Ventricular Tachycardia (VT) Ablation Versus Enhanced Drug Therapy (VANISH)

Patients with ischemic heart disease presenting with appropriate ICD therapy for ventricular tachycardia in spite of first-line antiarrhythmic drug therapy.

Inclusion Criteria:

• Prior Myocardial Infarction
• An implantable defibrillator

• One of the following VT events (within the past 3 months):

  • greater than or equal to 3 episodes of symptomatic VT treated with ATP
  • greater than or equal to 1 appropriate ICD shock
  • greater than or equal to 3 VT episodes within 24 hours
  • sustained VT below detection rate of the ICD documented by ECG

• "Failed" first-line antiarrhythmic drug therapy as defined by one of:

  • Appropriate ICD therapy or sustained VT occurred while patient was taking amiodarone (stable dose >/= 2 weeks)
  • Appropriate ICD therapy or sustained VT occurred on another antiarrhythmic drug (stable dose >/= 2 weeks)

Exclusion Criteria:

• Active ischemia (acute thrombus, dynamic ST elevation on ECG) or another reversible cause of VT (eg. electrolyte abnormalities, drug induced arrhythmia)
• Are known to be ineligible to take amiodarone (eg. active hepatitis, current hyperthyroidism, pulmonary fibrosis, known allergy)
• Are ineligible for ablation (left ventricular thrombus, implanted mechanical aortic and mitral valves)
• Renal Failure (creatinine clearance < 15 ml/min)
• Current NYHA functional class IV heart failure or CCS Functional Class IV angina
• Recent ST elevation myocardial infarction (< 1 month)
• Recent coronary bypass surgery (< 3 mon) or recent PCI (< 1 mon)
• Pregnant
• prior ablation for ventricular tachycardia
• A systemic illness likely to limit survival to < 1 year
• Unable or unwilling to provide informed consent