Treatment and Prevention of Recurrent VA in Patients With Ischemic Heart Disease Recommendations for Treatment of Recurrent VA in Patients With Ischemic Heart Disease References that support the recommendations are summarized in Online Data Supplements 22 and 23. 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. 