[What remains of anti-arrhythmia drugs?]

The use of antiarrhythmic agents in several indications has been in recent years the subject of debate. The risk of proarrhythmia has been emphasized and the risk-benefit ratio has to be considered for each indication. Non-pharmacological therapy of arrhythmia e.g. ablation of an accessory connection or an arrhythmogenic focus may reduce the indications of pharmacologic therapy. Its role needs to be reevaluated. Although not yet clarified, the incidence of proarrhythmia may be determined by the type of arrhythmia, the age of the patient and left ventricular function. It has underlined the complexity of the mechanism of action of antiarrhythmic therapy. The CAST study has shown that the use of antiarrhythmic therapy following a myocardial infarction may not be safe. Similarly the use of quinidine following cardioversion of atrial fibrillation may be associated with increased mortality. Implantable defibrillator in life-threatening arrhythmia may have reduce the use of antiarrhythmic agents. However, there are selected indications for pharmacological therapy. However recent data suggest that we should reconsider our approach to therapy and develop antiarrhythmic agents more "selective" safer and more adapted to the cardiologist needs.