[Sudden cardiac death--possibilities and limits of drug therapy].
Sudden cardiac death is a challenge for primary prevention efforts, the rescue system, and the prophylactic antiarrhythmic medical therapy. A prerequisite for the successful prevention is insight into the pathophysiologic interaction of the arrhythmogenic substrate, the ischemic events, the autonomous nervous system, ventricular premature beats, left-ventricular function, etc. Latest results of prophylactic antiarrhythmic therapy indicate that the benefit under a specific antiarrhythmic treatment depends on the ratio of antiarrhythmic to proarrhythmic effects and the prevalence of sudden cardiac death in a given population. In diseased hearts with ventricular tachycardia or ventricular fibrillation the chance of sudden cardiac death is high, therefore, antiarrhythmic therapy is indicated and should be controlled by programmed stimulation. In patients with a low likelihood of sudden cardiac death after myocardial infarction, beta receptor blockers should be given; in certain higher risk patients (non-sustained ventricular tachycardia, reduced left-ventricular function) class-III antiarrhythmic agents are recommended. In hypertrophic cardiomyopathy (less in dilative cardiomyopathy) a beneficial effect of amiodarone becomes apparent in subgroups with high risk. Treatment of symptomatic ventricular premature beats remains empiric; in case of no or minimal structural heart disease, the arrhythmogenic potential is low. For the management of recurrent ventricular tachycardia new concepts are proposed that include antiarrhythmic agents and magnesium.
Manz
M
M
Medizinische Universitätsklinik, Innere Medizin-Kardiologie, Bonn.
Lüderitz
B
B
D000889:Anti-Arrhythmia Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D006801:Humans; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy; D012151:Resuscitation; D012307:Risk Factors; D013610:Tachycardia / Q000150:complications / Q000188:drug therapy*
D000889:Anti-Arrhythmia Agents
Der plötzliche Herztod--Möglichkeiten und Grenzen der medikamentösen Therapie.