Timing of VT ablation does not factor in outcomes of patients with ICDs

In patients with implanted cardioverter defibrillators (ICDs), the risk of mortality or hospitalization does not change whether catheter ablation for ventricular tachycardia (VT) is done prior to or after the implantation, according to data from the BERLIN VT* study.

BERLIN VT included 159 patients with stable ischaemic cardiomyopathy, a left ventricular ejection fraction between 30 percent and 50 percent, and documented VT. Of these, 76 were randomly assigned to preventive ablation (undertaken before ICD implantation) and 83 to deferred ablation (after three ICD shocks for VT).

Over a mean follow-up of 396 days, the primary endpoint of a composite of all-cause death and unplanned hospitalization for either symptomatic ventricular arrhythmia or worsening heart failure occurred in 25 patients (32.9 percent) in the preventive ablation group and in 23 (27.7 percent) in the deferred ablation group (hazard ratio, 1.09, 95 percent confidence interval [CI], 0.62–1.92; p=0.77). The study was prematurely terminated due to futility.

In the preventive vs deferred ablation group, there were six vs two deaths (7.9 percent vs 2.4 percent; p=0.18), eight vs two hospitalizations for worsening heart failure (10.4 percent vs 2.3 percent; p=0.062), and 15 vs 21 hospitalizations for symptomatic ventricular arrhythmia (19.5 percent vs 25.3 percent; p=0.27).

Preventive ablation led to numerically lower proportion of patients with sustained ventricular tachyarrhythmia (39.7 percent vs 48.2 percent; p=0.050) and appropriate ICD therapy (34.2 percent vs 47.0 percent; p=0.030).

*The Preventive Ablation of Ventricular Tachycardia in Patients with Myocardial Infarction