Both map-guided endocardial resection (ER) and the automatic implantable cardioverter defibrillator (AICD) are currently used for surgical treatment of patients who have sustained ventricular tachyarrhythmias. Some authors have preferred AICD implant due to a lower published operative mortality rate. To determine if there is a discrepancy in mortality rates between the two techniques, we analyzed hospital survival in 46 patients undergoing ER and in 44 patients undergoing AICD implantation during the same 3-year period. Two ER patients (4%) died before hospital discharge. Two patients (4%) died after AICD implantation. At predischarge electrophysiologic study five patients (11%) had inducible ventricular tachycardia and received antiarrhythmic drug therapy after ER. In contrast 35 of 42 patients surviving AICD placement received chronic long-term antiarrhythmic therapy (p less than 0.05 compared to ER). Our experience shows that ER and AICD placement may be carried out with similar procedure-related mortality and morbidity rates. Lower operative risks should not be a reason for choosing the AICD over ER for surgical treatment of ventricular tachyarrhythmias. The AICD may actually improve the results of ER by offering an alternative to ventriculotomy in poor-risk surgical candidates.