VANISH Trial: Catheter Ablation vs Escalated medical tx in VT

 

NEJM VANISH Study Link 

ACC VANISH Summary

  • The primary outcome of death, ≥3 episodes of ventricular tachycardia within 24 hours, or appropriate ICD shock occurred in 59.1% of the catheter ablation group versus 68.5% of the escalated drug therapy group (p = 0.04).Secondary outcomes: In the ablation group, there were two cardiac perforations and three major bleeds. In the escalated drug therapy group, there were two deaths from pulmonary toxicity and one death from hepatic dysfunction.

2 Minute Medicine Summary

  • 1. Catheter ablation was found to be more effective than escalated antiarrhythmic drug (AAD) therapy at treating patients with ischemic cardiomyopathy and an implantable cardioverter-defibrillator (ICD) who had ventricular tachycardia (VT) despite AAD therapy.2. The increased effectiveness was only observed in patients treated with amiodarone at baseline.

My Two Cents:

  • Primary outcome statistically significant (p = 0.04), but no apparent difference in overall mortality
    • Primary outcome was a composite of 3 different outcomes
  • Practice correlations: if patient with hx of MI, implantable ICD and currently on amiodarone c/o recurrent shocks, then would send for EP work-up before considering increasing Amiodarone tx
    • If patient not currently on Amiodarone, unable to determine if EP would change outcomes since this study only focused on patients currently on Amiodarone, not other anti-arrhythmic drugs
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