Catheter Ablation vs Sotalol or Amiodarone for Ventricular Tachycardia
Bibliographic record
Abstract
BACKGROUND: In the VANISH2 multicenter randomized trial comparing catheter ablation to antiarrhythmic drugs (AADs) for patients with prior myocardial infarction and ventricular tachycardia (VT), randomization was stratified by drug eligibility based on clinical criteria. OBJECTIVES: The objective of this prespecified substudy was to compare the outcomes of catheter ablation vs AAD according to drug eligibility stratum. METHODS: Patients were considered eligible to be allocated to sotalol vs ablation if they met all the following criteria: estimated glomerular filtration rate ≥30 mL/min, NYHA functional class I-II, left ventricular ejection fraction ≥20%, qualifying arrhythmia was not VT storm, and no history of torsades de pointes or QT interval prolongation. All other patients were eligible to be randomly allocated to amiodarone vs ablation. The primary endpoint was a composite of death, appropriate implantable cardioverter-defibrillator shock, VT storm, or treated sustained VT below the detection limit of the implantable cardioverter-defibrillator >14-days postrandomization. Secondary endpoints included safety and the individual components of the primary endpoint. In this analysis, the primary and secondary outcomes for catheter ablation are compared with those for sotalol and to amiodarone separately. RESULTS: A total of 416 patients (199 in sotalol and 217 in amiodarone strata) were followed for a median of 4.3 years. In the sotalol stratum, a primary endpoint occurred in 44 of 95 patients (46%) assigned to catheter ablation and in 62 of 104 (59%) assigned to sotalol (HR: 0.64; 95% CI: 0.43-0.94; P = 0.02). In the amiodarone stratum, a primary endpoint occurred in 59 of 108 (55%) patients assigned to ablation and 67 of 109 (61%) assigned to AAD (HR: 0.86; 95% CI: 0.61-1.22; P = NS). In the sotalol stratum, sustained VT below detection occurred in 2 of 95 (2.1%) patients randomized to ablation and 18 of 104 (17.3%) assigned to sotalol (HR: 0.12; 95% CI: 0.03-0.5; P = 0.004). In the amiodarone stratum it occurred in 7 of 108 (6.5%) randomized to ablation and 17 of 109 (15.6%) assigned to amiodarone (HR: 0.41; 95% CI: 0.17-0.99; P = 0.048). In the amiodarone stratum, patients allocated to drug therapy had a 3-fold increase in noncardiac death (5.6% vs 16.5%), a 2-fold increase in respiratory failure (4.6% vs 11.0%), a 50% increase in heart failure hospitalization (19.4% vs 31.2%), a 65% increase in sepsis (5.6% vs 9.2%), a 3-fold increase in pneumonia (3.7% vs 11.9%), and 4.6% incidence of pulmonary fibrosis/infiltrate (vs 0%), when compared with patients allocated to ablation. CONCLUSIONS: In the sotalol-eligible patients, ablation led to lower risk of the primary composite endpoint. In the amiodarone-eligible group, efficacy outcomes were comparable between ablation and amiodarone. Adverse events were more marked among patients randomized to amiodarone (Antiarrhythmics or Ablation for Ventricular Tachycardia 2 [VANISH2]; NCT02830360).
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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 | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.003 |
| Insufficient payload (model declined to judge) | 0.005 | 0.001 |
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".