["Arrhythmica" or: history, extent and practical consequences of pro-arrhythmia effects]

It has been known for many years that antiarrhythmic drugs may have a potential proarrhythmic effect. But it was not until two very important prospective studies were published, of Velebit et al. (1982) and in particular the CAST study (1989), that the extent and potentially deleterious consequences of the proarrhythmic effect were realized. This review attempts to lessen some doubts that have emerged in the management of antiarrhythmic therapy and the prophylaxis of cardiac arrhythmias, in particular for general practitioners and specialists in internal medicine. First, it is pointed out that the diagnosis "healthy heart" is only permissible after careful clinical investigation and in some cases special studies (e.g. echocardiogram). Reasonable therapy (or non-therapy) is then proposed for the current arrhythmias having regard to left (or right) ventricular function, the patient's age, the implicated disease and the individual circumstances. Electrotherapy (catheter ablation and implantation of a cardioverter-defibrillator) is mentioned as being superior to drug therapy in some patients with supraventricular and ventricular arrhythmias.