Substrate Ablation vs Antiarrhythmic Drug Therapy for Symptomatic Ventricular Tachycardia
Ángel Arenal1, Pablo Ávila1, Javier Jiménez-Candil2
1Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Facultad de Medicina, Universidad Complutense, Madrid, Spain; Center for Biomedical Research in Cardiovascular Disease Network (CIBERCV).
Insights
Catheter ablation significantly reduced adverse events compared to antiarrhythmic drugs (AADs) in patients with implantable cardioverter-defibrillators and ventricular tachycardia. This approach offers a safer and more effective first-line therapy for managing these high-risk cardiac conditions.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Ischemic cardiomyopathy patients with implantable cardioverter-defibrillators (ICDs) often experience ventricular tachycardias (VTs).
- Both catheter ablation and antiarrhythmic drugs (AADs) are used to reduce ICD shocks, but their comparative effectiveness is unclear.
Purpose of the Study:
- To compare the efficacy and safety of catheter ablation versus AADs as a first-line therapy.
- To evaluate outcomes in ICD patients with symptomatic VTs.
Main Methods:
- The SURVIVE-VT trial was a prospective, multicenter, randomized study.
- 144 patients with ischemic cardiomyopathy and ICDs were randomized 1:1 to substrate-based catheter ablation or AADs (amiodarone +/- beta-blockers, or sotalol +/- beta-blockers).
- The primary outcome included cardiovascular death, appropriate ICD shock, heart failure hospitalization, or severe treatment complications.
Main Results:
- After 24 months, the primary outcome occurred in 28.2% of the ablation group versus 46.6% of the AAD group (HR 0.52, P=0.021).
- Catheter ablation significantly reduced severe treatment-related complications (9.9% vs 28.8%, HR 0.30, P=0.006).
- No significant differences were observed in cardiac mortality or heart failure hospitalizations between groups.
Conclusions:
- Catheter ablation is a more effective first-line therapy than AADs for reducing a composite endpoint in ICD patients with symptomatic VT.
- The benefit is primarily driven by a reduction in severe treatment-related complications.
Background:
In patients with ischemic cardiomyopathy and an implantable cardioverter-defibrillator (ICD), catheter ablation and antiarrhythmic drugs (AADs) reduce ICD shocks, but the most effective approach remains uncertain.
Objectives:
This trial compares the efficacy and safety of catheter ablation vs AAD as first-line therapy in ICD patients with symptomatic ventricular tachycardias (VTs).
Methods:
The SURVIVE-VT (Substrate Ablation vs Antiarrhythmic Drug Therapy for Symptomatic Ventricular Tachycardia) is a prospective, multicenter, randomized trial including patients with ischemic cardiomyopathy and appropriated ICD shock. Patients were 1:1 randomized to complete endocardial substrate-based catheter ablation or antiarrhythmic therapy (amiodarone + beta-blockers, amiodarone alone, or sotalol ± beta-blockers). The primary outcome was a composite of cardiovascular death, appropriate ICD shock, unplanned hospitalization for worsening heart failure, or severe treatment-related complications.
Results:
In this trial, 144 patients (median age, 70 years; 96% male) were randomized to catheter ablation (71 patients) or AAD (73 patients). After 24 months, the primary outcome occurred in 28.2% of patients in the ablation group and 46.6% of those in the AAD group (hazard ratio [HR]: 0.52; 95% CI: 0.30-0.90; P = 0.021). This difference was driven by a significant reduction in severe treatment-related complications (9.9% vs 28.8%, HR: 0.30; 95% CI: 0.13-0.71; P = 0.006). Eight patients were hospitalized for heart failure in the ablation group and 13 in the AAD group (HR: 0.56; 95% CI: 0.23-1.35; P = 0.198). There was no difference in cardiac mortality (HR: 0.93; 95% CI: 0.19-4.61; P = 0.929).
Conclusions:
In ICD patients with ischemic cardiomyopathy and symptomatic VT, catheter ablation reduced the composite endpoint of cardiovascular death, appropriate ICD shock, hospitalization due to heart failure, or severe treatment-related complications compared to AAD. (Substrate Ablation vs Antiarrhythmic Drug Therapy for Symptomatic Ventricular Tachycardia [SURVIVE-VT]: NCT03734562).
Related Concept Videos
01:12Antiarrhythmic Drugs: Class III Agents as Potassium Channel Blockers
01:25Dysrhythmias VI: Management of Dysrhythmias
01:25ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias
01:24Antiarrhythmic Drugs: Class II Agents as β-Adrenergic Blockers
01:20Antiarrhythmic Drugs: Class IV Agents as Calcium Channel Blockers
Verapamil, a calcium channel blocker, inhibits calcium movement across myocardial cell membranes and vascular smooth muscle. This results in the dilation of coronary and...
01:22Antiarrhythmic Drugs: Class I Agents as Sodium Channel Blockers
Class 1A Antiarrhythmic Drugs: These drugs work by moderately blocking sodium channels,...