Because of the high incidence of heart disease in the elderly, ventricular tachyarrhythmias are not infrequent. Determining the nature and extent of the underlying heart disease and identifying precipitating causes is required prior to instituting long-term therapy. Recent studies suggest that for hemodynamically unstable ventricular tachyarrhythmias, mortality is lower with the implantable cardioverter-defibrillator compared with pharmacologic therapy. This benefit is likely to be more modest in the elderly because of competing cardiac and noncardiac causes of death. For similar reasons, the favorable results reported with the prophylactic use of the implantable cardioverter-defibrillator are likely to be attenuated in the elderly.