{"id":"b0c4337ec4ec","type":"article","url":"https://hartvaat.nl/2022/04/19/substraatablatie-versus-antiaritmica-bij-symptomatische-vt/","title":"Substraatablatie versus antiaritmica bij symptomatische VT","title_en":"Substrate Ablation vs Antiarrhythmic Drug Therapy for Symptomatic Ventricular Tachycardia.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["supraventriculaire-tachycardie","ventriculaire-tachycardie"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2022.01.050","source_url":"https://doi.org/10.1016/j.jacc.2022.01.050","authors":["Ángel Arenal","Pablo Ávila","Javier Jiménez-Candil","Luis Tercedor","David Calvo","Fernando Arribas","Javier Fernández-Portales","José Luis Merino","Antonio Hernández-Madrid","Francisco J Fernández-Avilés","Antonio Berruezo"],"significance":7,"published":"2022-04-19","source_date":"2022-04-19","image":"","kennis":[],"congress":"","summary_en":"This study compared substrate-based catheter ablation with antiarrhythmic drug therapy for symptomatic ventricular tachycardia in patients with ischemic cardiomyopathy and an ICD, evaluating the optimal rhythm management approach.","created":"2026-07-03T10:29:42Z","updated":"2026-07-03T13:28:49Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Vergelijking van substraatablatie versus antiaritmische medicatie bij patiënten met symptomatische ventriculaire tachycardie.","abstract_original":"BACKGROUND: In patients with ischemic cardiomyopathy and an implantable cardioverter-defibrillator (ICD), catheter ablation and antiarrhythmic drugs (AADs) reduce ICD shocks, but the most effective approach remains uncertain. OBJECTIVES: This trial compares the efficacy and safety of catheter ablation vs AAD as first-line therapy in ICD patients with symptomatic ventricular tachycardias (VTs). METHODS: The SURVIVE-VT (Substrate Ablation vs Antiarrhythmic Drug Therapy for Symptomatic Ventricular Tachycardia) is a prospective, multicenter, randomized trial including patients with ischemic cardiomyopathy and appropriated ICD shock. Patients were 1:1 randomized to complete endocardial substrate-based catheter ablation or antiarrhythmic therapy (amiodarone + beta-blockers, amiodarone alone, or sotalol ± beta-blockers). The primary outcome was a composite of cardiovascular death, appropriate ICD shock, unplanned hospitalization for worsening heart failure, or severe treatment-related complications. RESULTS: In this trial, 144 patients (median age, 70 years; 96% male) were randomized to catheter ablation (71 patients) or AAD (73 patients). After 24 months, the primary outcome occurred in 28.2% of patients in the ablation group and 46.6% of those in the AAD group (hazard ratio [HR]: 0.52; 95% CI: 0.30-0.90; P = 0.021). This difference was driven by a significant reduction in severe treatment-related complications (9.9% vs 28.8%, HR: 0.30; 95% CI: 0.13-0.71; P = 0.006). Eight patients were hospitalized for heart failure in the ablation group and 13 in the AAD group (HR: 0.56; 95% CI: 0.23-1.35; P = 0.198). There was no difference in cardiac mortality (HR: 0.93; 95% CI: 0.19-4.61; P = 0.929). CONCLUSIONS: In ICD patients with ischemic cardiomyopathy and symptomatic VT, catheter ablation reduced the composite endpoint of cardiovascular death, appropriate ICD shock, hospitalization due to heart failure, or severe treatment-related complications compared to AAD. (Substrate Ablation vs Antiarrhythmic Drug Therapy for Symptomatic Ventricular Tachycardia [SURVIVE-VT]: NCT03734562)."}