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[Long-term drug therapy of arrhythmias (with special reference to ventricular tachyarrhythmias]
Insights
This review discusses diagnosing and treating ventricular arrhythmias in coronary artery disease patients. It emphasizes drug therapy for dangerous arrhythmias to prevent sudden cardiac death.
Area of Science:
- Cardiology
- Pharmacology
Context:
- Coronary artery disease (CAD) poses risks, including sudden death from ventricular arrhythmias.
- Accurate diagnosis and long-term medical treatment are crucial for managing these conditions.
Purpose:
- To review current diagnostic methods and long-term medical treatment strategies for ventricular arrhythmias in CAD patients.
- To highlight new electrocardiographic criteria for differentiating supraventricular and ventricular tachycardias.
Summary:
- Ventricular arrhythmias in healthy individuals generally have a good prognosis without drug therapy.
- Drug therapy for ventricular arrhythmias in CAD patients should target dangerous arrhythmias (Lown classes 3-5) to reduce sudden death risk.
- Consideration of antiarrhythmic drug side effects and toxicities is essential.
- Drug testing, including invasive and oral methods (ambulatory ECG, blood levels, simplified rhythm strips), aids in selecting appropriate antiarrhythmic drugs.
Impact:
- Provides guidance on appropriate antiarrhythmic drug selection and administration for CAD patients.
- Contributes to the understanding and management of ventricular arrhythmias, potentially reducing sudden cardiac death incidence.
- Highlights the challenges in practical application of new management concepts for ventricular arrhythmias.
Abstract:
Sudden death and its consequences in patients with coronary artery disease have stimulated research in this field. In the light of the literature an attempt is made to outline the present state of diagnosis and especially longterm medical treatment in ventricular arrhythmias. New morphological electrocardiographic criteria for differentiation between supraventricular and ventricular tachycardias are mentioned. It seems to be the general opinion that ventricular arrhythmias in persons with otherwise normal cardiac findings have a good prognosis and do not need drug therapy. Drug therapy of ventricular arrhythmias in patients with cardiac disease sets out to lower the incidence of sudden death and should be used only for dangerous arrhythmias (ventricular premature beats of Lown classes 3 to 5) and in patients with significant heart disease. Toxic factors and arrhythmogenic properties and other side effects of the antiarrhythmic drugs should be considered. The subdivision of these drugs into classes I to IV according to their effect on the action potential fo the isolated muscle fiber of the heart is briefly reviewed. Standard doses and important side effects of drugs generally used in the treatment of ventricular arrhythmias are given. Drug testing with invasive cardiac stimulation is complicated and expensive and is performed in a few specialized centers only. Oral drug testing with monitoring of the drug effect by ambulatory electrocardiography and measurement of blood levels usually permits the correct choice of an antiarrhythmic drug. For practical use a somewhat simplified method of oral drug testing is proposed in which rhythm strips replace the ambulatory ECG. This modification does not sufficiently allow for the spontaneous variability of ventricular ectopy, but will probably permit some guidance of the antiarrhythmic therapy. It is obvious that the practical application of the new concepts in the management of ventricular arrhythmias is difficult. Finally, the therapy of supraventricular tachyarrhythmias is briefly summarized.