Role of electrophysiologic evaluation in patients with ventricular arrhythmias.

The decision to perform electrophysiologic testing in patients with ventricular arrhythmia should be based on the presence, if any, of underlying heart disease and the clinical type of ventricular arrhythmia. Clinical presentations range from asymptomatic premature ventricular complexes identified on routine surface ECG to out-of-hospital cardiac arrest. Ventricular arrhythmias range from benign monomorphic ventricular ectopy to polymorphic VT and ventricular fibrillation. The goal in evaluating patients with ventricular arrhythmia is to identify those at high risk of suffering a life-terminating arrhythmic event. Risk stratification should be based on history, physical examination, clinical data and the likelihood that anti-arrhythmic therapy will prevent symptoms and more importantly, prolong life. Noninvasive evaluation with routine surface ECG, Holter monitoring, signal-averaged ECG and echocardiography are valuable tools in the risk stratification process. However, electrophysiologic testing in most forms of ventricular tachyarrhythmia is the optimal means of diagnosing, risk stratifying and managing potentially life-threatening ventricular arrhythmias.