- Question
- Does performing ventricular tachycardia ablation immediately after the first appropriate implantable cardioverter defibrillator (ICD) shock improve prognosis compared with standard therapy?
- Design
- Prospective, multicenter, randomized two-phase trial with a Bayesian adaptive design: an observational phase (A) until the first appropriate shock and a 1:1 randomized phase (B) after reconsent. Of 517 patients enrolled in phase A, 47 were randomized; phase B was stopped at the first interim analysis.
- Population
- Patients with ischemic or nonischemic dilated cardiomyopathy and a primary or secondary prevention ICD indication who received a first appropriate shock and agreed to join the randomized phase.
- Intervention
- Immediate catheter ablation of ventricular tachycardia, within 2 months of the shock.
- Control
- Continuation of standard therapy without immediate ablation; amiodarone was not allowed except for documented atrial tachyarrhythmias.
- Primary outcome
- Composite of death from any cause or hospitalization for worsening heart failure.
- Results
- The primary end point occurred in 1 of 23 patients (4%) in the ablation group and 10 of 24 (42%) in the control group (HR 0.11; 95% CI 0.01-0.85; P=0.034). There were no deaths in the ablation group versus 8 (33%) in the control group (P=0.004).
- Safety
- ICD shocks were less frequent in the ablation group (9%) than in the control group (42%; P=0.039).
- Conclusion
- Ventricular tachycardia ablation after the first appropriate shock was associated with a lower risk of death or heart failure hospitalization, lower mortality, and fewer ICD shocks.
- Why it matters
- It provided the first randomized evidence supporting early consideration of VT ablation after the first ICD shock rather than reserving it for arrhythmic storm, though with a small sample and early termination.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 14, 2026