Ventricular Tachycardia Ablation vs Enhanced Drug Therapy In Structural Heart Disease: The VANISH Trial

Ventricular Tachycardia (VT) is a dangerous heart rhythm that frequently causes sudden death in people who have survived heart attacks, even years later. It is caused by 'short circuits' of the heart's electrical system which are inside heart attack scar. Doctors will usually put in a device called an implantable cardioverter-defibrillator (ICD) if a person is at risk for VT. This device can shock the heart back to a normal rhythm if VT recurs. Shocks can save lives, but a person may get lots of shocks and they may be painful and have other adverse effects. Approximately 50,000 people in Canada have ICDs, and about 3400 per year experience at least one shock. To prevent shocks, we can use heart rhythm drug therapy or a procedure called a catheter ablation (ablation). The drugs which are available to control VT are better than nothing, but they have been quite disappointing. They have quite a few side-effects (some of which are dangerous) and work only moderately well. Ablation is a procedure which is an alternative to drug therapy. Heart rhythm specialists do this procedure by putting wires up through the blood vessels of the legs into the heart, and by testing the electrical properties of the heart attack scar. One of the wires has a special tip that can be used to cauterize the short circuits that are in the heart attack scar. This procedure may be complex, is not always perfectly successful, and has a small risk of complications which could be serious. We don't know whether it is better to use drugs or ablation for people who get shocks from their ICD. The VANISH Trial is a study which will be carried out across multiple specialized hospitals to compare ablation to drug therapy for patients with VT. 260 patients who need VT treatment will (randomly) receive either drugs or ablation and the outcomes will be studied. This will determine whether there is any advantage of one over the other for better survival or for reduction/delay in shocks.