6/30/23, 12:10 AM VANISH Pathway Feedback Search Clinical Topics Home Studies VANISH VANISH Disease Disease Dilated cardiomyopathy Ventricular arrhythmias Trial question What is the role of catheter ablation in patients with ischemic cardiomyopathy and an ICD who had VT despite use of antiarrhythmic drugs? Study design Multi-center Open label RCT Population Characteristics of study participants 7.0% female N = 259 93.0% male 259 patients (18 female, 241 male) Inclusion criteria: patients with ischemic cardiomyopathy and an ICD who had VT despite the use of antiarrhythmic drugs Key exclusion criteria: acute coronary syndrome, or another reversible cause of VT, ineligible to take amiodarone, ineligible for ablation, renal failure, recent coronary bypass surgery, prior ablation for VT Interventions N=132 catheter ablation (procedure within 14 days of randomization plus continued baseline antiarrhythmic medications) N=127 escalated antiarrhythmic therapy (dose of amiodarone increased if dose < 300 mg/day or mexiletine added if dose already 300 mg per day) Primary outcome https://web.pathway.md/studies/recEi9zo0AjTOqhFd 1/2 6/30/23, 12:10 AM VANISH Pathway Death, ventricular tachycardia storm, or appropriate implantable cardioverter-defibrillator shock 68.5 % 68.5 59.1 51.4 % 34.3 % Significant decrease 17.1 % NNT = 11 0.0 % Catheter ablation Escalated antiarrhythmic therapy Significant decrease in death, VT storm, or appropriate ICD shock (59.1% vs. 68.5%; HR 0.72, 95% CI 0.53 to 0.98) Secondary outcomes No significant difference in death (27.3% vs. 27.6%; HR 0.96, 96% CI 0.6 to 1.53) No significant difference in VT storm at 30 days (24.2% vs. 33.1%; HR 0.66, 95% CI 0.42 to 1.05) Significant decrease in sustained VT below ICD detection limit at any time (3% vs. 10.2%; HR 0.27, 95% CI 0.09 to 0.84) Safety outcomes No significant differences in procedural complications, vascular injury, cardiac perforation, and heart block. Significant differences in treatment-related adverse events (15.2% vs. 30.7%), hepatic dysfunction (0% vs. 4.7%), tremor or ataxia (0% vs. 4.7%), and drug therapy change (0% vs. 4.7%). Conclusion In patients with ischemic cardiomyopathy and an ICD who had VT despite the use of antiarrhythmic drugs, catheter ablation was superior to escalated antiarrhythmic therapy with respect to death, VT storm, or appropriate ICD shock. Reference Sapp JL, Wells GA, Parkash R et al. Ventricular Tachycardia Ablation versus Escalation of Antiarrhythmic Drugs. N Engl J Med. 2016 Jul 14;375(2):111-21. Open reference URL https://web.pathway.md/studies/recEi9zo0AjTOqhFd 2/2