Patients with wide QRS complex tachycar- dia and known structural heart disease should be presumed to have VT until proven otherwise. Administration of a calcium channel blocker such as verapamil to a patient with VT may result in severe hypotension or syncope.S6-31 The exception is verapamil-sensitive VT (interfascicu- lar reentry) that occurs in a structurally normal heart; but this is often difficult to recognize on 7. ONGOING MANAGEMENT OF VA AND SCD RISK RELATED TO SPECIFIC DISEASE STATES 7.1. Ischemic Heart Disease 7.1.1. Secondary Prevention of SCD in Patients With Ischemic Heart Disease Recommendations for Secondary Prevention of SCD in Patients With Ischemic Heart Disease References that support the recommendations are summarized in Online Data Supplements 17 and 18. COR LOE Recommendations I B-R In patients with ischemic heart disease, who either survive SCA due to VT/VF or experience hemodynamically unstable VT (LOE: B-R) S7.1.1-1 S7.1.1-4 or stable sustained VT (LOE: B-NR) S7.1.1-5 not due to reversible causes, an ICD is recommended if meaningful survival greater than 1 year is expected. 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. 