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For patients with implantable cardioverter defibrillators (ICDs), catheter ablation and antiarrhythmic drug therapy appear to be on par for the prevention of shockable ventricular tachycardias, a meta-analysis found.

There was a following catheter ablation (odds ratio 0.45, 95% confidence interval 0.28-0.71) and antiarrhythmic drug treatment (OR 0.66, 95% CI 0.44-0.97) after more than a year of follow-up.

Of note, the benefit of antiarrhythmic drugs was driven by amiodarone (Cordarone) alone -- with no impact of sotalol (Betapace, Sorine) or novel agents azimilide and celivarone -- , of the Hospital of the University of Pennsylvania in Philadelphia, and colleagues reported online in HeartRhythm.

In addition, a reduction of inappropriate ICD interventions was seen with medication (OR 0.30, 95% CI 0.14-0.62) but not with catheter ablation. Neither treatment was associated with decreased mortality over follow-up, while amiodarone was associated with greater risk of death (OR 3.36, 95% CI 1.36-8.30).

"The potential for harm associated with amiodarone use in patients with ICD and ventricular tachycardia is a new finding, and is particularly relevant in this context since amiodarone was the only agent convincingly associated with a reduction of ventricular tachycardia episodes in our pooled analysis," the authors wrote.

Santangeli's meta-analysis included eight randomized trials with a total of 2,268 participants evaluating antiarrhythmic drugs and six randomized trials with a total of 427 participants evaluating catheter ablation. Both sets of trials used standard medical therapy as the comparator to prevent ventricular tachycardia in patients with ICDs.

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