CHICAGO — Research presented at the American Heart Association Scientific Sessions indicates that catheter ablation leads to better outcomes than antiarrhythmic drug therapy for patients suffering from ventricular tachycardia (VT) and ischemic cardiomyopathy.
Dr. John L. Sapp, a clinical cardiac electrophysiologist at the Queen Elizabeth II Health Sciences Centre and assistant dean of clinical research at Dalhousie University in Halifax, Nova Scotia, highlighted the significance of this finding during a press conference. He noted that patients experiencing VT and receiving shocks generally have poorer outcomes than those who do not. “Sometimes we need to suppress VT,” he stated, explaining that there are two primary methods: catheter ablation and antiarrhythmic drugs. Previous studies, including the VANISH trial, showed that when antiarrhythmic drugs fail, catheter ablation is a more effective option.
The recent VANISH2 trial involved 416 patients who had a history of myocardial infarction (MI), an implantable cardioverter defibrillator (ICD), and clinically significant VT. Participants were randomly assigned to receive either catheter ablation or antiarrhythmic drug therapy (sotalol or amiodarone). The average age of participants in the catheter ablation group was 67.7 years, with 95.1% being men, while the drug therapy group had an average age of 68.4 years, with 92.5% men.
The primary outcome measured was a combination of all-cause mortality during follow-up or incidents of VT storm, appropriate ICD shocks, or sustained VT requiring medical intervention after more than 14 days from randomization. The median follow-up period lasted 4.2 years.
Results showed that catheter ablation reduced the risk of death by 16%, VT storms by 5%, appropriate ICD shocks by 25%, and emergency treatments for VT by an impressive 74%. The latter result was statistically significant (HR = 0.26; 95% CI, 0.13-0.55), although it was observed in a smaller subset of patients.
In the catheter ablation group, two patients (1%) died within 30 days post-procedure, while 23 patients (11.3%) experienced adverse events.
In contrast, the drug therapy group reported one patient (0.5%) who died from pulmonary toxicity related to the medication and 46 patients (21.6%) who suffered nonfatal adverse events linked to drug therapy.
Dr. Sapp concluded that for patients with a history of heart attacks presenting with VT, catheter ablation proved to be more effective in suppressing the primary outcomes compared to antiarrhythmic drugs.
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