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document
Catheter ablation of stable ventricular tachycardia before defibrillator implantation in patients with coronary heart disease ( VTACH ) : a multicentre randomised controlled trial . BACKGROUND In patients with ventricular tachycardia ( VT ) and a history of myocardial infarction , intervention with an implantable cardioverter defibrillator ( ICD ) can prevent sudden cardiac death and thereby reduce total mortality . However , ICD shocks are painful and do not provide complete protection against sudden cardiac death . We assessed the potential benefit of catheter ablation before implantation of a cardioverter defibrillator . METHODS The Ventricular Tachycardia Ablation in Coronary Heart Disease ( VTACH ) study was a prospective , open , randomised controlled trial , undertaken in 16 centres in four European countries . Patients aged 18-80 years were eligible for enrolment if they had stable VT , previous myocardial infarction , and reduced left-ventricular ejection fraction ( LVEF ; < or=50 % ) . 110 patients were randomly allocated in a 1:1 ratio to receive catheter ablation and an ICD ( ablation group , n=54 ) or ICD alone ( control group , n=56 ) . Randomisation was done by computer-generated randomly permuted blocks and stratified by centre and LVEF ( < or=30 % or > 30 % ) . Patients were followed up for at least 1 year . The primary endpoint was the time to first recurrence of VT or ventricular fibrillation ( VF ) . Analysis was by intention to treat ( ITT ) . This study is registered with ClinicalTrials.gov , number NCT00919373 . FINDINGS 107 patients were included in the ITT population ( ablation group , n=52 ; control group , n=55 ) . Two patients ( one in each group ) withdrew consent immediately after randomisation without any follow-up data and one patient ( ablation group ) was excluded because of a protocol violaton . Mean follow-up was 22.5 months ( SD 9.0 ) . Time to recurrence of VT or VF was longer in the ablation group ( median 18.6 months [ lower quartile 2.4 , upper quartile not determinable ] ) than in the control group ( 5.9 months [ IQR 0.8-26.7 ] ) . At 2 years , estimates for survival free from VT or VF were 47 % in the ablation group and 29 % in the control group ( hazard ratio 0.61 ; 95 % CI 0.37-0.99 ; p=0.045 ) . Complications related to the ablation procedure occurred in two patients ; no deaths occurred within 30 days after ablation . 15 device-related complications requiring surgical intervention occurred in 13 patients ( ablation group , four ; control group , nine ) . Nine patients died during the study ( ablation group , five ; control group , four ) . INTERPRETATION Prophylactic VT ablation before defibrillator implantation seemed to prolong time to recurrence of VT in patients with stable VT , previous myocardial infarction , and reduced LVEF . Prophylactic catheter ablation should therefore be considered before implantation of a cardioverter defibrillator in such patients . FUNDING St Jude Medical .
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Intervention_Physical
Catheter ablation of stable ventricular tachycardia
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Intervention_Surgical
defibrillator
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Intervention_Surgical
implantable cardioverter defibrillator ( ICD )
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Intervention_Physical
catheter ablation
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Intervention_Physical
receive catheter ablation and an ICD ( ablation group , n=54 ) or
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Intervention_Control
ICD alone ( control group , n=56 )
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Intervention_Physical
ablation group
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Intervention_Control
control
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Intervention_Physical
ablation group
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Intervention_Control
control group
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Intervention_Physical
ablation group
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Intervention_Control
control group
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Intervention_Physical
ablation group
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Intervention_Control
control group
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Intervention_Physical
ablation
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Intervention_Control
control
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Intervention_Physical
Prophylactic VT ablation
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Intervention_Surgical
defibrillator implantation
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Intervention_Physical
Prophylactic catheter ablation
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Intervention_Surgical
cardioverter defibrillator
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Outcome_Physical
time to first recurrence of VT or ventricular fibrillation ( VF )
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Outcome_Physical
Time to recurrence of VT or VF
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Outcome_Mortality
survival
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Outcome_Physical
VT or VF
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Outcome_Mortality
no deaths
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Outcome_Mortality
died
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Participant_Condition
ventricular tachycardia
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Participant_Condition
defibrillator implantation
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Participant_Condition
coronary heart disease ( VTACH )
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Participant_Condition
ventricular tachycardia ( VT )
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Participant_Condition
myocardial infarction
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Participant_Condition
Ventricular Tachycardia Ablation in Coronary Heart Disease ( VTACH )
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Participant_Age
18-80 years
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Participant_Condition
stable VT
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Participant_Condition
previous myocardial infarction
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Participant_Condition
reduced left-ventricular ejection fraction ( LVEF ; < or=50 % )
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Participant_Sample-size
110
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Participant_Sample-size
107
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Participant_Sample-size
Nine
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Participant_Condition
stable VT
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Participant_Condition
previous myocardial infarction
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Participant_Condition
reduced LVEF