Résumé
Twenty one patients with symptomatic sustained ventricular tachycardia [VT] all males [with mean age of 55 years], and largely with prior myocardial infarction [93%] underwent serial electrophysiologic drug testing. All patients had at least one electrocardiographically documented attack of V.T. All patients were subjected to a complete control EPS. Reproducible induction of VT was the rule in all patients having documented sustained VT, but in none of a control group of 10 patients with similar ischemic heart disease but with no documented V.T. Inducible sustained VT could be ultimately prevented in 16 pts. [76%] [gpA] after a mean of 3 +/- 3 tests. During a mean follow-up of 16 +/- 36 months 15 patients in gp A [93.7%] had no recurrence of VT. On the other hand of the 5 pts discharged on drug which did not prevent sustained VT induction [gp.B], only one had recurrence of VT [20%]. Holter monitoring revealed persistence of malignant ventricular arrhythmia [couplets. triplets and multifocal VPB] in 6 pts. in gp A. However, only 1/16 had recurrence [16%]. Serial EP testing had high predictive value for long term efficacy of antiarrhythmic drug therapy [93.7%] but low predictive value for recurrence [20%]. Thus, inefficacy as shown by inducibility of sustained VT or positive holter recording of malignant ventricular arrhythmias did not preclude a good clinical outcome. For successful therapy of life -threatening VT particularly in the selling of ischemic heart disease and post-myocardial infarction phase, rational rather than empiric pharmacologic drug selection is highly justified. PES was shown by our study to be an effective method to guide drug selection