The Lead Episode 121: A Discussion of Catheter Ablation or Antiarrhythmic Drugs for Ventricular Tachycardia, LIVE at HRX-A Discussion of Catheter Ablation or Antiarrhythmic Drugs for Ventricular Tachycardia, LIVE at HRX (Bonus Video)

A Discussion of Catheter Ablation or Antiarrhythmic Drugs for Ventricular Tachycardia, LIVE at HRX (Bonus Video)

Video Transcription

Video Summary

This episode of Heart Rhythm Society’s The Lead discusses the VANISH II trial, a large randomized study comparing catheter ablation versus antiarrhythmic drug therapy (Sotalol or Amiodarone) in patients with ventricular tachycardia (VT) and implantable cardioverter-defibrillators. The trial showed catheter ablation reduced VT recurrence and ICD shocks by about 25%, though it did not significantly impact overall mortality or VT storm, likely because ablation treats the arrhythmia mechanism but not the underlying heart disease. Experts caution the results apply to ischemic cardiomyopathy patients treated at experienced centers, noting limitations such as patient selection and crossover between treatments. They emphasize the difficulty demonstrating mortality benefit due to patient illness severity and discuss evolving procedural techniques to improve safety and effectiveness, such as minimizing procedural duration and leveraging new technologies like alcohol ablation and advanced mapping. The discussion underscores the ongoing challenges in VT management and the need for earlier intervention and better substrate targeting.

Keywords

VANISH II trial

catheter ablation

ventricular tachycardia

implantable cardioverter-defibrillator

antiarrhythmic drug therapy

ischemic cardiomyopathy