[Pharmacologic treatment for ventricular arrhythmias]

Pharmacologic management of patients with ventricular arrhythmias remains in a state of considerable flux. New findings from controlled clinical trials, suggest that use of the principles of risk stratification permits identification of patients at very high risk for developing sustained ventricular tachyarrhythmias or ventricular fibrillation. Available data suggest that patients with sustained ventricular tachyarrhythmias require treatment. Patients with frequent ventricular ectopy or nonsustained ventricular tachycardia in the absence structural heart disease do not require treatment except when relief of symptoms is warranted. The indication for treatment of patients with underlying structural heart disease, particularly coronary artery disease and a previous myocardial infarction, who manifest frequent ventricular ectopy or more particular nonsustained ventricular tachycardia remain uncertain. From meta-analytic studies, it has become clear that beta-blockers reduce sudden death and total cardiac mortality. Data also suggest that amiodarone appears to be the safest antiarrhythmic drug for treatment sustained and nonsustained arrhythmias, and improved survival in patients with advanced heart failure.