Research News In Brief

Ablation SMASHes VT: Substrate-based catheter ablation reduces defibrillator shocks in patients with an ICD and a history of myocardial infarction, according to results of the 128-patient SMASH-VT trial, published in the Dec. 27 New England Journal of Medicine. The National Institutes of Health-supported trial randomized patients with a previous heart attack and spontaneous ventricular tachycardia or fibrillation to be treated with an ICD alone or an ICD plus catheter ablation. The primary endpoint was survival with no ICD shocks or pacing needed to treat an arrhythmia. Mean follow-up was 22.5 months. 31% of the patients in the ICD-only group received an appropriate shock compared with 9% of the ICD-plus-ablation group. Mortality was statistically similar for both groups - 17% for the control and 9% for the ablation group. Lead author Vivek Reddy, M.D., Massachusetts General Hospital, says the study results should be confirmed in larger studies that also analyze the impact of antiarrhythmic drugs. "In addition, a formal economic analysis would be needed to adequately understand the relationship between the immediate costs of the ablation procedure and the long-term costs of care for patients with ICDs," Reddy explains