Arrhythmias & electrophysiology
Catheter Ablation vs Sotalol or Amiodarone for Ventricular Tachycardia: A Substudy of the VANISH2 Trial
Authors' conclusion
In the sotalol-eligible patients, ablation led to lower risk of the primary composite endpoint. In the amiodarone-eligible group, efficacy outcomes were comparable between ablation and amiodarone. Adverse events were more marked among patients randomized to amiodarone
Study context
- Population
- Patients with prior MI and ventricular tachycardia (VT)199 sotalol / 217 amiodarone strata
- Participants
- 416 patients
- Comparison
- Catheter ablation vs sotalol or amiodarone, by drug-eligibility stratum
- Ablation (sotalol stratum)n = 95
- Sotaloln = 104reference
- Ablation (amiodarone stratum)n = 108
- Amiodaronen = 109reference
- Primary endpoint
- Death, appropriate ICD shock, VT storm, or treated sustained VT below ICD detection limit
- Follow-up
- >14-days postrandomization
Methodological detailsprespecified substudy, multicentre, stratified by drug eligibility
- Prespecified substudy
- Multicentre
- Stratified by drug eligibility
Primary result
As reported in the abstract
Primary composite endpoint, by stratum · median 4.3 years
Ablation (sotalol stratum) vs Sotalol
Estimate (95% CI)P value
Hazard ratio
0.64(0.43–0.94)
P = 0.02Ablation (amiodarone stratum) vs Amiodarone
Estimate (95% CI)P value
Hazard ratio
0.86(0.61–1.22)
P = NSSecondary outcomes
| Outcome | Ablation (sotalol stratum) | Sotalol | Ablation (amiodarone stratum) | Amiodarone | HR (95% CI) | P value | |
|---|---|---|---|---|---|---|---|
| Sustained VT below detectionAblation (sotalol stratum)vs Sotalol | 2.1% | 17.3% | 6.5% | 15.6% | 0.12 (0.03–0.5) | P = 0.004 | |
| Sustained VT below detectionAblation (amiodarone stratum)vs Amiodarone | 0.41 (0.17–0.99) | P = 0.048 | |||||
| 0.050.21520Hazard ratio (log scale) |
Safety
| Outcome | Ablation (amiodarone stratum) | Amiodarone |
|---|---|---|
| Adverse events, amiodarone stratum | ||
| Noncardiac death | 5.6% | 16.5% |
| Respiratory failure | 4.6% | 11.0% |
| HF hospitalization | 19.4% | 31.2% |
| Sepsis | 5.6% | 9.2% |
| Pneumonia | 3.7% | 11.9% |
| Pulmonary fibrosis/infiltrate | 0% | 4.6% |
Original publication
Catheter Ablation vs Sotalol or Amiodarone for Ventricular Tachycardia: A Substudy of the VANISH2 Trial. J Am Coll Cardiol. Published 11 October 2025. doi:10.
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