Management of Ventricular Arrhythmias - Detection, Drugs, and Devices
David S. Cannom; Eric N. Prystowsky
The goals of treatment of the patient with ventricular arrhythmias are to suppress symptoms and prevent a fatal event. The steps in providing such therapy include defining the cardiac anatomy, assessing arrhythmia risk through noninvasive or invasive testing, and prescribing treatment based on these results. Patients may be separated into high- and low-risk groups to help identify appropriate treatment. While low-risk groups may benefit from reassurance or medications such as -blockers or verapamil, high-risk groups have been more difficult to treat. Recent randomized trials of implantable cardioverter defibrillators for ventricular arrhythmias suggest that they may provide better protection for high-risk patients than do antiarrhythmic medications.
Conclusions: Treatment and understanding of risk from ventricular arrhythmias
have advanced substantially in recent years. Classifying patients as being
at high or low risk for fatal arrhythmias allows the physician to identify
appropriate treatments for the high-risk patient without exposing the low-risk
patient to unnecessary treatment-related risks.
JAMA. January 13, 1999;281:172-179
The Antiarrhythmics Versus Implantable Defibrillators (AVID) Investigators.
A comparison of antiarrhythmic drug therapy with implantable defibrillators in patients resuscitated from near-fatal sustained ventricular arrhythmias. N Engl J Med. 1997;337:1576-1583.
Gregoratos G, Cheitlin MD, Conill A, et al.
ACC/AHA guidelines for implantation of cardiac pacemakers and antiarrhythmia devices. -
J Am Coll Cardiol. 1998;31:1175-1209.