B-NR Value Statement: Intermediate Value (LOE: B-R) A transvenous ICD provides intermediate value in the secondary prevention of SCD particularly when the patient s risk of death due to a VA is deemed high and the risk of nonarrhythmic death (either cardiac or noncardiac) is deemed low based on the patient s burden of comorbidities and I B-NR In patients with ischemic heart disease and unexplained syncope who have inducible sustained monomorphic VT on electrophysiological study, an ICD is recommended if meaningful survival of greater than 1 year is expected.S7.1.1-7 CLINICAL STATEMENTS AND GUIDELINES Recommendation-Specific Supportive Text 1. In the AVID trial,S7.1.1-1 the ICD improved overall sur- vival compared with antiarrhythmic medication ther- apy (primarily amiodarone) in patients who survived SCD or with hemodynamically unstable VT, with a 2-year relative risk reduction in mortality of 27% and an absolute risk reduction of 7%. CIDS (Canadian Implantable Defibrillator Study),S7.1.1-2 which was stopped early after the results of the AVID trial were released, showed a similar, but not statistically signifi- cant, benefit of the ICD over antiarrhythmic medi- cation therapy. A subsequent meta-analysis using data from 3 RCTs showed a statistically significant reduction in both arrhythmic and all-cause mortal- ity with secondary prevention ICDs.S7.1.1-3 In survivors of life-threatening VA that may be due to transient or reversible factors, such as AMI, proarrhythmic medication effects, or electrolyte disturbances, an ICD is not implanted if the cause may be correctable. 