{"id":138550,"date":"2024-11-17T20:36:04","date_gmt":"2024-11-18T01:36:04","guid":{"rendered":"https:\/\/cardiologynownews.org\/?p=138550"},"modified":"2026-02-12T10:37:53","modified_gmt":"2026-02-12T15:37:53","slug":"catheter-ablation-better-than-antiarrhythmic-drugs-for-vt-in-ischemic-cardiomyopathy-with-icd-vanish2-trial","status":"publish","type":"post","link":"https:\/\/cardiologynownews.org\/?p=138550","title":{"rendered":"Catheter Ablation Better Than Antiarrhythmic Drugs for VT in Ischemic Cardiomyopathy With ICD: VANISH2 Trial"},"content":{"rendered":"<p><strong>Key Takeaways<\/strong>:<\/p>\n<ul>\n<li>The VANISH2 trial compared catheter ablation with systematic antiarrhythmic drug therapy as a first-line treatment strategy in patients with an ICD ischemic cardiomyopathy, and ventricular tachycardia who had no history of nonresponse to antiarrhythmic drug therapy.<\/li>\n<li>Catheter ablation significantly reduced the composite primary outcome (death, VT storm, ICD shock, and VT emergency treatment) compared with antiarrhythmic drug therapy (HR, 0.75; 95% CI, 0.58\u20130.97;\u00a0P=0.03).<\/li>\n<li>Sustained VT requiring treatment below the detection limit of an ICD was notably reduced in the catheter ablation group (HR, 0.26; 95% CI, 0.13\u20130.55;\u00a0P&lt;0.001).<\/li>\n<li>Mortality rates were similar between groups, with no statistically significant difference (HR, 0.84; 95% CI, 0.56\u20131.24;\u00a0P=0.38).<\/li>\n<li>Catheter ablation demonstrated a comparable safety profile, with fewer drug-related adverse events compared to antiarrhythmic drugs.<\/li>\n<\/ul>\n<p><!--more--><\/p>\n<p>Ventricular tachycardia (VT) poses a major risk for patients with ischemic cardiomyopathy, often leading to recurrent ICD shocks and worse outcomes. Antiarrhythmic drugs such as sotalol and amiodarone are typically the first-line treatments, but they carry risks of systemic toxicity.<\/p>\n<p>The Ventricular Tachycardia Antiarrhythmics or Ablation in Ischemic Heart Disease (VANISH) trial showed that ablation and continuation of baseline antiarrhythmic medications in patients with ventricular tachycardia and ischemic cardiomyopathy led to a lower risk of a composite of death, appropriate ICD shock, or ventricular tachycardia storm than escalation of antiarrhythmic drug therapy. The VANISH2 trial compared catheter ablation with systematic antiarrhythmic drug therapy as a first-line treatment strategy in patients with an ICD, ischemic cardiomyopathy, and ventricular tachycardia who had no history of nonresponse to antiarrhythmic drug therapy (ClinicalTrials.gov number, NCT02830360.) The results of this study were presented at AHA Scientific Sessions 2024 with <a href=\"https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMoa2410027\">simultaneous publication<\/a> in the <em>New England Journal of Medicine.<\/em><\/p>\n<p>The VANISH2 trial was a multicenter, open-label randomized trial comparing catheter ablation with antiarrhythmic drug therapy (amiodarone or sotalol) in 416 patients with ischemic cardiomyopathy, ICDs, and recent VT episodes. Catheter ablation was performed within 14 days after randomization; sotalol or amiodarone was administered as antiarrhythmic drug therapy according to prespecified criteria. The primary endpoint was a composite of all-cause death, VT storm, ICD shocks, and sustained VT requiring medical intervention, measured over a median follow-up of 4.3 years. Secondary endpoints assessed individual components of the composite outcome and adverse events.<\/p>\n<p>After a median of 4,3 years, the primary composite endpoint occurred in\u00a050.7%\u00a0of the catheter ablation group and\u00a060.6%\u00a0of the antiarrhythmic drug group (HR, 0.75; 95% CI, 0.58\u20130.97;\u00a0P=0.03). Sustained VT requiring treatment below the detection limit of an ICD occurred in\u00a04.4%\u00a0of the catheter ablation group versus\u00a016.4%\u00a0in the antiarrhythmic drug group (HR, 0.26; 95% CI, 0.13\u20130.55;\u00a0P&lt;0.001). Rates of VT storm were\u00a021.7%\u00a0in the catheter ablation group and\u00a023.5%\u00a0in the drug group (HR, 0.95; 95% CI, 0.63\u20131.42;\u00a0P=0.81), while ICD shocks occurred in\u00a029.6%\u00a0and\u00a038.0%, respectively (HR, 0.75; 95% CI, 0.53\u20131.04;\u00a0P=0.08). All-cause mortality was\u00a022.2%\u00a0in the catheter ablation group and\u00a025.4%\u00a0in the drug therapy group, with no significant difference (HR, 0.84; 95% CI, 0.56\u20131.24;\u00a0P=0.38). Adverse events were reported in\u00a028.1%\u00a0of the catheter ablation group and\u00a030.5%\u00a0of the drug therapy group (P=0.62). Among catheter ablation patients, procedural complications included two deaths (1%) and nonfatal cardiac events, such as stroke and perforation, in 11.3% of patients. In the antiarrhythmic drug group, drug-related adverse events such as pulmonary toxicity and thyroid dysfunction occurred in 21.6% of patients, leading to treatment discontinuation in several cases.<\/p>\n<p>Dr. John L. Sapp, the lead investigator, stated, \u201cThese results may change how heart attack survivors with ventricular tachycardia are treated. Currently, catheter ablation is often reserved as a last-resort therapy when antiarrhythmic medications fail or cannot be tolerated. Now we know that ablation is a reasonable option for first-line treatment.\u201d These findings highlight catheter ablation&#8217;s effectiveness as an early intervention for VT management, offering an alternative to drug therapy.<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Key Takeaways: The VANISH2 trial compared catheter ablation with systematic antiarrhythmic drug therapy as a first-line treatment strategy in patients with an ICD ischemic cardiomyopathy, and ventricular tachycardia who had no history of nonresponse to antiarrhythmic drug therapy. Catheter ablation significantly reduced the composite primary outcome (death, VT storm, ICD shock, and VT emergency treatment) [&hellip;]<\/p>\n","protected":false},"author":40616,"featured_media":138551,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[896,8],"tags":[897,45,47,185],"ppma_author":[1070],"class_list":{"0":"post-138550","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-aha-2024","8":"category-news","9":"tag-aha-2024","10":"tag-conference","11":"tag-featured","12":"tag-news","13":"author-joseph-kim-md"},"authors":[{"term_id":1070,"user_id":40616,"is_guest":0,"slug":"joseph-kim-md","display_name":"Joseph Kim MD","avatar_url":"https:\/\/secure.gravatar.com\/avatar\/bf0879bf0ca450025acf71d7345cf24be4748f67f7b0c6423d186a5765c5cda9?s=96&r=g","0":null,"1":"","2":"","3":"","4":"","5":"","6":"","7":"","8":""}],"_links":{"self":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/138550","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/users\/40616"}],"replies":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=138550"}],"version-history":[{"count":1,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/138550\/revisions"}],"predecessor-version":[{"id":138552,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/posts\/138550\/revisions\/138552"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=\/wp\/v2\/media\/138551"}],"wp:attachment":[{"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=138550"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=138550"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=138550"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/cardiologynownews.org\/index.php?rest_route=%2Fwp%2Fv2%2Fppma_author&post=138550"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}