Management of ventricular arrhythmias.
Underlying causes of ventricular tachycardia (VT) or complex ventricular arrhythmias (VA) should be treated if possible. Anti-arrhythmic drugs should not be used to treat asymptomatic patients with complex VA and no heart disease. Beta blockers are the only antiarrhythmic drugs that have been documented to reduce mortality in patients with VT or complex VA. Radiofrequency catheter ablation of VT has been beneficial in treating selected patients with arrhythmogenic foci of monomorphic VT. The automatic implantable cardioverter-defibrillator (AICD) is the most effective treatment for patients with life-threatening VT or ventricular fibrillation. The American College of Cardiology/American Heart Association class I indications for an AICD are discussed. Other indications for an AICD are discussed. Patients with AICDs should be treated with biventricular pacing, not with dual-chamber rate-responsive pacing at a rate of 70/minute. Patients with AICDs should be treated with beta blockers, statins, and angiotensin-converting enzyme inhibitors or angiotensin blockers.
Cardiology Division, Department of Medicine, New York Medical College, Valhalla, New York, NY 10595, USA. wsaronow@aol.com
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D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D058406:Cardiac Resynchronization Therapy / Q000379:methods; D017115:Catheter Ablation; D001026:Coronary Artery Bypass; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D017147:Defibrillators, Implantable; D004359:Drug Therapy, Combination; D006329:Heart Conduction System / Q000503:physiopathology; D006801:Humans; D015995:Prevalence; D011379:Prognosis; D012720:Severity of Illness Index; D016019:Survival Analysis; D017180:Tachycardia, Ventricular / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000628:therapy
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000889:Anti-Arrhythmia Agents; D002121:Calcium Channel Blockers