2016, VANISH Trial – Ventricular Tachycardia Ablation versus Escalation of Antiarrhythmic Drugs, NEJM
VANISH Trial Key Points:
- Patients with ischemic cardiomyopathy and LVEF < 35% are candidated for ICD implantation but high VT burden in these patients is associated with higher mortality despite ICD placement.
- Previously, antiarrhythmic therapy (AAT) specifically amiodarone has been used to suppress VT in these patients. However, newer data suggested VT ablation in addition to AAT lowers mortality further.
- The VANISH trial answered this particular question of using VT ablation rather than escalating AAT for patients with recurrence of VT despite being on AAT.
- The trial showed 10% absolute decrease in composite outcome of death, VT storm (3 more episodes of VT within 24 hours), and appropriate ICD shock after 2 years of follow up.
Guideline Changes based on VANISH trial:
The 2017 AHA/ACC/HRS guidelines recommend:
In patients with prior myocardial infarction and recurrent episodes of symptomatic sustained ventricular tachycardia (VT), or who present with VT or ventricular fibrillation storm and have failed or are intolerant of amiodarone (Level of Evidence B-R) or other antiarrhythmic medications (Level of Evidence B-NR), catheter ablation is recommended.https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2017/10/29/08/56/2017-guideline-for-management-of-patients-with-ventricular-arrhythmias