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Thus far, there has not been a randomized controlled trial to compare catheter ablation to antiarrhythmic drug therapy as a first-line treatment the VANISH-2 study has been initiated as a pilot to examine this question.Īntiarrhythmic medications Catheter ablation Implantable cardioverter defibrillator Sudden cardiac death Ventricular tachycardia. The optimal first-line suppressive therapy for VT, after ICD implantation and appropriate programming, remains to be determined. Early catheter ablation may be appropriate in some clinical situations such as patients presenting with relatively slow VT below ICD detection, electrical storms, hemodynamically stable VT, or in very selected patients with left ventricular assist devices. If VT occurs despite amiodarone therapy, there is evidence that catheter ablation is superior to administration of more aggressive antiarrhythmic drug therapy. If sotalol is ineffective in suppressing VT, either catheter ablation or initiation of amiodarone is a reasonable option. There is evidence for the effectiveness of both catheter ablation and antiarrhythmic drug therapy for patients with myocardial infarction, an implantable defibrillator, and VT. In a subgroup analysis, patients having VT despite amiodarone had better outcomes with ablation as compared to increasing amiodarone dose or adding mexiletine. During 28 months of follow-up, catheter ablation resulted in a 28% relative risk reduction in the composite endpoint of death, VT storm, and appropriate ICD shock (p = 0.04). The most recent trial is the VANISH trial which randomly allocated patients with ICD, prior infarction, and SMVT despite first-line antiarrhythmic drug therapy to catheter ablation or more aggressive antiarrhythmic drug therapy. Conclusions: In a population study with long-term follow-up, NSIVCD and Minnesota definition of LBBB were independently associated with CV mortality. During 28 months of follow-up, catheter ablation resulted in a 28 relative risk reduction in the composite endpoint of death, VT storm, and appropriate ICD shock (p 0.04). There are four published randomized trials of catheter ablation for sustained monomorphic VT (SMVT) in the setting of ischemic heart disease there are no randomized studies for non-ischemic ventricular substrates. Background: Previous population studies have presented conflicting results regarding the prognostic impact of intraventricular conduction delays (IVCD). A shared clinical decision process accounting for patients' cardiac status, comorbidities, and goals of care is often required. Catheter ablation can be effective but acute complications and long-term VT recurrence risk necessitating repeat ablation should be recognized. Antiarrhythmic drugs are limited by incomplete efficacy and an unfavorable adverse effect profile. Prevention of ventricular tachycardia (VT) recurrence with the use of antiarrhythmic drugs or catheter ablation may be warranted. In addition, shocks may have deleterious mechanical and psychological effects.
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Ventricular tachycardia occurrence in implantable cardioverter defibrillator (ICD) patients may result in shock delivery and is associated with increased morbidity and mortality.