Detection, significance and management of VPBs in ambulatory patients

The detection, clinical significance, and management strategies of VPBs in ambulatory patients have been presented. VPBs can be easily detected by a variety of recording techniques, and the major risk posed by VPBs occurs predominantly in patients with complex VPB patterns and concomitant organic heart disease. Available antiarrhythmic therapy is quite limited, and efficacy, convenience, and tolerance considerations dictate a conservative approach to initiating therapy. Risk-benefit considerations must be reasoned through in each patient. Presently, drug risks closely approximate those of the underlying cardiac condition, and the benefits from antiarrhythmic drug therapy are marginal at the very best. However, antiarrhythmic therapy has special relevance for the high risk cardiac patient. A Yiddish proverb states, "Ever since dying came into fashion, life hasn't been safe." Hopefully, antiarrhythmic therapy is making life safer for the high risk ambulatory patient.