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When implantable cardioverter–defibrillator (ICD) therapy takes the form of shock, it not only is painful but also may increase the risks for ventricular arrhythmia and death. In the partly industry-funded VANISH trial, researchers enrolled 259 patients with ischemic cardiomyopathy, antiarrhythmic drug (AAD) therapy, and ICD implantation who (in the previous 6 months) had a ventricular arrhythmia treated by the ICD or a sustained ventricular arrhythmia below the rate cutoff of the ICD. Participants were randomized to VT ablation (targeting all inducible VTs) or intensified AAD therapy (switching to amiodarone if not taking it already or, if on amiodarone, increasing the dose or adding mexiletine). Mean follow-up was 28 months.
After a 30-day…