Beta blockers: evidence versus wishful thinking

Catecholamines and ischemia play an important role in the induction of ventricular tachyarrhythmias. Beta blockers antagonize the effect of catecholamines and have anti-ischemic properties. Several controlled studies performed in the early 1980s in patients after myocardial infarction have shown that beta-blocker therapy clearly decreases sudden and nonsudden cardiac death. Despite the lack of recent randomized trials, data from uncontrolled studies suggest that the beneficial effect of beta blockers is still present in the thrombolytic era. Thus, it is incomprehensible that today in the United States and in most parts of Europe, < 40% of post-myocardial infarction patients are treated with beta blockers. Even in patients with documented sustained ventricular tachycardias (VTs) or ventricular fibrillation (VF), clinical studies indicate that beta blockers improve survival. Thus, even in the thrombolytic era, beta blockers should be used as a basic therapy in patients who are at risk of sudden cardiac death.