In considering alternatives to the implantable cardioverter-defibrillator (ICD) in patients with malignant ventricular arrhythmias, both pharmacologic and nonpharmacologic therapies are available. Unfortunately, both pharmacologic methods (even when therapy is individualized and optimized) and nonpharmacologic methods (including coronary revascularization and radiofrequency or surgical ablation) yield long-term results that are unacceptable for many patients. Thus, the ICD should be strongly considered as complementary therapy, even when alternative methods are selected. More importantly, early implantation of an ICD often may be justified as the first therapeutic alternative, rather than as complementary therapy, in patients with life-threatening ventricular arrhythmias. (Am J Cardiol 1996;78(suppl 5A):89–91)