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VTACH, 2009 - catheter ablation before ICD vs no ablation

SMASH-VT, 2007 - catheter ablation before ICD vs no ablation



See also:

  • All patients with implantable cardioverter defibrillators clinical trials
  • All ventricular tachycardia in patients with structural heart disease clinical trials
  • All clinical trials of catheter ablation of ventricular tachycardia
  • All clinical trials of catheter ablation before ICD
    		•  

    VTACH study, 2009

    [NCT00919373]

    Treatments

    Studied treatment catheter ablation for ventricular tachycardia (VT) plus implantable cardioverter defibrillator
    Control treatment implantable cardioverter defibrillator alone

    Patients

    Patients Patients undergoing implantation of an ICD Patients undergoing implantation of an ICD
    Inclusion criteria patients aged 18¡ª80 years with stable VT, previous myocardial infarction, and reduced left-ventricular ejection fraction (LVEF; ¡Ü50%).
    Exclusion criteria myocardial infarction within the last month; cardiac surgery within the last 2 months; LV thrombus; valvular heart disease or mechanical heart valve; unstable angina; incessant VT; bundle branch re-entry tachycardia; contraindication to heparin;renal insufficiency;rdvanced heart failure; expected survival <12 months
    Baseline characteristics
    Age (mean), years 66y 
    Men (%) 93% 
    LVEF (mean), % 66% 

    Method and design

    Randomized effectives 54 / 56 (studied vs. control)
    Design Parallel groups
    Blinding open
    Follow-up duration 27 mo
    Lost to follow-up 2.7% (3)
    Number of centre 16
    Geographic area Europe
    Primary endpoint first VT or ventricular fibrillation


    Results

    Endpoint Studied treat.
    n/N     Control treat.
    n/N     Graph RR [95% CI]

    VT or VF

    NA / 54
         NA / 56
         0,61 [0,37;1,00]

    Syncope

    NA / 54
         NA / 56
         0,36 [0,07;1,83]

    all ICD shock (appropriate and inappropriate)

    17 / 54
         29 / 56
         0,61 [0,38;0,97]

    Appropriate ICD shock

    26 / 54
         38 / 56
         0,71 [0,51;0,99]

    hospitalisation for cardiovascular causes

    NA / 54
         NA / 56
         0,55 [0,30;1,00]

    All cause death

    NA / 54
         NA / 56
         classic 1,32 [0,35;4,96]

    Inappropriate ICD shock

    4 / 54
         6 / 56
         classic 0,69 [0,21;2,32]     0 2 1.0

    Relative risks
    Endpoint Events (%) Relative Risk 95% CI Endpoint definition
    in the trial    		 Ref
    Studied treat. Control treat.
    all ICD shock (appropriate and inappropriate) 17 / 54 (31,5%) 29 / 56 (51,8%) 0,61 [0,38;0,97]   12008 
    Appropriate ICD shock 26 / 54 (48,1%) 38 / 56 (67,9%) 0,71 [0,51;0,99]   12008 
    Inappropriate ICD shock 4 / 54 (7,4%) 6 / 56 (10,7%) 0,69 [0,21;2,32]   12008 
    The primary endpoint (if exists) appears in blod characters
    Reference(s) used for data extraction:
  • 12008: Kuck KH, Schaumann A, Eckardt L, Willems S, Ventura R, Delacrétaz E, Pitschner HF, Kautzner J, Schumacher B, Hansen PSCatheter ablation of stable ventricular tachycardia before defibrillator implantation in patients with coronary heart disease (VTACH): a multicentre randomised controlled trial.Lancet 2010 Jan 2;375:31-40

    • Endpoint studied treat. control treat. mean diff

    Absolute risk reduction
    Endpoint Events rate Absolute risk
    reduction (ARR)
    Studied treat. Control treat.
    all ICD shock (appropriate and inappropriate) 31,48% 51,79% -203,0‰
    Appropriate ICD shock 48,15% 67,86% -197,1‰
    Inappropriate ICD shock 7,41% 10,71% -33,1‰


    Reference(s)

    Trials register # NCT00919373
    • Kuck KH, Schaumann A, Eckardt L, Willems S, Ventura R, Delacrétaz E, Pitschner HF, Kautzner J, Schumacher B, Hansen PS. Catheter ablation of stable ventricular tachycardia before defibrillator implantation in patients with coronary heart disease (VTACH): a multicentre randomised controlled trial.. Lancet 2010 Jan 2;375:31-40
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