Ventricular tachycardia--practical and provocative electrophysiology.

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Abstract
Horowitz et al. and Mason and Winkle describe the use of catheter induction of ventricular tachycardia (VT) in selecting antiarrhythmic regimens. The purposeful provocation of a potentially lethal arrhythmia, even under safe, controlled catheterization laboratory conditions is a foreign idea to many physicians, and some perspective is required. The high mortality associated with recurrent VT prompted efforts to secure objective proof of the efficacy of antiarrhythmic regimens before disharge from the hospital. The methods used to assess efficacy may be active (provocative) or passive. The passive-objective approach estimates the effectiveness of antiarrhythmic therapy by measurement of drug blood levels or trendscription, i.e., continuous ECG monitoring with automatic counting of premature ventricular complexes. The provocative-o bjective approach to VT is based on 4 concepts which are discussed. The role of provocative testing in the control of VT is undefined. There is no agreement on the details of patient selection, testing protocol, choice of drugs for testing and the role of special implantable pacemarkers.