- Question
- In patients with ventricular tachycardia and ischemic cardiomyopathy, is catheter ablation as an initial strategy superior to antiarrhythmic drug therapy?
- Design
- International, randomized 1:1, open-label trial enrolling 416 patients, all with an implantable cardioverter-defibrillator (ICD), with a median follow-up of 4.3 years.
- Population
- Patients with prior myocardial infarction and clinically significant ventricular tachycardia, defined as VT storm, an appropriate ICD shock or antitachycardia pacing, or sustained VT terminated by emergency treatment.
- Intervention
- Catheter ablation of ventricular tachycardia, performed within 14 days after randomization.
- Control
- Antiarrhythmic drug therapy with sotalol or amiodarone, assigned according to prespecified criteria.
- Primary outcome
- Composite of death from any cause or, more than 14 days after randomization, VT storm, appropriate ICD shock, or sustained VT treated by medical intervention.
- Results
- A primary event occurred in 103 of 203 patients (50.7%) in the ablation group and 129 of 213 (60.6%) in the drug group (HR 0.75; 95% CI 0.58 to 0.97; P = 0.03).
- Safety
- In the ablation group, within 30 days there were 2 deaths (1.0%) and nonfatal adverse events in 23 patients (11.3%). In the drug group, there was 1 death from pulmonary toxicity (0.5%) and nonfatal drug-attributed adverse events in 46 patients (21.6%).
- Conclusion
- In patients with ischemic cardiomyopathy and ventricular tachycardia, initial catheter ablation lowered the risk of the composite primary endpoint compared with antiarrhythmic drug therapy.
- Why it matters
- It supports considering ablation as a first-line option rather than only a rescue strategy after antiarrhythmic drug failure in this patient group.
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