for ventricular tachycardia recurrence of 28.34%, with a number needed to treat (NNT) of 3.53. However, the endo-epicardial ablation group was also associated with a higher risk of major complications when compared to the endocardial ablation group alone (risk ratio [RR], 3.58; 95% confidence interval [CI], 1.01-12.71; P = 0.37). This was associated with an attributable risk (AR) of 2.81%, and a number needed to harm (NNH) of 35.58.

Through our meta-analysis, we observed that a combined endocardial-epicardial VT ablation approach was associated with a significant reduction in VT recurrence when compared with endocardial ablation alone. On balance, endo-epicardial ablation is also associated with greater risk of major complications when compared with endocardial ablation alone, thus shedding light on avenues for further study of this approach.

Findings of Endo-Epicardial vs Endo