INTRODUCTION
In patients with ischemic cardiomyopathy (ICM), ventricular tachycardia and ventricular fibrillation (VT/VF) typically originate from a relatively discrete portion of the myocardium, within or bordering the infarct zone that is amenable to catheter ablation.1However, the mainstay of treatment for these patients is typically based on medical therapy and implantable cardioverter defibrillators (ICDs).2 Use of anti-arrhythmic drugs (AAD) is typically the first approach as an adjunctive therapy to reduce ICD therapies; yet, success is limited and may be associated with significant drug-related adverse events.3 Conversely, catheter ablation has emerged as a an important therapeutic strategy for VT/VF with the advent of improved mapping technologies and ablation strategies, particularly the success seen with substrate based approaches.4 As such, randomized controlled trials (RCTs) have shown improved outcomes in patients undergoing first-line catheter ablation for VT in patients with ICM.5,6However, increased early mortality has been reported in patients with severely depressed left ventricular ejection fraction (LVEF), whereas outcomes in moderately depressed LVEF seem different.7Herein, we characterized outcomes based on LVEF of patients with ICM presenting with VT undergoing first line VT ablation compared to an initial approach based on medical therapy.