VANISH2: Antiarrhythmic Drug Therapy or Catheter Ablation in MI Plus VT?

Dec 05, 2024

Photo Credit: Stanislav Tarasov

For patients with prior myocardial infarction (MI) and ventricular tachycardia (VT), first-line catheter ablation may be preferred over antiarrhythmic drug therapy, reducing death and serious arrhythmia outcomes, according to the results of the VANISH2 trial.

“VT in the setting of a prior MI may result in severe symptoms, defibrillator shocks, an impaired quality of life, and a declined survival,” outlined Dr. John Sapp, MD, from Queen Elizabeth II Health Sciences Center, in Canada^1,2. The multicenter, phase 4 VANISH2 study (NCT02830360) compared groups of patients to assess whether antiarrhythmic drug therapy or catheter ablation should be the first line of therapy for this population. The research team randomly assigned 416 participants with a prior MI and VT who had an implanted defibrillator 1:1 to antiarrhythmic drug therapy or catheter ablation. Depending on disease characteristics, participants in the drug group received amiodarone or sotalol. The primary endpoint was the first occurrence of death, appropriate shock, VT storm, or treated sustained VT below detection.

After a median of 4.3 years of follow-up, catheter ablation was superior to antiarrhythmic drug therapy (HR 0.75; 95% CI 0.58–0.97; P=0.028). “The effect was mainly driven by a reduction in treated sustained VT below the detection limit of the device after 14 days,” commented Dr. Sapp¹. The effect appeared to be somewhat larger when sotalol was compared with ablation (HR 0.64; 95% CI 0.46–0.93) than when amiodarone was compared with ablation (HR 0.86; 95% CI 0.58–1.27).

Death was reported in 22.2% and 25.4% of the participants in the ablation and antiarrhythmic drug groups, respectively. Serious non-fatal AEs happened in 28.1% of the participants in the ablation arm and 30.5% of those in the antiarrhythmic drug arm. “In total 21.6% of the participants in the antiarrhythmic drug arm had a drug-attributed AE leading to reduction or discontinuation compared with only 3.4% of the patients in the ablation arm,” added Dr. Sapp.

“For patients with prior MI and VT events, a strategy of first-line catheter ablation rather than antiarrhythmic drug therapy may lead to better health outcomes,” concluded Dr. Sapp.

Medical writing support was provided by Robert van den Heuvel.