Assessment of the risk-benefit ratio for antiarrhythmic drug use

Arrhythmia treatment has always been difficult, particularly as there are no good indicators of the optimal management strategy. The introduction of new antiarrhythmic agents has forced reappraisal of how these drugs are used. Dynamic electrocardiography and invasive electrophysiological studies are important tools for classifying and characterizing arrhythmias and for assessing the efficacy of therapy. There is still an enormous gulf between present day treatment and a scientific basis for drug selection, but risk-benefit analysis is possible, at least for patient populations and for some specific arrhythmias. Individual risk-benefit analysis, much needed by clinicians, is still a long way from reality. This article examines the concept of risk-benefit analysis and indicates those areas where progress can be made.