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Early Catheter Ablation for Unstable Ventricular Tachycardia: Still Too Early to Tell.

In this issue of Circulation: Arrhythmia and Electrophysiology , Kuck et al1 report the results of the SMS (Substrate Modification Study), in which patients presenting with coronary artery disease and ventricular fibrillation, ventricular tachycardia (VT) with hemodynamic instability, or syncope and inducible hemodynamically unstable VT were randomly assigned to receive either catheter ablation of VT or no specific therapy in addition to insertion of an implantable cardioverter–defibrillator (ICD). This trial is a welcome addition to the small number of randomized controlled multicenter trials of catheter ablation of VT and provides a natural complement to the VTACH trial (Catheter Ablation of Stable Ventricular Tachycardia Before Defibrillator Implantation in Patients With Coronary Heart Disease),2 which was similar in design, but enrolled only patients with hemodynamically tolerated VT. The observations in the trial provide a contrast with the 2 most directly comparable studies, the VTACH study2 and the SMASH-VT trial (Prophylactic Catheter Ablation for the Prevention of Defibrillator Therapy).3

See Article by Kuck et al 

Reducing the burden of recurrent ventricular arrhythmias for patients with implantable defibrillators and ischemic cardiomyopathy is highly important—recurrent VT and consequent ICD therapy is associated with adverse quality of life4 and adverse prognosis.5 Our options for accomplishing this include optimization of ICD programming6 to avoid unnecessary therapy (especially unnecessary shocks) and utilization of therapies to reduce recurrent arrhythmias.7 Unfortunately, treatments to reduce recurrent arrhythmias are limited; both catheter ablation and antiarrhythmic drugs have only …