The VANISH2 Trial: Ventricular Tachycardia Antiarrhythmics or Ablation in Structural Heart Disease 2

Background: The VANISH2 trial is designed to determine the best treatment for people who have life-threatening abnormalities of heart rhythm. Heart attacks leave scars in the heart muscle. The scars can interfere with the normal signaling within the heart that controls the heart beat. In some cases, the interference can cause a very dangerous abnormal heart rhythm known as ventricular tachycardia (VT). This rhythm is the most common cause of sudden death in Canada. When patients are at high risk for recurrences of VT, a defibrillator (ICD) can be implanted which can shock the heart back to normal rhythm from a cardiac arrest. These devices are life-saving but do not prevent the abnormal rhythm, they just provide a rescue when it occurs. In order to prevent dangerous arrhythmias, doctors use strong rhythm control drugs or a procedure called catheter ablation. An ablation is performed by advancing wires through the blood vessels into the heart, using X-rays and other imaging to see where they are and the short circuits within the scar can then be identified and interrupted (ablated). Neither the drugs nor the ablation procedure work perfectly and both carry risk. This trial is designed to determine which treatment is the best. Study design: Patients who have had heart attacks and develop VT will be randomly allocated (50:50) to be treated either with rhythm control drugs or catheter ablation. All patients will receive an implanted defibrillator. We will enroll a total of 366 patients and follow them for at least 2 years to see which group does the best with respect to recurrent abnormal heart rhythms and survival. Expected Outcomes: This trial will determine whether the best treatment for VT is heart rhythm drugs or catheter ablation. This evidence will permit more optimal treatment for many thousands of patients worldwide.