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).
RCT (n=144)
1:1
Yes
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?
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.
Effect estimate: HR 0.52 (95% CI 0.30-0.90)
Absolute Event Rate: 28.2% vs 46.6%
p-value: p=0.021
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).
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).