VANISH2
Trial question
What is the role of catheter ablation in patients with ischemic cardiomyopathy and VT?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
6.0% female
94.0% male
N = 416
416 patients (26 female, 390 male).
Inclusion criteria: patients with ischemic cardiomyopathy and VT.
Key exclusion criteria: active ischemia or another cause of VT; recent acute coronary syndrome within 30 days; coronary revascularization; allergy or contraindication to antiarrhythmic drug; protruding LV thrombus or mechanical aortic and mitral valves; prior catheter ablation procedure for VT.
Interventions
N=203 catheter ablation (catheter ablation procedure within 14 days of randomization).
N=213 drug therapy (sotalol or amiodarone administered as antiarrhythmic drug therapy).
Primary outcome
Rate of death from any cause during follow-up or > 14 days after randomization, ventricular tachycardia storm, appropriate implantable cardioverter-defibrillator shock, or sustained ventricular tachycardia treated by medical intervention
50.7%
60.6%
60.6 %
45.5 %
30.3 %
15.2 %
0.0 %
Catheter
ablation
Drug
therapy
Significant
decrease ▼
NNT = 10
Significant decrease in the rate of death from any cause during follow-up or > 14 days after randomization, VT storm, appropriate ICD shock, or sustained VT treated by medical intervention (50.7% vs. 60.6%; HR 0.75, 95% CI 0.58 to 0.97).
Secondary outcomes
No significant difference in death from any cause during follow-up (22.2% vs. 25.4%; HR 0.84, 95% CI 0.56 to 1.24).
No significant difference in the rate of appropriate ICD shock after 14 days (29.6% vs. 38%; HR 0.75, 95% CI 0.53 to 1.04).
No significant difference in the rate of VT storm after 14 days (21.7% vs. 23.5%; HR 0.95, 95% CI 0.63 to 1.42).
Safety outcomes
No significant difference in serious nonfatal adverse events.
Conclusion
In patients with ischemic cardiomyopathy and VT, catheter ablation was superior to drug therapy with respect to the rate of death from any cause during follow-up or > 14 days after randomization, VT storm, appropriate ICD shock, or sustained VT treated by medical intervention.
Reference
John L Sapp, Anthony S L Tang, Ratika Parkash et al. Catheter Ablation or Antiarrhythmic Drugs for Ventricular Tachycardia. N Engl J Med. 2025 Feb 20;392(8):737-747.
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