Invasive electrophysiologic testing: Role in sudden death prediction

The placement of intracardiac catheters to assess the risk of arrhythmia dates back nearly 40 years. The discovery by Wellens et al. in 1972 that clinical ventricular tachycardia (VT) in patients with prior myocardial infarction (MI) could be initiated by programmed ventricular stimulation (PVS) generated real enthusiasm about the technique. In the 1980s, many cardiologists would have labeled PVS the most precise and perhaps the most important tool for risk stratifi cation of patients at risk for sudden cardiac death (SCD). Selection of antiarrhythmic treatment on the basis of suppression of VT inducibility was reasonably believed to represent a scientific approach to management of life-threatening arrhythmias.