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; 1. 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 of intra-cardiac device therapy that could either be self-terminating or require reversion by pharmacological therapy or external cardioversion; 2. Spontaneous VT: ≥1 episode of sustained spontaneous monomorphic VT lasting ≥30 seconds documented on Holter, ECG, Loop recorder or other cardiac monitoring device that could either be self-terminating or require reversion by pharmacological therapy or external cardioversion; 3. Inducible VT: with syncope or palpitations - inducible VT defined as sustained monomorphic VT of CL ≥200 ms lasting for ≥10 s during a cardiac electrophysiology study (note with 4 extrastimuli with or without provocation with isoprenaline); 2. Already a recipient of an implanted cardiac device such as a pacemaker, defibrillator or a cardiac resynchronisation therapy device and/or is indicated to receive one given a new diagnosis of structural heart disease, based on current guideline recommendations; 3. 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 is not 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 the opinion of the study team/ primary care physician could interfere with the conduct of the study including outcome assessments; 6. Known channelopathy such as long QT, short QT, Brugada syndrome, catecholaminergic polymorphic VT; 7. Known prior diagnosis of no structural heart disease, or idiopathic ventricular arrhythmia.