Insights into BERLIN study of catheter ablation for ventricular tachycardia treatment

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Karl-Heinz Kuck, Asklepios Clinic St Georg, Hamburg, Germany, discussed at the 8th annual Expert Meeting Berlin Conference (sponsored by Biotronik and GE Healthcare, 7–8 February) details on the BERLIN study, a prospective, multicentre study that seeks to determine the best time for catheter ablation in the treatment of patients with sustained ventricular tachycardia and coronary artery disease.

The study, conducted by the German Center for Cardiovascular Research, aims to enrol 208 patients with coronary artery disease and moderately reduced left-ventricular function or LVEF (≥30 to ≤50%) with an implantable cardioverter-defibrillator (ICD) indication and documented ventricular tachycardia.

Kuck explained that the patients will be randomised into two groups. The intervention group will receive prophylactic catheter ablation followed by an ICD. The control group will receive an ICD followed by catheter ablation after the third ICD shock (the standard prophylaxis for sudden cardiac death). Primary endpoint is all-cause mortality or hospital admission due to cardiovascular complications. Secondary endpoint is time until first shock. The Biotronik Home Monitoring system will be used to keep track of patients’ conditions remotely.

Although the link between ICD shock delivery and mortality is not yet fully understood, it is already known that shocks-both appropriate and inappropriate-are associated with increased mortality. Furthermore, data from studies such as VTACH (Kuck et al, Lancet 2010; 375:31-40) and SMASH VT (Reddy et al, New England Journal of Medicine 2007; 357:2657-65) already suggest a benefit in early or prophylactic catheter ablation of ventricular tachycardia. “Although current guidelines do not recommend ventricular tachycardia ablation before the use of an ICD,” Kuck explained, “We feel we have seen enough evidence of the benefit of early ablation to proceed with a study to determine its true clinical value.”

Kuck stressed the importance of reaction time when it comes to the treatment of heart conditions. The BERLIN study will emphasise how much early detection and early intervention matters. This study outlines the potential for Home Monitoring-guided therapy across various indications and patient groups in cardiology.

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