Catheter ablation gains ground in practice-changing Australian trial

An Australian-led clinical trial is challenging the conventional treatment pathway for ventricular tachycardia (VT), with new findings suggesting catheter ablation delivers better outcomes. The results of the landmark CAAD-VT* trial were presented recently at the Heart Rhythm Society congress by Associate Professor Saurabh Kumar, cardiologist and cardiac electrophysiologist at Westmead Private Hospital in Sydney.

VT is a life-threatening heart rhythm disorder that occurs more frequently in patients with underlying heart disease and remains a major contributor to sudden cardiac death (SCD). The CAAD-VT trial found that catheter ablation may reduce VT events in patients with both ischemic and non-ischemic cardiomyopathy.

For decades, most clinical trials investigating VT therapies have centred on patients with coronary atherosclerosis which leads to to ischemic heart disease. Researchers say the focus has largely reflected the higher prevalence of ischemic disease, along with its more predictable and uniform disease substrate, making it easier to evaluate in controlled study environments.

Patients with non-ischemic cardiomyopathy, however, have historically been underrepresented in VT research because of the condition’s clinical heterogeneity. As a result, uncertainty has persisted around how established therapies translate to this broader patient population. The CAAD-VT study was specifically designed to address that gap by recruiting an “all-comers” cohort of patients with structural heart disease intended to better mirror real-world clinical practice.

“Over the past two decades, there have been very few randomised studies examining treatment strategies for ventricular tachycardia, particularly in broader patient populations with structural heart disease,” said A/Professor Kumar. “CAAD-VT provides important evidence to help guide treatment decisions earlier in the patient journey, rather than waiting until therapies have failed.”

The study followed 100 patients over a median period of 35.7 months. Investigators reported that the primary endpoint, a composite of recurrent VT, VT storm, or all-cause mortality, occurred in 51% of patients treated with catheter ablation, compared with 71% of those receiving antiarrhythmic drug (AAD) therapy. Patients undergoing catheter ablation also experienced significantly lower rates of VT recurrence and VT storm, while mortality outcomes were similar between the two groups.

“While catheter ablation is widely used to treat ventricular tachycardia, continued evaluation across diverse patient populations is essential to ensure every patient receives the most effective therapy,” said A/Professor Kumar. “These findings add to growing evidence supporting catheter ablation as a viable option for treating patients with ventricular tachycardia, with both ischemic and non-ischemic cardiomyopathies.”

VT remains one of the most serious complications associated with cardiomyopathy and other structural heart diseases, frequently leading to repeat hospitalisations and substantial declines in quality of life. The findings have important implications not only for cardiac electrophysiologists, but also for general cardiologists managing patients at risk of ventricular arrhythmias.

“This trial demonstrates Australia’s ability to deliver high-quality, practice-changing cardiovascular research through strong national collaboration across leading centres,” A/Professor Kumar added.

*Catheter Ablation versus Anti-arrhythmic Drugs for Ventricular Tachycardia

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