August 19, 2026Circulation
First-Line Catheter Ablation of Monomorphic Ventricular Tachycardia in Cardiomyopathy Concurrent With Defibrillator Implantation: The PAUSE-SCD Randomized Trial
Key result
Early catheter ablation at ICD implantation cuts VT recurrence, CV hospitalization, or death ~42%.
- HR 0.58
- 95% CI 0.35-0.96
- P=0.04
- n=180
Why the study?
First-line catheter ablation for VT at the time of ICD implantation has not been adopted into guidelines, and prospective data in nonischemic cardiomyopathy were needed.
Does first-line catheter ablation plus an ICD reduce the composite of VT recurrence, cardiovascular hospitalization, or death in patients with cardiomyopathy and monomorphic VT compared to conventional medical therapy plus an ICD?
Population
121 randomized patients with cardiomyopathy and monomorphic VT with an ICD indication
Comparison
Ablation plus an ICD vs conventional medical therapy plus an ICD
Design
International multicenter randomized controlled trial
Follow-up
31 months
Discussion
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Member takes
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
RTRoderick TungElectrophysiologist, University of Chicago Medicine
“Ablation has historically been viewed as a palliative, last-resort strategy and bringing it upfront as concurrent therapy with ICD implantation is a potentially meaningful paradigm shift. It is also the first to include patients with VT without prior myocardial infarction as well as the first to include more contemporary procedural strategies, such as high-resolution mapping and epicardial approaches. We hope that these results will influence future guidelines that are trending toward earlier use of catheter ablation over medical therapy in the course of patient treatment.”
RTRoderick TungElectrophysiologist, University of Chicago Medicine
“Typically the defibrillator is put in and we look to see if there are consequences, and then we think about ablation as a palliative, last-resort strategy. If their results bear out, ablation really needs to be introduced in the dialogue between [physicians] and patients at risk for sudden cardiac death at the time of ICD implantation.”
“Congrats to @DrRoderickTung and team for PAUSE-SCD LBCT showing benefit of first-line VT ablation for reducing recurrent VT. Consistent with results of other trials on preventive approach to VT ablation but now with added inclusion of non-MI VT etiologies.”
Implication
Supports first-line VT ablation at ICD implantation in cardiomyopathy; extends evidence to nonischemic patients and challenges guideline omission.
Key Points
- To determine whether early first-line catheter ablation performed at the time of implantable cardioverter defibrillator (ICD) implantation improves clinical outcomes in patients with cardiomyopathy and monomorphic ventricular tachycardia (VT).
- International, multicenter randomized controlled trial (NCT02848781) enrolling 180 patients with cardiomyopathy and monomorphic VT indicated for ICD implantation.
- A total of 121 patients were randomly assigned (1:1) to catheter ablation plus ICD implantation versus conventional medical therapy plus ICD implantation, with a median follow-up of 31 months.
- The primary outcome was a composite endpoint of VT recurrence, cardiovascular hospitalization, or death.
- The primary composite outcome occurred in 49.3% of the ablation group versus 65.5% of the control group (hazard ratio, 0.58 [95% CI, 0.35–0.96]; P=0.04).
- Ablation significantly reduced VT recurrence (hazard ratio, 0.51 [95% CI, 0.29–0.90]; P=0.02), ICD shocks (10.0% vs 24.6%; P=0.03), and antitachycardia pacing (16.2% vs 32.8%; P=0.04).
- No significant differences occurred in cardiovascular hospitalizations (32.0% vs 33.7%; HR, 0.82 [95% CI, 0.43–1.56]; P=0.55) or mortality (8.9% vs 8.8%; HR, 1.40 [95% CI, 0.38–5.22]; P=0.62), with ablation-related complications reported in 8.3% of patients.
Study Design
Type
RCT (n=180)
Randomization
1:1
Multicenter
Yes
Structured PICO
Does first-line catheter ablation plus an ICD reduce the composite of VT recurrence, cardiovascular hospitalization, or death in patients with cardiomyopathy and monomorphic VT compared to conventional medical therapy plus an ICD?
P
Population
180 enrolled patients (121 randomized; mean age 55, 19% female) with cardiomyopathy and monomorphic VT indicated for ICD implantation, followed for 31 months.
I
Intervention
First-line catheter ablation plus an implantable cardioverter defibrillator (ICD), with ablation performed a median of 2 days before ICD implantation.
C
Comparator
Conventional medical therapy plus an implantable cardioverter defibrillator (ICD).
O
Outcome
Composite end point of ventricular tachycardia (VT) recurrence, cardiovascular hospitalization, or death at 31 months.composite
Main Result
Hazard Ratio: 0.58 (95% CI 0.35–0.96)
Absolute Event Rate: 49.3% vs 65.5%
p-value: p=0.04
First-line catheter ablation performed at the time of ICD implantation significantly reduces the composite of VT recurrence, cardiovascular hospitalization, or death in patients with cardiomyopathy and monomorphic VT.
Cite This Study
A 2022 study conducted an RCT in Cardiomyopathy and monomorphic ventricular tachycardia (n=180). Catheter ablation plus an ICD vs. Conventional medical therapy plus an ICD was evaluated on Composite of VT recurrence, cardiovascular hospitalization, or death (HR 0.58, 95% CI 0.35-0.96, p=0.04). Early catheter ablation at the time of ICD implantation significantly reduced the composite of VT recurrence, cardiovascular hospitalization, or death (49.3% vs 65.5%; HR 0.58; 95% CI 0.35-0.96; P=0.04).