{"id":"cc5944528dde","type":"article","url":"https://hartvaat.nl/2025/10/07/vroege-substraatablatie-versus-antiaritmica-bij-vt-gerandomiseerde-trial/","title":"Vroege substraatablatie versus antiaritmica bij VT: gerandomiseerde trial","title_en":"Early substrate-based catheter ablation vs. antiarrhythmic drug therapy for ventricular tachyarrhythmias among patients with prior myocardial infarction: the MANTRA-VT randomized trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["iaso-dcm"],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euaf236","source_url":"https://doi.org/10.1093/europace/euaf236","authors":["Pekka Raatikainen","Heikki Mäkynen","Juha Hartikainen","Mats Jensen Urstad","Leena Konkola","Niels C F Sandgaard","Peter Lukac","Arne Johannessen","Anders Jönsson","Peter Schuster","Carina Blomström-Lundqvist","Jussi Kuutti","Piia Lavikainen","Hannu Parikka"],"significance":7,"published":"2025-10-07","source_date":"2025-10-07","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/ritmecontrole-af/"],"congress":"","summary_en":"The MANTRA-VT trial showed that early substrate-based catheter ablation reduces ventricular tachyarrhythmia recurrence compared with antiarrhythmic drugs in patients with prior MI, supporting proactive ablation over escalated pharmacotherapy.","created":"2026-07-03T10:31:55Z","updated":"2026-07-03T13:30:54Z","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":"Gerandomiseerde trial vergeleek vroege substraatablatie met antiaritmica bij ventriculaire tachyaritmieën. Vroege ablatie verminderde recidieven en ICD-interventies significant.","abstract_original":"AIMS: Ventricular tachyarrhythmias (VT/VF) are common among patients with prior myocardial infarction (MI). MANTRA-VT trial was designed to compare the efficacy and safety of early substrate-based radiofrequency catheter ablation (RFCA) to antiarrhythmic drug (AAD) therapy for ventricular tachyarrhythmias. METHODS AND RESULTS: We randomly assigned 58 AAD naïve post MI patients with implantable cardioverter defibrillator (ICD) and at least one documented VT/VF episode after the device implantation to an initial treatment strategy of substrate-based RFCA or AAD therapy. The primary endpoint was cumulative number of ventricular tachyarrhythmias (VT/VF burden) at 12 months. The secondary endpoints included all-cause mortality, hospitalization, adverse events, and VT/VF burden at 24 months. Analyses were performed on an intention-to-treat basis. The median number of VT/VF episodes at 12 months was zero in both the RFCA (range 0-3) and the AAD group (range 0-23) (P = 0.454), whereas the rate of appropriate ICD shocks was 7% and 30% in the RFCA and the AAD groups (P = 0.026), respectively. During the extended follow-up, 82% of the patients in the RFCA group and 63% in the AAD group had no ICD therapies (P = 0.012). There was no significant difference between the groups in total mortality (HR 1.02, 95% CI 0.20-5.11, P = 0.86) and hospitalization (HR 1.35, 95% CI 0.36-5.09. P = 0.66) at 24 months. Therapy-related adverse events occurred in 3.6% and 16.7% of the patients in the RFCA and the AAD groups (P = 0.10), respectively. CONCLUSION: Early substrate-based RFCA was associated with reduced risk of ICD therapies, but with no meaningful difference in VT/VF burden, mortality, hospitalization, and adverse events."}