[Is programmed ventricular stimulation still up to date in the medicinal evaluation of ventricular tachycardia?]

Despite considerable advances in the understanding of cardiac arrhythmia mechanisms, death in relation to ventricular tachyarrhythmias remains an important public health problem, and management of ventricular arrhythmias remains a perpetual challenge in clinical cardiology. In the last decade, the development and refinement of implantable cardioverter defibrillators and the progress in techniques of radiofrequency electrode catheter ablation and antiarrhythmic surgery have been revolutionary in the management of ventricular tachycardia. On the other hand, there have been major changes in the use of drug therapy since the publication of the results of the CAST study. Inclusion of mortality as an endpoint in clinical trials highlights the fact that some antiarrhythmic drugs may have the proclivity to exert fatal proarrhythmic reactions while also having the potential to control recurrences of ventricular tachycardia. All these changes that now need to be integrated into global approaches for ventricular arrhythmia control led us to wonder whether serial testing is still up to date in the management of ventricular tachycardia. After more than 20 years of clinical use, there is much concern about the use of serial drug testing to guide antiarrhythmic drug therapy for the management of life-threatening sustained ventricular tachyarrhythmias in light of recent advances in the management of cardiac arrhythmias. The purpose of this article is to discuss, within a relatively brief compass, the cumulative data from different lines of investigations, results of randomized clinical trials, recently acquired beliefs and meta-analytic findings concerning the present place of serial electrophysiologic drug testing in the management of ventricular tachycardia.