[Malignant ventricular hyperkinetic arrhythmia: role of permanent electric treatment]

While the technics of cardiac pacing have shown to have a precise role in the diagnosis and treatment of ventricular arrhythmias on a temporary basis, the role of permanent antiarrhythmic devices (PAD) in the treatment of these arrhythmias is still ill defined mainly because of the technological limits concerning the pacemakers and the frequent complications observed during the attempts to interrupt such tachycardias. On the basis of the available data and of theoretical considerations, three groups of pts susceptible of treatment with PAD can be selected: a) pts with brady-dependent arrhythmias where PAD is used as a prophylactic mean; b) pts with recurrent sustained ventricular tachycardia refractory to medical treatment, in whom PAD can be used to interrupt tachycardia; c) pts affected by ventricular fibrillation or rapidly deteriorating ventricular tachycardia (sudden death pts), refractory to conventional treatment, in whom the implantable defibrillator represents the only therapeutic possibility. Even if scanty, the data available seem to confirm that PAD does have a role in the treatment of malignant arrhythmias, although in selected cases and almost always together with drug treatment.