The Lead Episode 90: Catheter Ablation or Antiarrhythmic Drugs for Ventricular Tachycardia-The New England Journal of Medicine

The New England Journal of Medicine

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The study, published in the New England Journal of Medicine, investigates the efficacy of catheter ablation versus antiarrhythmic drug therapy as a first-line treatment for patients with ventricular tachycardia (VT) and ischemic cardiomyopathy who have implantable cardioverter-defibrillators (ICDs). The international, randomized VANISH2 trial included 416 patients with prior myocardial infarction and clinically significant VT. They were assigned to either catheter ablation or receive antiarrhythmic drugs, such as sotalol or amiodarone. The primary endpoint was a composite of death during follow-up or significant VT events needing intervention more than 14 days post-randomization.<br /><br />Over a median follow-up of 4.3 years, the study found that catheter ablation resulted in a lower risk of reaching the primary endpoint compared to drug therapy (50.7% vs. 60.6%, with a hazard ratio of 0.75, P=0.03). Catheter ablation was associated with lower incidences of appropriate ICD shock and treated sustained VT below the detection limit of ICDs.<br /><br />Despite the benefits of catheter ablation, the procedure carried risks, including a 1% mortality rate and non-fatal complications in 11.3% of cases. Comparatively, serious adverse events related to antiarrhythmic drugs occurred in 21.6% of the drug therapy group. The study highlighted the importance of determining optimal treatment strategies for VT management, balancing efficacy with potential adverse events.<br /><br />Overall, the findings suggest that catheter ablation might be a more effective initial strategy than antiarrhythmic drugs for reducing recurrent VT and ICD interventions in patients with ischemic cardiomyopathy, although it involves procedural risks that must be carefully considered. The research was supported by the Canadian Institutes of Health Research, among others.

Keywords

catheter ablation

antiarrhythmic drug therapy

ventricular tachycardia

ischemic cardiomyopathy

implantable cardioverter-defibrillators

VANISH2 trial

myocardial infarction

sotalol

amiodarone

treatment strategies