Prolonging survival by reducing arrhythmic death: pharmacologic therapy of ventricular tachycardia and fibrillation.
Antiarrhythmic drug therapy of sustained ventricular tachyarrhythmias is undertaken to reduce arrhythmic symptoms, recurrences, and mortality. Ideally, reduction of arrhythmic death will reduce total mortality as well, although this may not hold true in the presence of competing risk. Whether, in fact, antiarrhythmic therapy actually reduces arrhythmic death remains uncertain in the absence of any placebo-controlled trials. Nonetheless, the following conclusions can be drawn from the Electrophysiologic Study versus Electrocardiographic Monitoring (ESVEM) trial, the Cardiac Arrest Study Hamburg (CASH), and the Cardiac Arrest in Seattle: Conventional versus Amiodarone Drug Evaluation (CASCADE) study, as well as a beta blocker study by Steinbeck et al: (1) class I antiarrhythmics are less effective than amiodarone or sotalol for the prevention of recurrent sustained ventricular tachycardia/ventricular fibrillation; (2) sympathetic inhibition as a component of the antiarrhythmic regimen may strongly contribute to mortality reduction; and (3) the respective roles of antiarrhythmic drugs, implantable devices, and the concurrent use of both are in a state of flux, awaiting results of randomized controlled clinical trials.
Reiffel
J A
JA
Department of Medicine, Columbia University, College of Physicians and Surgeons, Columbia-Presbyterian Medical Center, New York, New York, USA.
D000368:Aged; D001145:Arrhythmias, Cardiac / Q000517:prevention & control*; D016757:Death, Sudden, Cardiac / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D016019:Survival Analysis; D015996:Survival Rate; D017180:Tachycardia, Ventricular / Q000188:drug therapy* / Q000401:mortality*; D014693:Ventricular Fibrillation / Q000188:drug therapy* / Q000401:mortality*