Thus, amiodarone plus beta blocker were more effective than sotalol in preventing ICD shocks but at the expense of increased risk of medication-related adverse Sotalol should not be used in patients with an LVEF <20% due to its negative inotropic effects. 2. Sustained monomorphic VT due to NICM is most often due to scar-related reentry. Cardiac MRI often indicates scar location, which tends to be basal along the mitral annulus or in the The VT substrate can be CLINICAL STATEMENTS AND GUIDELINES Figure 6. Secondary and primary prevention of SCD in patients with NICM. Colors correspond to Class of Recommendation in Table 1. See Section 7.2 for discussion. *ICD candidacy as determined by functional status, life expectancy or patient preference. 2 indicates secondary; EP, electrophysiological; GDMT, guideline-directed management and therapy; HF, heart failure; ICD, implantable cardioverter-defibrillator; LVEF, left ventricular ejection fraction; NICM, nonischemic cardiomyopathy; SCA, sudden cardiac arrest; SCD, sudden cardiac death; VA, ventricular arrhythmia; and WCD, wearable cardioverter-defibrillator. subendocardial, subepicardial, or intramyo- cardial, and all locations may be affected and require endocardial and epicardial ablation. In the HELP-VT (Heart Center of Leipzig VT) successful ablation of all VT mor- phologies was achieved in 66.7% of patients with NICM, compared with the 77.4% suc- cess rate in ischemic cardiomyopathy. An epi- cardial approach to ablation was required in 30.2% of NICM patients, compared with only 1.2% with ischemic cardiomyopathy. Epicardial ablation was an independent predictor of suc- cessful ablation. Acute and long-term success of ablation is lower for NICM, compared with post-MI patients. The long-term survival-free of VT recurrence after catheter ablation appears to be better for patients with ischemic than Risks are similar to those observed for post-MI VT ablation, with additional risks of epicardial access and ablation when required. 