[Ventricular anti-arrhythmic treatments during postinfarction]

Antiarrhythmic agents may be prescribed in the post-infarction period either as systematic therapy to prevent sudden death or as prophylactic treatment against recurrences of documented life-threatening arrhythmias. Systematic therapy or even the treatment of symptomatic ventricular extrasystoles by Class IC anti-arrhythmics is associated with an increased risk, especially in patients with a low risk of sudden death at the outset. Betablockers are effective on symptoms: they are not always effective on the arrhythmia but at least they do not aggravate the mortality of these patients. However, for high risk patients with post-infarction left ventricular dysfunction, betablockers are the only drugs which have a proven efficacy: they should therefore be prescribed, especially those whose efficacy has been demonstrated, at the same dosages as those used in clinical trials. Preventive treatment of sustained ventricular tachycardia should be chosen with respect to the patient's hemodynamic status. When the ejection fraction is under 40%, amiodarone and betablockers are the drugs of first intention, with controls of their efficacy by the inability to induce or the slowing of the tachycardia rhythm during endocavitary electrophysiological studies.