Catheter Ablation -> Ventricular Arrhythmias -> Clinical Trials / Outcomes D-AB08 - Ventricular Tachycardia Ablation: New Technology, Techniques and Insights (ID 30) Abstract

D-AB08-06 - Ventricular Tachycardia Characteristics And Response To Catheter Ablation Versus Antiarrhythmic Drugs: Insights From The Vanish Trial (ID 751)

  M.W. Deyell: Research (Contracted Grants for PIs and Named Investigators only) - Biosense Webster, Inc..


Background: In the Ventricular Tachycardia Ablation versus Escalated Antiarrhythmic Drug Therapy in Ischemic Heart Disease (VANISH) trial, ablation was superior for treatment of drug-refractory VT. However, a significant proportion of patients experienced VT recurrence with both therapies. Patient-level VT characteristics may be important in determining which patients may respond to either therapy.
Objective: We examined whether clinical presentation and cycle length of the qualifying VT were associated with the primary composite outcome of death, VT storm or appropriate ICD shock in the VANISH trial.
Methods: All 259 VANISH patients were included. Clinical presentation was divided into 1) VT below detection, 2) VT treated with antitachycardia pacing (ATP), 3) VT treated with shocks and 4) electrical storm (≥3 episodes in 24h). VT cycle length was divided into 1) >400ms, 2) 400-321ms and 3) 320-240ms. Unadjusted hazard ratios were calculated for the overall trial and for those taking amiodarone at baseline.
Results: Clinical presentation was not associated with the primary outcome in the overall group (figure panel A), however, ablation was more successful for those with electrical storm in those on amiodarone at baseline (panel B). Ablation was superior in those with slower VT (panel C). In the baseline amiodarone group, the superiority of ablation increased with slower VT cycle lengths (panel D).
Conclusion: Among patients with ischemic heart disease and VT despite the use of amiodarone, electrical storm and VT cycle lengths of >400 ms predicted better outcomes with catheter ablation. These factors can help guide patient selection for catheter ablation.