Pan-Asia United States PrEvention of Sudden Cardiac Death Catheter Ablation Trial

Inclusion Criteria: * Patient is receiving a new implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy device (CRT-D) implant that has study required programing capabilities and is appropriate for remote monitoring. Patient who has received the ICD / CRT-D within 90 days of enrollment can also be enrolled. * Patient who has a high risk of ICD shock as shown by documented Monomorphic VT (MMVT) by one or more of the following: * Spontaneous MMVT * Inducible MMVT during electrophysiology study, * Inducible MMVT during noninvasive programmed stimulation study \*Inducible MMVT is defined as MMVT \> 30 seconds or requiring electrical termination (ATP or cardioversion) * Patient has ejection fraction \< 50% or right ventricular dysfunction * Patient has a cardiomyopathy with structural heart disease of any cause Exclusion Criteria: * Any history of debilitating stroke with neurologic deficit * ST-segment elevation myocardial infarction or previous cardiac surgery within 60 days prior to enrollment * Patient is pregnant or nursing * Patient has chronic New York Heart Association (NYHA) class IV heart failure * Patient has incessant VT necessitating immediate treatment * Patient has ventricular tachycardia/ventricular fibrillation thought to be from channelopathies * Limited life expectancy (less than one year) * Patient has current class IV angina * Recent coronary artery bypass graft or percutaneous coronary intervention (\< 45 days) * Patient is currently participating in another investigational drug or device study * Known presence of intracardiac thrombi * Prosthetic mitral or aortic valve or mitral or aortic valvular heart disease requiring immediate surgical intervention * Major contraindication to anticoagulation therapy or coagulation disorder * Left Ventricular Ejection Fraction \< 15% * Patient has had a previous ablation procedure for VT, excluding remote (\> 3 months) outflow tract tachycardia * Patient has glomerular filtration rate (GFR) \< 30 mL/min/1.73m2 * Patient has peripheral vascular disease that precludes left ventricular access * Patient is thought to have idiopathic outflow VT as only VT * Patient has a premature ventricular contraction (PVC) or VT induced cardiomyopathy that is expected to resolve with ablation and will not require an ICD * Patient has reversible cause of VT * Patient does not meet criteria for ICD or CRT-D