Perspectives on the current treatment of cardiac arrhythmias

Our current understanding of human cardiac arrhythmias is primitive and their treatment is largely empirical. For a few arrhythmias for which the mechanism is known, this information is valuable in selecting therapy. Primary methods for arrhythmia detection are 24-hour electrocardiographic recordings, patient-activated recordings, exercise and cardiac electrophysiologic studies. A search for removable causes of arrhythmia should be sought before instituting specific treatment with antiarrhythmic drugs, surgery or implantable devices. Over the past 20 years, the spectrum of antiarrhythmic drug action has broadened; sodium channel blockers, beta-adrenergic blockers and calcium channel blockers have extended our therapeutic options, but the ideal drug has yet to appear. Efficacy and convenience of antiarrhythmic drugs have improved significantly, but adverse effects and drug interactions still occur much too frequently. The outlook for patients with malignant arrhythmias has improved significantly. However, the 2 methods for evaluating therapy of malignant arrhythmias are time-consuming, uncomfortable and expensive. Basic and clinical research is rapidly advancing our knowledge and effectiveness in dealing with cardiac arrhythmias. As a result, we can expect substantial improvements in arrhythmia control in the future.