Ventricular arrhythmia: management strategy

The management of ventricular arrhythmia continues to be one of the most difficult therapeutic problems in medicine today. Both invasive and noninvasive techniques have demonstrated success in management of patients at high risk for sudden cardiac death. High-risk subgroups include patients who have experienced sudden cardiac death and have been resuscitated successfully, patients with high-grade ventricular ectopy associated with left ventricular dysfunction, and patients who have had recent myocardial infarction. Traditional and experimental antiarrhythmic agents are available to the clinician, and in some patients combination therapy may prove more useful than application of a single agent alone. In individuals in whom pharmacologic intervention fails, map-guided surgical excision may be beneficial. The application of the automatic implantable defibrillator appears to have promise in truly refractory situations.