Congestive heart failure and arrhythmias: therapeutic modalities

Congestive heart failure affects millions of Americans, and thousands of new cases are reported each year. The prognosis continues to be grim. Most deaths in heart failure patients can be attributed to low-output states (pump failure) and arrhythmias (sudden). Attempts have been made to decrease the incidence of pump failure deaths by using contractility agents that, in most cases, have been shown to be detrimental. The results of trials using beta blockers are encouraging. Vasodilators have made a positive impact on outcome. However, the use of pharmacologic antiarrhythmic agents to decrease sudden death has failed to improve survival. Studies with implantable devices are ongoing and will provide an answer to the question of whether a reduction in sudden death will translate into a reduction of all-cause mortality. Antiplatelet and antithrombotic agents appear to be favorable, and revascularization is recommended when feasible.