We performed a pilsicainide challenge test in a 38-year-old man who was resuscitated from ventricular fibrillation without apparent baseline electrocardiogram (ECG) abnormality. His father had a history of ventricular fibrillation and his brother had multiple episodes of syncope. Pilsicainide (1 mg/kg) induced short coupled ventricular premature beats followed by repetitive polymorphic ventricular tachycardia without apparent J wave and ST elevation, and excessive changes in QRS duration and QT interval. An implantable cardioverter defibrillator was implanted.