Left ventricular (LV) dysfunction, as an abrupt occurrence due to acute myocardial infarction (AMI), or as a chronic pathology in the setting of heart failure, represents a known risk factor and putative cause for sudden cardiac death (SCD). Historically, rates of SCD in the setting of LV dysfunction vary from about 10% post-MI to nearly 50% for chronic ambulatory heart failure. Appropriately, primary prevention of SCD indications for implantable cardiovascular defibrillators (ICD) remain Class 1, level of evidence A recommendations in extant clinical practice guidelines.¹ However, data supporting ICD therapy are leveraged by decades-old historic clinical trials and event rates for SCD predating contemporary evidence-based management.² Predicate data now demonstrate a striking reduction in the risk of SCD in ambulatory heart failure attributable to institution of enhanced guideline-directed medical therapy (GDMT).^1,3 A lingering question is whether this remarkable attenuation of a fatal complication due to LV dysfunction similarly improved post AMI.