The treatment of sustained ventricular tachycardia (VT) by map-directed surgical ablation has evolved over the last 20 years from an experimental possibility to a clinically useful form of therapy. In most cases, the VT arises from one or more discrete anatomical sites, which can be identified by electrophysiological mapping techniques. Computerization has greatly enhanced the practical application of mapping techniques to identify the sites of origin of VT. Surgical techniques have evolved rapidly and now provide, in properly selected patients, cure rates of VT in excess of 90% with a hospital mortality of < 10%. The most commonly used techniques are endocardial resection, cryoblation, isolating incisions, and surgical excision of myocardium. Other forms of therapy that are indicated in some patients include the automatic implantable defibrillator and cardiac transplantation. Thus, when considering the management of drug refractory VT, map-directed surgery should be considered along with amiodarone and antitachycardia devices.