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The occurrence of a sustained monomorphic ventricular tachycardia in patients with structural heart disease is a class 1 indication for ICD because of the expected relevant risk of sudden death. However, if this concerns selected patients with preserved left ventricular function and well-tolerated arrhythmias is still poorly known. In this article, we review the available data about the natural history of nonimplanted patients with structural heart disease and sustained ventricular tachycardia and the possible role of catheter ablation alone in this population. In structural heart disease patients with well-tolerated sustained ventricular tachycardia and preserved LVEF, catheter ablation alone, without ICD implantation, does not seem to carry an important risk of sudden death and the prognosis of these patients is mainly nonarrhythmic. Randomized prospective trials are urgently needed for evaluating the place of first choice ablation without ICD implantation in these populations.

expert review of medical devices

Ventricular tachycardia ablation as an alternative to implantable cardioverter-defibrillators in patients with preserved ejection fraction: current status and future prospects Are ICDs still always really mandatory after catheter ablation of well-tolerated ventricular tachycardia in mild structural heart disease and preserved ejection fraction? The true time to revisit this issue