New research indicates that ablation, a minimally invasive procedure, should be considered the primary treatment for patients experiencing rapid heartbeat (ventricular tachycardia, VT) following a heart attack. The study, presented at the American Heart Association meeting in Chicago and published in the New England Journal of Medicine, challenges the current practice of reserving ablation for cases where medication fails.
Ablation vs. Medication for Post-Infarction VT
Ventricular tachycardia is a common cause of sudden cardiac death in individuals who have survived a heart attack. Heart attacks often leave scar tissue that can disrupt the heart's electrical circuits, leading to VT. Currently, anti-arrhythmic medications are typically the first line of defense, with ablation used when drugs are ineffective.
Dr. John Sapp, assistant dean of clinical research at Dalhousie University, the lead author, stated, "For people who have survived a heart attack and developed VT, our findings show that performing a catheter ablation to directly treat the heart's abnormal scar tissue causing the arrhythmia, rather than prescribing heart rhythm medications that can affect other organs as well as the heart, provides better overall outcomes." He added that these results may change how heart attack survivors with ventricular tachycardia are treated.
Study Details and Outcomes
The study followed 416 patients with recurrent VT episodes and implanted defibrillators across three countries. Patients were divided into two groups: one receiving anti-arrhythmic medication and the other undergoing ablation. Over a median follow-up period of 4.3 years, the ablation group experienced a 25% reduction in the combined risk of death or VT episodes requiring defibrillator shocks.
The researchers also noted that the ablation group had fewer defibrillator shocks, fewer instances of three or more VT episodes in a single day, and fewer VT episodes that the defibrillator missed. Ablation uses radiofrequency energy to eliminate the abnormal tissue causing VT, leaving the rest of the heart undamaged.
Implications and Future Research
"Currently, catheter ablation is often reserved as a last-resort therapy when anti-arrhythmic medications fail or cannot be tolerated," Sapp said. "Now we know that ablation is a reasonable option for first-line treatment."
Dr. Sapp also noted the study did not identify specific patient characteristics that would favor one treatment over the other. The findings are also limited to patients whose heart scarring resulted from a blocked artery. He emphasized the need for further research to develop even better treatments, as VT episodes remained relatively high despite both treatment approaches.
