Scott Buzby , 2025-04-30 15:00:00
April 30, 2025
3 min read
Key takeaways:
- Meta-analysis further supports catheter ablation vs. drug therapy for management of ventricular arrythmias in ischemic heart disease.
- “VANISH-2 is going to impact guidelines,” a speaker said.
Results of the VANISH-2 trial, building on prior research, further upheld superiority of catheter ablation over antiarrhythmic drug therapy for patients with ventricular tachycardia and ischemic heart disease, a speaker reported.
The results of an updated meta-analysis including new data from the VANISH-2 trial evaluating catheter ablation for ventricular tachycardia (VT) in patients with ischemic cardiomyopathy were presented at Heart Rhythm 2025.
Meta-analysis further supports catheter ablation vs. drug therapy for management of ventricular arrythmias in ischemic heart disease. Image: Adobe Stock
“Ventricular arrhythmias are often associated with an adverse outcome of death and [implantable cardioverter defibrillator] shocks, which are often disturbing to the patients with a spectrum of posttraumatic stress disorder and even severe depression in some. For many years, we only had antiarrhythmic medications as a treatments option until the pioneers of catheter alation started the process developing tools and techniques for ablating the scars and the substrate for VT,” Girish M. Nair, MBBS, MD, MHS, director of cardiac electrophysiology and arrhythmia service at the University of Ottawa Heart Institute in Ontario, Canada, said during the presentation. “Despite the first randomized trial being published in 2008, over the last 15 to 20 years, we’ve only had a limited number of catheter ablation trials, attesting to the fact that [they are] very difficult trials to recruit and conduct well.”
Nair and colleagues completed a systematic review of randomized controlled trials evaluating outcomes of catheter ablation in patients with ischemic heart disease, now including the results of the VANISH-2 trial presented at the 2024 American Heart Association Scientific Sessions.
As Healio previously reported, catheter ablation was associated with lower risk for the primary composite outcome of all-cause death during follow-up or VT storm, appropriate ICD shock or sustained VT treated by medical intervention, compared with antiarrhythmic drug therapy in patients with VT and ischemic cardiomyopathy in the VANISH-2 trial.
For the present meta-analysis, the VANISH-2 population comprised nearly one-third of the overall cohort of 1,440 patients.
The primary composite outcomes included appropriate ICD shocks, VT storm, recurrent VT, hospitalization and mortality.
With the inclusion of the positive results of the VANISH-2 trial in the meta-analysis, researchers observed significantly lower risk for the primary outcome with catheter ablation for VT in patients with ischemic heart disease compared with medical therapy (RR = 0.81; 95% CI, 0.66-0.99; P = .04).
Compared with antiarrhythmic drug therapy, catheter ablation for VT was associated with lower risk for:
- ICD shocks (RR = 0.68; 95% CI, 0.53-0.88; P = .003);
- VT storm (RR = 0.74; 95% CI, 0.56-0.98; P = .03);
- recurrent VT (RR = 0.85; 95% CI, 0.73-0.98; P = .05); and
- hospitalizations (RR = 0.82; 95% CI, 0.68-0.98; P = .03).
Similar to pre-VANISH-2 meta-analyses of catheter ablation for VT in patients with ischemic cardiomyopathy, the researchers reported no significant impact on mortality compared with medical therapy (RR = 0.91; 95% CI, 0.72-1.14; P = .4); however, the presenter said the analysis was not powered to detect mortality.
“VANISH-2 reinforces that catheter ablation is superior to medical management. … And it has refined the estimation of catheter ablation for management of ventricular arrhythmias,” Nair said during the presentation. “Due to the difficulty of replicating the trial, it probably strengthens our conviction that catheter ablation does work in this situation.”
Christine M. Albert
After the presentation, discussant Christine M. Albert, MD, MPH, FHRS, FACC, chair of the department of cardiology, Lee and Harold Kapelovitz Distinguished Chair in Cardiology, Smidt Heart Institute at Cedars-Sinai and past president of the Heart Rhythm Society, discussed the importance of VANISH-2 as a randomized clinical trial in guiding clinical practice.
“Compared to antiarrhythmic drugs or maybe control in patients who haven’t had a shock, VT ablation works and reduces VT. The reduction in hospitalization is much more iffy. It’s based on one trial that had a strange high rate of complications [Árenal A, et al. J Am Coll Cardiol. 2022;doi:10.1016/j.jacc.2022.01.050],” Albert said. “VANISH-2 is going to impact guidelines based upon its individual results. This meta-analysis, unfortunately, can’t replace such a well-designed, large randomized controlled trial.”
Sources/Disclosures
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Nair GM, et al. Late-breaking clinical trials and science: Clinical trials updates and registries. Presented at: Heart Rhythm 2025; April 24-27, 2025; San Diego.
Disclosures:
Albert reports serving on advisory committees for Boston Scientific, Element Science, Medtronic and Novartis and consulting for Illumina. Nair reports receiving honoraria, speaking fees, consultant fees and/or grant support from Biosense Webster.
