Abstract 21033: Effect of Baseline Antiarrhythmic Drug on Outcomes With Ablation in Ischemic Ventricular Tachycardia: A Vanish Substudy
Bibliographic record
Abstract
Introduction: The VANISH trial enrolled patients with prior myocardial infarction, an implanted defibrillator and ventricular tachycardia (VT) despite antiarrhythmic (AAD) drugs and compared the effectiveness of escalated AAD therapy to catheter ablation. We sought to compare the effectiveness of these interventions in patients with sotalol-refractory VT versus amiodarone-refractory VT. Methods: All patients enrolled in the VANISH study were included (n=259). VT recurrence was compared in patients despite amiodarone (amio-refractory) as compared to non-amiodarone drugs (sotalol-refractory). Outcomes were a composite of death, VT storm, appropriate ICD shock, each of these components and any ventricular arrhythmia. Results: At baseline, 169 (65.2%) were amio-refractory and 90 (34.7%) were sotalol-refractory (1 patient was enrolled with VT despite procainamide). Amio-refractory patients had more renal insufficiency (23.7% vs 10%, p=0.0008), worse NYHA class (82.3% II/III vs 65.5%, p=0.0003), and lower ejection fraction (29 ± 9.7% vs 35.2 ± 11%, p<0.0001). After adjusting for these baseline differences, there was no difference in mortality between the two groups. When examined within the escalated drug therapy arm, amio-refractory patients had a higher incidence of the composite outcome (HR 1.94, 95%CI (1.14, 3.29), p=0.0144), and a trend to higher mortality (HR 2.40, 95%CI (0.93, 6.22), p=0.07), while no difference in outcomes were observed within the ablation treatment group. Within the amio-refractory group, ablation resulted in significant reduction of any ventricular arrhythmia (HR 0.53, 95%CI (0.31, 0.9), p=0.020). Sotalol-refractory patients had trends towards higher mortality and VT storm with ablation, with no effect on ICD shocks. Conclusions: The benefit of catheter ablation is greater for patients with amio-refractory VT than for patients with sotalol-refractory VT who are then switched to amiodarone.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".