The use of an antitachycardia pacemaker for the treatment of recurrent, drug resistant nonsyncopal sustained ventricular tachycardia in a 28-year-old patient is described. The report emphasizes the role of electrocardiographic recording during manual activation of the tachycardia response in an outpatient setting. The follow-up covers 12 months with 26 spontaneous tachycardia episodes forcing the patient to go to an emergency room to monitor tachycardia termination. Mean ventricular tachycardia cycle length was 340 +/- 21 ms. Tachycardias were terminated either by the primary or secondary modality without acceleration or degeneration to ventricular fibrillation. Thus, it was possible to assess the efficacy and the safety of the termination programs. Unlike during intensive in-hospital testing, restoration of stable sinus rhythm was complicated by re-emergence of ventricular tachycardia. It is concluded that manual activation with medical supervision provides safe management of selected patients with ventricular tachycardia. However, in-hospital testing overestimated, in this case, the efficacy of tachycardia response modalities to terminate spontaneous tachycardia episodes. The customization of an antitachycardia pacemaker with an automatic implantable cardioverter/defibrillator may increase the quality of life as it would allow switching to automatic pace termination.