Ventricular Tachycardia (VT) Ablation or Escalated Drug Therapy

Inclusion Criteria: * Prior Myocardial Infarction * An implantable defibrillator * One of the following VT events (within the past 3 months): * greater than or equal to 3 episodes of symptomatic VT treated with ATP * greater than or equal to 1 appropriate ICD shock * greater than or equal to 3 VT episodes within 24 hours * sustained VT below detection rate of the ICD documented by ECG * "Failed" first-line antiarrhythmic drug therapy as defined by one of: * Appropriate ICD therapy or sustained VT occurred while patient was taking amiodarone (stable dose \>/= 2 weeks) * Appropriate ICD therapy or sustained VT occurred on another antiarrhythmic drug (stable dose \>/= 2 weeks) Exclusion Criteria: * Active ischemia (acute thrombus, dynamic ST elevation on ECG) or another reversible cause of VT (eg. electrolyte abnormalities, drug induced arrhythmia) * Are known to be ineligible to take amiodarone (eg. active hepatitis, current hyperthyroidism, pulmonary fibrosis, known allergy) * Are ineligible for ablation (left ventricular thrombus, implanted mechanical aortic and mitral valves) * Renal Failure (creatinine clearance \< 15 ml/min) * Current NYHA functional class IV heart failure or CCS Functional Class IV angina * Recent ST elevation myocardial infarction (\< 1 month) * Recent coronary bypass surgery (\< 3 mon) or recent PCI (\< 1 mon) * Pregnant * prior ablation for ventricular tachycardia * A systemic illness likely to limit survival to \< 1 year * Unable or unwilling to provide informed consent