ICDs Save Lives, But Is That Enough? The Battle Against Recurrent Ventricular Tachycardia
Catheter ablation or drugs for VT
Implantable Cardioverter Defibrillators (ICDs) are life-saving devices that help post MI patients with myocardial scar from a sudden cardiac death . If any abnormal heart rhythm occurs like ventricular tachycardia (VT), ICDs can deliver a small electrical pulse or a shock to restore a normal heartbeat, increasing survival chances.
However, ICDs do not prevent VT from happening—they only stop it when it occurs. In fact, within three years of getting an ICD, about one in three patients will still experience VT episodes ranging from clusters of VTs known as electrical storms to more hospitalisations for heart failure. recurrent ventricular tachycardia is associated with worse outcomes despite the presence of an ICD,this highlights the need for additional treatments to better manage VT and improve patient outcomes.
Any post MI arrhythmias are initially treated with drugs like sotalol[lower risk of side effects when used for long term] than amiadarone [increased side effects but better efficacy-used in severe cases]. Only when drug therapy fails, catheter ablation is opted owing to an increased risk of procedural complications.
The VANISH trial (Ventricular Tachycardia Antiarrhythmics or Ablation in Ischemic Heart Disease) found that catheter ablation, combined with continuing regular antiarrhythmic medications, was more effective than simply increasing medication doses for patients with ventricular tachycardia (VT) and ischemic cardiomyopathy.
Patients who underwent ablation had a lower risk of serious outcomes, including death, ICD shocks, or severe VT episodes (VT storm), compared to those who only received stronger drug therapy. This highlights ablation as a better treatment option for managing VT in these high-risk patients.
