Catheter Ablation Versus Anti-arrhythmic Drugs for Ventricular Tachycardia

Inclusion Criteria:

Patients will be eligible for inclusion if they have:

1. ≥1 prior episode of sustained VT in the prior 6 months;

2. Spontaneous VT: ≥1 episode of monomorphic VT treated by anti-tachycardia pacing (ATP) and/or internal shock by an ICD; lasting ≥30 seconds in the absence ofintra-cardiac device therapy that could either be self-terminating or requirereversion by pharmacological therapy or external cardioversion;

3. Spontaneous VT: ≥1 episode of sustained spontaneous monomorphic VT lasting ≥30seconds documented on Holter, ECG, Loop recorder or other cardiac monitoringdevice that could either be self-terminating or require reversion bypharmacological therapy or external cardioversion;

4. Inducible VT: with syncope or palpitations - inducible VT defined as sustainedmonomorphic VT of CL ≥200 ms lasting for ≥10 s during a cardiacelectrophysiology study (note with 4 extrastimuli with or without provocationwith isoprenaline);

5. Already a recipient of an implanted cardiac device such as a pacemaker,defibrillator or a cardiac resynchronisation therapy device and/or is indicated toreceive one given a new diagnosis of structural heart disease, based on currentguideline recommendations;

6. Aged ≥18 years.

Exclusion Criteria:

Patients will be excluded if they are:

1. Unable or unwilling to provide informed consent or patients physician feels there isnot significant equipoise to justify randomisation;

2. Women who are pregnant, breast feeding;

3. Medical illness with an anticipated life expectancy <3 months;

4. Unable to complete study procedures or unwilling to be followed up;

5. Have a concomitant illness, physical impairment or mental condition which in theopinion of the study team/ primary care physician could interfere with the conductof the study including outcome assessments;

6. Known channelopathy such as long QT, short QT, Brugada syndrome, catecholaminergicpolymorphic VT;

7. Known prior diagnosis of no structural heart disease, or idiopathic ventriculararrhythmia.