Catheter Ablation or Antiarrhythmic Drugs for Ventricular Tachycardia (VANISH2)
Sapp J et al. NEJM (November 2024)
Bottom Line: This international trial compared the effectiveness of catheter ablation versus antiarrhythmic drug therapy as a first-line treatment for patients with clinically significant ventricular tachycardia and ischemic cardiomyopathy. A total of 416 patients , all of whom already had an implantable cardioverter-defibrillator (ICD) were randomly assigned to receive either catheter ablation within 14 days after randomization or drug therapy (sotalol or amiodarone, dependent on prespecified criteria). The primary outcome was a composite of death from any cause during follow-up or, more than 14 days after randomization, ventricular tachycardia storm, appropriate ICD shock, or sustained ventricular tachycardia treated by medical intervention. A primary end-point event occurred in 103 of 203 patients (50.7%) assigned to catheter ablation and in 129 of 213 (60.6%) assigned to drug therapy (hazard ratio, 0.75; 95% confidence interval, 0.58 to 0.97; P=0.03). These results showed that catheter ablation was more effective in reducing the risk of adverse outcomes compared to drug therapy. Adverse events were reported in both groups, with a lower incidence in the catheter ablation group.
High-Flow Nasal Oxygen vs Noninvasive Ventilation in Patients With Acute Respiratory Failure: The RENOVATE Randomized Clinical Trial
RENOVATE Investigators and the BRICNet Authors. JAMA (December 2024)
Bottom Line: This noninferiority, randomized clinical trial evaluated whether high-flow nasal oxygen is noninferior to noninvasive ventilation in 1800 hospitalized adults with acute respiratory failure (ARF) at 33 hospitals in Brazil. Patients were divided into five groups based on their medical history: nonimmunocompromised with hypoxemia, immunocompromised with hypoxemia, chronic obstructive pulmonary disease (COPD) exacerbation with respiratory acidosis, acute cardiogenic pulmonary edema, or hypoxemic COVID-19. The intervention group received high-flow nasal oxygen (HFNO) while the comparator group received noninvasive ventilation (NIV). The primary outcome was endotracheal intubation or death at 7 days, which occurred in 39% of the HFNO group and 38% of the NIV group. HFNO was found to be noninferior to NIV in 4 out of 5 patient groups with ARF. The incidence of serious adverse events was similar in both groups. Further study is needed in patients with COPD, immunocompromised patients, and patients with acute cardiogenic pulmonary edema.
Biomarker-Guided Antibiotic Duration for Hospitalized Patients With Suspected Sepsis: The ADAPT-Sepsis Randomized Clinical Trial
Dark P et al. JAMA (December 2024)
Bottom line: This multicenter, intervention-concealed randomized clinical trial evaluated whether decisions based on assessment of C-reactive protein (CRP) or procalcitonin (PCT) can safely reduce the duration of antibiotic therapy. The study enrolled 2760 hospitalized critically ill adults with suspected sepsis within 24 hours of initiating intravenous antibiotics and likely to continue antibiotics for at least 72 hours. The primary outcomes were total duration of antibiotics (effectiveness) and all-cause mortality (safety) to 28 days. The study found that the daily PCT-guided protocol significantly reduced antibiotic duration compared to standard care (mean duration, 10.7 [SD, 7.6] days for standard care and 9.8 [SD, 7.2] days for PCT; mean difference, 0.88 days; 95% CI, 0.19 to 1.58, P = .01), while the daily CRP-guided protocol did not. There was no significant difference in all-cause mortality between the PCT-guided protocol and standard care, while the daily CRP-guided protocol was inconclusive compared to standard care. The study concluded that PCT-guided protocol can safely reduce antibiotic duration in this patient population.
Trial Files Issue #2025-03