From the VANISH trial (Ventricular Tachycardia Ablation Versus Escalated Antiarrhythmic Drug Therapy in Ischemic Heart Disease), this substudy analyzed patients with prior myocardial infarction, an implanted defibrillator, and ventricular tachycardia to compare the effectiveness of escalated antiarrhythmic drug therapy with catheter ablation. Patients with ventricular tachycardia despite amiodarone treatment (amio-refractory group) had worse heart failure and renal function at baseline than the sotalol-refractory group. Catheter ablation was more successful than the escalation of antiarrhythmic therapy in reducing ventricular arrhythmias for the amio-refractory group. Ablation was not helpful in comparison with escalation of therapy in the sotalol-refractory group.

Ratika Parkash, MD, MS

Isabelle Nault, MD

Lena Rivard, MD, MSc

Lorne Gula, MD

Vidal Essebag, MD, PhD

Pablo Nery, MD

Stanley Tung, MD

Jean-Marc Raymond, MD

Laurence Sterns, MD

Steve Doucette, MSc

George Wells, PhD

Anthony S.L. Tang, MD

William G. Stevenson, MD

John L. Sapp, MD

Correspondence to: Ratika Parkash, MD, MS, Dalhousie University, Rm 2501D, 1796 Summer St, Halifax, Nova Scotia B3H 3A7, Canada. E-mail ratika.parkash@nshealth.ca

BACKGROUND: The VANISH trial (Ventricular Tachycardia Ablation Versus Escalated Antiarrhythmic Drug Therapy in Ischemic Heart Disease) compared the effectiveness of escalated antiarrhythmic drug therapy to catheter ablation in patients with prior myocardial infarction, an implanted defibrillator, and ventricular tachycardia (VT). The effectiveness of these interventions in patients on sotalol versus amiodarone was compared.

METHODS AND RESULTS: Analysis was conducted based on whether patients had recurrent VT, despite amiodarone (amio-refractory) or nonamiodarone drugs (sotalol-refractory). Outcomes included death, VT storm, appropriate implantable cardioverter defibrillator shock, and any ventricular arrhythmia. At baseline, 169 (65.2%) were amio-refractory, and 90 (34.7%) were sotalol-refractory (1 patient on procainamide rather than sotalol). Amio-refractory patients had more renal insufficiency (23.7% versus 10%; P=0.0008), worse New York Heart Association class (82.3% II/III versus 65.5%; P=0.0003), and lower ejection fraction (29±9.7% versus …

从VANISH试验（室速消融对缺血性心脏病的抗心律失常药物的逐步治疗）中，该子研究分析了既往有心肌梗死，植入除颤器和室速的患者，以比较逐步消融的抗心律失常药物治疗与导管消融的有效性。尽管使用胺碘酮治疗（心梗顽固组）但心室心动过速的患者在基线时的心力衰竭和肾功能较索他洛尔难治组更严重。导管消融术比抗心律失常疗法的升级在减少难治性心律失常组患者室性心律失常方面更为成功。与索他洛尔难治组的治疗升级相比，消融没有帮助。

Ratika Parkash，医学博士，硕士

医学博士伊莎贝尔·诺特（Isabelle Nault）

莉娜·里瓦尔德（Lena Rivard），医学博士，理学硕士

洛恩·古拉（Lorne Gula），医学博士

Vidal Essebag，医学博士

医学博士Pablo Nery

董建华，医学博士

尚·马克·雷蒙德，医学博士

劳伦斯·斯特恩斯，医学博士

史蒂夫·杜塞特（Steve Doucette），理学硕士

乔治·威尔斯博士

汤兆麟（医学博士）

威廉·史蒂文森（William G.Stevenson），医学博士

约翰·L·萨普，医学博士

通讯员：Dalhousie大学医学博士，Ratika Parkash，Rm 2501D，1796 Summer St，Halifax，新斯科舍省B3H 3A7，加拿大。电子邮件ratika.parkash@nshealth.ca

背景： VANISH试验（在缺血性心脏病中进行室性心动过速消融与抗心律不齐药物治疗逐步升级）比较在先发性心肌梗死，植入的除颤器和心室心动过速（VT）患者中，心律失常药物治疗与导管消融的有效性。比较了这些干预对索他洛尔和胺碘酮治疗的效果。

方法和结果：根据患者是否复发室速进行了分析，尽管使用了胺碘酮（胺碘酸难治性）或非胺碘酮药物（索他洛尔难治性）。结果包括死亡，VT风暴，适当的植入式心脏复律除颤器电击以及任何心律失常。在基线时，有169例（65.2％）的难治性贫血患者，以及90例（34.7％）的耐索他洛尔性（1例普鲁卡因胺而非索他洛尔患者）。难治性难治性肾功能不全的患者有更多的肾功能不全（23.7％比10％；P = 0.0008），纽约心脏协会等级更差的患者（82.3％II / III比65.5％；P = 0.0003），射血分数较低（29±9.7％）相对 …