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Circulation: Arrhythmia and Electrophysiology
From the VANISH trial (Ventricular Tachycardia Ablation Versus Escalated Antiarrhythmic Drug Therapy in Ischemic Heart Disease), this substudy analyzed patients with prior myocardial infarction, an implanted defibrillator, and ventricular tachycardia to compare the effectiveness of escalated antiarrhythmic drug therapy with catheter ablation. Patients with ventricular tachycardia despite amiodarone treatment (amio-refractory group) had worse heart failure and renal function at baseline than the sotalol-refractory group. Catheter ablation was more successful than the escalation of antiarrhythmic therapy in reducing ventricular arrhythmias for the amio-refractory group. Ablation was not helpful in comparison with escalation of therapy in the sotalol-refractory group.
Effect of Baseline Antiarrhythmic Drug on Outcomes With Ablation in Ischemic Ventricular Tachycardia
A VANISH Substudy (Ventricular Tachycardia Ablation Versus Escalated Antiarrhythmic Drug Therapy in Ischemic Heart Disease)
Ratika Parkash, MD, MS
Isabelle Nault, MD
Lena Rivard, MD, MSc
Lorne Gula, MD
Vidal Essebag, MD, PhD
Pablo Nery, MD
Stanley Tung, MD
Jean-Marc Raymond, MD
Laurence Sterns, MD
Steve Doucette, MSc
George Wells, PhD
Anthony S.L. Tang, MD
William G. Stevenson, MD
John L. Sapp, MD
Correspondence to: Ratika Parkash, MD, MS, Dalhousie University, Rm 2501D, 1796 Summer St, Halifax, Nova Scotia B3H 3A7, Canada. E-mail firstname.lastname@example.org
BACKGROUND: The VANISH trial (Ventricular Tachycardia Ablation Versus Escalated Antiarrhythmic Drug Therapy in Ischemic Heart Disease) compared the effectiveness of escalated antiarrhythmic drug therapy to catheter ablation in patients with prior myocardial infarction, an implanted defibrillator, and ventricular tachycardia (VT). The effectiveness of these interventions in patients on sotalol versus amiodarone was compared.
METHODS AND RESULTS: Analysis was conducted based on whether patients had recurrent VT, despite amiodarone (amio-refractory) or nonamiodarone drugs (sotalol-refractory). Outcomes included death, VT storm, appropriate implantable cardioverter defibrillator shock, and any ventricular arrhythmia. At baseline, 169 (65.2%) were amio-refractory, and 90 (34.7%) were sotalol-refractory (1 patient on procainamide rather than sotalol). Amio-refractory patients had more renal insufficiency (23.7% versus 10%; P=0.0008), worse New York Heart Association class (82.3% II/III versus 65.5%; P=0.0003), and lower ejection fraction (29±9.7% versus …