The Lead Episode 121: A Discussion of Catheter Ablation or Antiarrhythmic Drugs for Ventricular Tachycardia, LIVE at HRX-A Discussion of Catheter Ablation or Antiarrhythmic Drugs for Ventricular Tachycardia, LIVE at HRX (Bonus Video)

A Discussion of Catheter Ablation or Antiarrhythmic Drugs for Ventricular Tachycardia, LIVE at HRX (Bonus Video)

Video Transcription

Video Summary

This episode of Heart Rhythm Society's The Lead discusses the Vanish II trial, which compared catheter ablation to antiarrhythmic drugs (Sotalol or Amiodarone) for ventricular tachycardia (VT) patients with implanted defibrillators. The trial enrolled 124 patients experiencing their first significant VT and found catheter ablation reduced VT recurrence, appropriate ICD shocks, and treated VT events, but did not significantly impact overall mortality or VT storm rates. Experts highlight that ablation addresses the electrical mechanisms underlying VT but doesn’t alter the disease’s progression, which often culminates in heart failure. Limitations include patient selection (only ischemic cardiomyopathy), procedural expertise at high-volume centers, and the challenge of safely accessing deeper arrhythmic substrates. The discussants emphasize the need for earlier intervention, improved ablation techniques, hemodynamic management during procedures, and advancements in mapping and lesion delivery to improve outcomes. While current standard ablation methods prove beneficial, evolving technologies and better patient stratification offer hope for enhanced VT management.

Keywords

Vanish II trial

catheter ablation

ventricular tachycardia

antiarrhythmic drugs

implantable cardioverter defibrillator

ischemic cardiomyopathy