Antiarrhythmics or Ablation for Ventricular Tachycardia 2

Prior treatment

• Have had a prior catheter ablation procedure for VT

Other illness

• Active ischemia (acute thrombus diagnosed by coronary angiography, or dynamic ST segment changes demonstrated on ECG) or another reversible cause of VT (e.g. drug-induced arrhythmia), had recent acute coronary syndrome within 30 days, coronary revascularization (\<90 days bypass surgery, \<30 days percutaneous coronary intervention), or have CCS functional class IV angina. Note that biomarker level elevation alone after ventricular arrhythmias does not denote acute coronary syndrome or active ischemia.
• Are ineligible to take the antiarrhythmic drug to which they would be assigned due to allergy, intolerance or contraindication
• Presenting arrhythmia: polymorphic VT or ventricular fibrillation (VF)
• Have had recent ST elevation myocardial infarction or non-ST elevation MI (\< 30 days); note that biomarker elevation alone after ventricular arrhythmias does not denote MI.

Lab values

• Are in renal failure (Creatinine clearance \<15 mL/min), have NYHA Functional class IV heart failure, or a systemic illness likely to limit survival to \<1 year

Other

• Unable or unwilling to provide informed consent.
• Are known to have protruding left ventricular thrombus or mechanical aortic and mitral valves
• Are pregnant.

• Prior Myocardial Infarction and
• One of the following VT events while not being treated with amiodarone, sotalol, or another class I or class III antiarrhythmic drug) within the last 6 months:
  • Sustained monomorphic VT documented on 12-lead ECG or rhythm strip terminated by pharmacologic means or DC cardioversion
  • ≥3 episodes of VT treated with antitachycardia pacing (ATP), at least one of which was symptomatic
  • ≥ 5 episodes of VT treated with antitachycardia pacing (ATP) regardless of symptoms
  • ≥1 appropriate ICD shocks,
  • ≥3 VT episodes within 24 hours