VANISH: Ablation reduces shock burden compared with anti-arrhythmic drug in ventricular tachycardia

Catheter ablation was associated with a reduced shock-treated ventricular tachycardia (VT) event burden and appropriate shock burden compared with escalated anti-arrhythmic drug (AAD) treatment in patients with AAD-refractory VT who experienced a prior myocardial infarction (MI).

The previously published, multicentre, randomised-controlled VANISH trial (NCT00905853) included 259 patients with an implantable cardioverter-defibrillator (ICD) who experienced a prior MI and VT event on AAD treatment in the last 6 months. These patients were randomised to catheter ablation (n=132) or escalated AAD therapy (n=127). After a median follow-up of 23.4 months, the primary composite endpoint of all-cause mortality, VT storm, and appropriate ICD shock favoured ablation over escalated AAD therapy (HR 0.72; P=0.04) [1]. In the current analysis, Prof. Michelle Samuel (University of Montreal, Canada) and colleagues compared shock-treated VT event burden and appropriate shock burden between the 2 study arms [2]. Shock-treated VT event burden was defined as the total number of VT events treated with ≥1 ICD or external shock. Appropriate shock burden was calculated as the total number of appropriate ICD or external shocks, regardless of the number of VT events.

The number of shock-treated VT events per 100 person-years was lower in the catheter ablation arm (39.07) than in the escalated AAD therapy arm (64.60; Anderson-Gill HR 0.60; 95% CI 0.38–0.95; see Figure). Similarly, the number of appropriate shock events favoured the ablation arm (48.35) over the AAD arm (78.23; Anderson-Gill HR 0.61; 95% CI 0.37–0.96).

Figure: Shock-treated ventricular tachycardia event burden [2]



 

 

 

 

 

 

 

 

 

 

 

 

 

AAD, anti-arrhythmic drug; AG HR, Anderson-Gill hazard ratio; CI, confidence interval VT, ventricular tachycardia.

“Among patients with AAD-refractory VT and a prior MI, catheter ablation reduced shock-treated VT event burden by 40% and appropriate shock burden by 39%, compared with escalated AAD therapy,” concluded Dr Samuel.

1. Sapp JL, et al. N Eng J Med 2016;375:111–121.
2. Samuel M, et al. Reduction in shock burden with catheter ablation versus escalated antiarrhythmic drug therapy: Insights from the VANISH trial. News from ventricular ablation, EHRA 2022, 3–5 April, Copenhagen, Denmark.

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Posted on 1 June, 20221 June, 2022