title: Is a baseline electrophysiologic study mandatory for the management of patients with spontaneous, sustained, ventricular tachyarrhythmias?
abstract: Should the patient being treated for spontaneous, sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) routinely undergo a baseline, diagnostic, catheter electrophysiologic (EP) study? The potential patient advantages of such a policy include identification of the tachyarrhythmia-initiating episodes of presumed VT or VF, prediction of the subsequent risk of VT/VF recurrences, identification of VT mechanisms amenable to cure by catheter ablation, assessment of the response of a patient's VT to attempts at pace termination, evaluation of the patient's candidacy for some of the approaches to VT/VF therapy selection, and enhancement of our understanding of the mechanisms and therapeutics of VT/VF. Disadvantages of such a policy include patient discomfort, patient risks, and cost. Recognizing that the decision to perform a baseline catheter EP study in a patient with VT/VF must be based on an individualized, patient-based, risk-benefit analysis; this review details each of the advantages and disadvantages of doing so to identify patient populations for whom a baseline catheter EP study is or is not usually indicated.
authors.affiliation: Division of Cardiology, Foothills Hospital/University of Calgary, Alberta, Canada.
authors.forename: L B
authors.initials: LB
authors.lastname: Mitchell
authors.forename: L S
authors.initials: LS
authors.lastname: Gettes
mesh_terms: D002304:Cardiac Pacing, Artificial; D004562:Electrocardiography; D006801:Humans; D011379:Prognosis; D012008:Recurrence; D012307:Risk Factors; D017180:Tachycardia, Ventricular / Q000175:diagnosis* / Q000628:therapy; D014693:Ventricular Fibrillation / Q000175:diagnosis* / Q000628:therapy