Among patients with an implantable cardioverter-defibrillator (ICD) who have symptomatic ventricular tachycardia, catheter ablation was found to be superior to antiarrhythmic drugs (AADs) according to results of a study published in the Journal of the American College of Cardiology.
Substrate Ablation versus Antiarrhythmic Drug Therapy for Symptomatic Ventricular Tachycardia (SURVIVE-VT; ClinicalTrials.gov identifier: NCT03734562) was a phase 4, investigator-driven, multicenter, randomized, controlled trial conducted at 9 centers in Spain between 2010 and 2017. Patients (N=144) with sustained ventricular tachycardia (VT) treated with ICD shock were randomly assigned in a 1:1 ratio to receive either catheter ablation within 15 days (n=71) or immediate treatment with AADs (n=73). Patients in the AAD group received amiodarone plus beta-blockers. Those with contraindications received sotalol plus beta-blockers or amiodarone alone in cases of beta-blocker intolerance. The primary composite outcome was cardiovascular death, appropriate ICD shock, heart failure hospitalization, and severe treatment-related complications up to 24 months.
The ablation and AAD cohorts were aged median 70 (IQR, 63-75) and 71 (IQR, 64-76) years; 98.6% and 93.2% were men; BMI was 27.3 (IQR, 25.2-31.6) and 27.6 (IQR, 25.9-30.0); the last myocardial infarction occurred 14 (IQR, 6-24) and 14 (IQR, 7-23) years previously; 78.9% and 64.4% had hypertension; and 13.6% and 12.3% had atrial fibrillation or atrial flutter, respectively.
Among those randomized to receive ablation, 6 did not undergo the procedure and 8 crossed over to the AAD group. Among the AAD cohort, 18 underwent catheter ablation after VT recurrence.
At 24 months, the primary composite outcome occurred among 28.2% of the ablation and 46.6% of the AAD cohorts. Ablation was associated with decreased risk for the composite outcome (hazard ratio [HR], 0.52; 95% CI, 0.30-0.90; P =.021).
Stratified by individual events, ablation was associated with decreased risk for severe treatment-related complications (HR, 0.30; 95% CI, 0.13-0.71; P =.006), hospitalization for ventricular arrhythmia (HR, 0.21; 95% CI, 0.08-0.57; P =.002), incessant or undetected VT or electric storm (HR, 0.17; 95% CI, 0.05-0.58; P =.005), cardiac hospitalization (HR, 0.42; 95% CI, 0.22-0.82; P =.011), and slow undetected VT (HR, 0.18; 95% CI, 0.04-0.84; P =.028).
Severe adverse events occurred in 7 patients in the ablation cohort, all of which were resolved completely. For the AAD cohort, 21 patients had an adverse event, and 17 events were severe enough to require hospitalization or discontinuation.
In secondary and post-hoc analyses, ablation was preferred for the outcomes of recurrence as VT storm, incessant VT, slow undetected VT, and hospital admission for ventricular arrhythmia.
This study was limited by its low recruitment rates and the steering committee decided to stop recruiting patients.
“In ICD patients with ischemic cardiomyopathy and symptomatic VT, catheter ablation reduced the composite endpoint of cardiovascular death, appropriate ICD shock, hospitalization due to heart failure, or severe treatment-related complications compared to AAD,” the study authors concluded.
Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.
Arenal Á, Ávila P, Jiménez-Candil J, et al. Substrate ablation vs antiarrhythmic drug therapy for symptomatic ventricular tachycardia. J Am Coll Cardiol. Published online April 19, 2022. doi:10.1016/j.jacc.2022.01.050