Ventricular tachycardia: is serial testing still up to date?

Despite considerable advances in the understanding of cardiac arrhythmia me chanisms, death in relation to ventricular tachyarrhythmias remains an impo rtant public health problem, and management of ventricular arrhythmias rema ins a perpetual challenge in clinical cardiology. III the last decade, the development and refinement of implantable cardiove rter defibrillators and the progress in techniques of radiofrequency electr ode catheter ablation and antiar-rhythmic surgery have been revolutionary i n 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 clinica l trials highlights the fact that some antiarrhythmic drugs may have the pr oclivity to exert fatal proarrhythmic reactions while also have the potenti al to control recurrences of ventricular tachycardia. All these changes tha t now need to be integrated into global apl,approaches for ventricular arrh ythmia control led us to wonder whether serial testing is still up to dare in the management of ventricular tachycardia. After more than 20 years of clinical use, there is much concern about the u se of serial drug testing to guide antiarrhythmic drug therapy for the mana gement 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 cumulat ive data from different lines of investigations, results of randomized clin ical trials, recently acquired beliefs and meta-analytic findings concernin g the present place of serial electrophysiologic drug testing ill the manag ement of ventricular tachycardia.