Catheter ablation for ventricular tachycardia (VT) reduces the recurrence of VT in
patients with implantable cardioverter-defibrillators (ICDs). The appropriate timing
of VT ablation and its effects on mortality and heart failure progression remain a
matter of debate. In patients with life-threatening arrhythmias necessitating ICD
implantation, we compared outcomes of preventive VT ablation (undertaken before ICD
implantation to prevent ICD shocks for VT) and deferred ablation after 3 ICD shocks
for VT.The BERLIN VT study (Preventive Ablation of Ventricular Tachycardia in Patients
With Myocardial Infarction) was a prospective, open, parallel, randomized trial performed
at 26 centers. Patients with stable ischemic cardiomyopathy, a left ventricular ejection
fraction between 30% and 50%, and documented VT were randomly assigned 1:1 to a preventive
or deferred ablation strategy. The primary outcome was a composite of all-cause death
and unplanned hospitalization for either symptomatic ventricular arrhythmia or worsening
heart failure. Secondary outcomes included sustained ventricular tachyarrhythmia and
appropriate ICD therapy. We hypothesized that preventive ablation strategy would be
superior to deferred ablation strategy in the intention-to-treat population.During
a mean follow-up of 396±284 days, the primary end point occurred in 25 (32.9%) of
76 patients in the preventive ablation group and 23 (27.7%) of 83 patients in the
deferred ablation group (hazard ratio, 1.09 [95% CI, 0.62-1.92]; P=0.77). On the basis
of prespecified criteria for interim analyses, the study was terminated early for
futility. In the preventive versus deferred ablation group, 6 versus 2 patients died
(7.9% versus 2.4%; P=0.18), 8 versus 2 patients were admitted for worsening heart
failure (10.4% versus 2.3%; P=0.062), and 15 versus 21 patients were hospitalized
for symptomatic ventricular arrhythmia (19.5% versus 25.3%; P=0.27). Among secondary
outcomes, the proportions of patients with sustained ventricular tachyarrhythmia (39.7%
versus 48.2%; P=0.050) and appropriate ICD therapy (34.2% versus 47.0%; P=0.020) were
numerically reduced in the preventive ablation group.Preventive VT ablation before
ICD implantation did not reduce mortality or hospitalization for arrhythmia or worsening
heart failure during 1 year of follow-up compared with the deferred ablation strategy.
Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02501005.
