What question did this study set out to answer?

This trial aims to compare the efficacy and safety of catheter ablation against antiarrhythmic drugs for treating symptomatic ventricular tachycardias in patients with ICD.

May 17, 2026Journal of the American College of CardiologyOpen Access

Substrate Ablation vs Antiarrhythmic Drug Therapy for Symptomatic Ventricular Tachycardia

Q: What is the clinical evidence from this study?

Study design: RCT. Population: Ischemic cardiomyopathy and symptomatic ventricular tachycardia (n=144). Intervention: Complete endocardial substrate-based catheter ablation vs. Antiarrhythmic therapy (amiodarone + beta-blockers, amiodarone alone, or sotalol ± beta-blockers). Primary outcome: Composite of cardiovascular death, appropriate ICD shock, unplanned hospitalization for worsening heart failure, or severe treatment-related complications (HR 0.52, 95% CI 0.30-0.90, p=0.021).

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Key result

Catheter ablation cuts major events ~48% versus antiarrhythmic drugs.

HR 0.52
95% CI 0.30-0.90
P=0.021
n=144

Why the study?

In patients with ischemic cardiomyopathy and an ICD, both catheter ablation and antiarrhythmic drugs reduce shocks, but the most effective approach remains uncertain.

Does complete endocardial substrate-based catheter ablation reduce the composite of cardiovascular death, appropriate ICD shock, unplanned hospitalization for worsening heart failure, or severe treatment-related complications in patients with ischemic cardiomyopathy and appropriate ICD shock compared to antiarrhythmic therapy?

Population

144 patients with ischemic cardiomyopathy and appropriated ICD shock

Comparison

Endocardial substrate-based catheter ablation vs antiarrhythmic therapy

Design

Prospective, multicenter, 1:1 randomized trial

Follow-up

24 months

Authors

ÁAÁngel ArenalElectrophysiology PÁPablo ÁvilaElectrophysiology JJJavier Jiménez‐CandilUniversidad de Salamanca

Discussion

Member takes

Implication

Ablation was associated with fewer events than AAD in this cohort; leaves open confirmation in randomized trials.

Key Points

This trial aims to compare the efficacy and safety of catheter ablation against antiarrhythmic drugs for treating symptomatic ventricular tachycardias in patients with ICD.
Prospective, multicenter randomized trial with 1:1 patient randomization.
Included patients with ischemic cardiomyopathy requiring ICD shock.
Compared outcomes of catheter ablation and antiarrhythmic therapy (amiodarone + beta-blockers or sotalol).
28.2% experienced the primary outcome in the ablation group vs. 46.6% in the AAD group (HR: 0.52; 95% CI: 0.30-0.90; P = 0.021).
Significant reduction in severe treatment-related complications: 9.9% in ablation vs. 28.8% in AAD (HR: 0.30; 95% CI: 0.13-0.71; P = 0.006).
No significant difference in cardiac mortality (HR: 0.93; 95% CI: 0.19-4.61; P = 0.929).

Study Design

Type

RCT (n=144)

Randomization

1:1

Multicenter

Yes

Structured PICO

Population

144 patients with ischemic cardiomyopathy and appropriate ICD shock (symptomatic ventricular tachycardias), median age 70 years, 96% male.

Intervention

Complete endocardial substrate-based catheter ablation

Comparator

Antiarrhythmic therapy (amiodarone + beta-blockers, amiodarone alone, or sotalol ± beta-blockers)

Outcome

Composite of cardiovascular death, appropriate ICD shock, unplanned hospitalization for worsening heart failure, or severe treatment-related complications at 24 monthscomposite

Main Result

Effect estimate: HR 0.52 (95% CI 0.30-0.90)

Absolute Event Rate: 28.2% vs 46.6%

p-value: p=0.021

First-line catheter ablation significantly reduces the composite of cardiovascular death, appropriate ICD shock, HF hospitalization, or severe treatment-related complications compared to antiarrhythmic drugs in patients with ischemic cardiomyopathy and symptomatic VT.

Cite This Study

Arenal et al. (2022) conducted an RCT in Ischemic cardiomyopathy and symptomatic ventricular tachycardia (n=144). Complete endocardial substrate-based catheter ablation vs. Antiarrhythmic therapy (amiodarone + beta-blockers, amiodarone alone, or sotalol ± beta-blockers) was evaluated on Composite of cardiovascular death, appropriate ICD shock, unplanned hospitalization for worsening heart failure, or severe treatment-related complications (HR 0.52, 95% CI 0.30-0.90, p=0.021). Catheter ablation reduced cardiovascular death, ICD shock, heart failure hospitalization, or severe complications compared to antiarrhythmic drugs (HR 0.52; 95% CI 0.30-0.90; P=0.021).

synapsesocial.com/papers/6a0933a60d00267143bfdce2 https://doi.org/10.1016/j.jacc.2022.01.050

Topics

Ventricular arrhythmias Cardiac device therapy Cardiomyopathy HFrEF treatment Heart failure

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Substrate Ablation vs Antiarrhythmic Drug Therapy for Symptomatic Ventricular Tachycardia

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Topics

Substrate Ablation vs Antiarrhythmic Drug Therapy for Symptomatic Ventricular Tachycardia

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Also Consider

Topics

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