"Ventricular Tachycardia Ablation versus Escalation of Antiarrhythmic Drugs".The New England Journal of Medicine. 2016. 375(2):111-121.
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Among patients with ischemic cardiomyopathy and an implantable cardioverter–defibrillator (ICD) with ventricular tachycardia despite antiarrhythmic drug therapy, is catheter ablation more effective than escalated antiarrhythmic drug therapy in reducing the rate of death, ventricular tachycardia storm, or appropriate ICD shock?
Catheter ablation was more effective than escalated antiarrhythmic drug therapy in reducing the composite outcome of death, ventricular tachycardia storm, or appropriate ICD shock among patients with ischemic cardiomyopathy who have ventricular tachycardia despite antiarrhythmic drug therapy.
The Ventricular Tachycardia Ablation versus Escalated Antiarrhythmic Drug Therapy in Ischemic Heart Disease (VANISH) trial concluded that for patients with ischemic cardiomyopathy and recurrent ventricular tachycardia despite antiarrhythmic drug therapy, catheter ablation reduces the rate of a composite outcome of death, ventricular tachycardia storm, or appropriate ICD shock compared to escalated antiarrhythmic drug therapy.
Current guidelines recommend catheter ablation when antiarrhythmic drug therapy does not prevent recurrent ventricular tachycardia, although this recommendation has been based on expert opinion and nonrandomized case series. This trial provides evidence for preferring catheter ablation over escalated antiarrhythmic drug therapy to reduce recurrent ventricular tachycardia in this population.
Multicenter, randomized, controlled trial.
259 patients with ischemic cardiomyopathy and an ICD with ventricular tachycardia despite antiarrhythmic drugs.
Patients were randomized to either catheter ablation (n=132) or escalated antiarrhythmic drug therapy (n=127).
Composite outcome of death at any time, ventricular tachycardia storm, or appropriate ICD shock. Primary outcome occurred in 59.1% of the ablation group vs. 68.5% of the escalated-therapy group (HR 0.72; 95% CI, 0.53 to 0.98; P=0.04). No significant differences in mortality.
The trial was not powered to assess the effects of treatments on mortality and was conducted at experienced centers, limiting generalizability.
Canadian Institutes of Health Research with additional financial support from St. Jude Medical and Biosense Webster.
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