COR LOE Recommendations I B-R In patients with ischemic heart disease and recurrent VA, with significant symptoms or ICD shocks despite optimal device programming and ongoing treatment with a beta blocker, amiodarone or sotalol is useful to suppress recurrent VA.S7.1.3-1 S7.1.3-3 I B-R In patients with prior MI and recurrent episodes of symptomatic sustained VT, or who present with VT storm and have failed or are intolerant of amiodarone or other antiarrhythmic medications (LOE: B-NR) S7.1.3-5 S7.1.3-9 , catheter ablation is recommended S7.1.3-10 S7.1.3-12 B-NR IIb C-LD In patients with ischemic heart disease and ICD shocks for sustained monomorphic VT or symptomatic sustained monomorphic VT that is recurrent, or hemodynamically tolerated, catheter ablation as first-line therapy may be considered to reduce recurrent VA.S7.1.3-10,S7.1.3-11 III: Harm B-R In patients with prior MI, class IC antiarrhythmic medications (eg, flecainide and propafenone) should not be used.S7.1.3-13 CLINICAL STATEMENTS AND GUIDELINES III: Harm C-LD In patients with incessant VT or VF, an ICD should not be implanted until sufficient control of the VA is achieved to prevent repeated ICD shocks.S7.1.3-14 III: No Benefit C-LD In patients with ischemic heart disease and sustained monomorphic VT, coronary revascularization alone is an ineffective therapy to prevent recurrent VT.S7.1.3-15,S7.1.3-16 Recommendation-Specific Supportive Text 1. The most common antiarrhythmic medications used for suppression of VA include amiodarone and sotalol, while mexiletine, quinidine, and ranolazine are occasionally used.S7.1.3-17,S7.1.3-18 Amiodarone appears to be more effective than sotalol and has a low rate of ventricular proarrhythmia, but has an increased risk of medication-related adverse effects that lead to its discontinuation in many patients within 18 to 24 months from initiation of therapy.S7.1.3- Data supporting effectiveness of sotalol for suppression of VA are conflicting, but given its more favorable adverse effect profile than amiodarone, it may be a better first-line antiar- rhythmic medication in appropriate patients.S7.1.3- However, sotalol is generally avoided in patients with a severely reduced LVEF <20% due to its negative inotropic effects and the risk of torsades de pointes. 