Catheter Ablation vs Sotalol or Amiodarone for Ventricular Tachycardia

作者：Pablo B. Nery, George A. Wells, ANTHONY S.L. TANG, Ratika Parkash, William G. Stevenson, Jeff S. Healey, Lorne J. Gula, Girish M. Nair, Vidal Essebag, Léna Rivard, Marc William Deyell, JEAN‐FRANÇOIS SARRAZIN, Guy Amit, Jean-François Roux, Amir M. AbdelWahab, Chris Lane, Michelle Samuel, Navjot Sandila, John L. Sapp · 发表于：Journal of the American College of Cardiology · 年份：2025 · DOI：10.1016/j.jacc.2025.09.1595 · 被引用次数：8 · 研究领域：Cardiac Arrhythmias and Treatments、Atrial Fibrillation Management and Outcomes、Cardiac electrophysiology and arrhythmias

BACKGROUND: In the VANISH2 multicenter randomized trial comparing catheter ablation to antiarrhythmic drugs (AADs) for patients with prior myocardial infarction and ventricular tachycardia (VT), randomization was stratified by drug eligibility based on clinical criteria. OBJECTIVES: The objective of this prespecified substudy was to compare the outcomes of catheter ablation vs AAD according to drug eligibility stratum. METHODS: Patients were considered eligible to be allocated to sotalol vs ablation if they met all the following criteria: estimated glomerular filtration rate ≥30 mL/min, NYHA functional class I-II, left ventricular ejection fraction ≥20%, qualifying arrhythmia was not VT storm, and no history of torsades de pointes or QT interval prolongation. All other patients were eligible to be randomly allocated to amiodarone vs ablation. The primary endpoint was a composite of death, appropriate implantable cardioverter-defibrillator shock, VT storm, or treated sustained VT below the detection limit of the implantable cardioverter-defibrillator >14-days postrandomization. Secondary endpoints included safety and the individual components of the primary endpoint. In this analysis, the primary and secondary outcomes for catheter ablation are compared with those for sotalol and to amiodarone separately. RESULTS: A total of 416 patients (199 in sotalol and 217 in amiodarone strata) were followed for a median of 4.3 years. In the sotalol stratum, a primary endpoint occurred in...