[Drug therapy of cardiac arrhythmias 199]

Current antiarrhythmic drug therapy is employed in strict compliance with the proper indication, which is itself limited by the side effects of the available drugs, and modified by the increasing success of such non-drug options as electrical ablation and implantable cardioverters/defibrillators. Drug treatment is restricted to 3 major indications, regular paroxysmal supraventricular tachycardias, atrial flutter and fibrillation, and ventricular tachycardias. Class IA and IC agents are used only to treat supraventricular and ventricular arrhythmias with no structural heart disease. Class III drugs, e.g. sotalol and in particular amiodarone are used preferentially to treat the pre-damaged heart, in particular left-ventricular functional impairment and in coronary heart disease in consideration of their side effects. In the case of the most common treatment-requiring arrhythmia-atrial fibrillation-anticoagulation alone may be indicated. For the prevention of sudden death, beta-blockers continue to be the drugs of first choice.