title: Advances in the pharmacologic treatment of ventricular arrhythmias.
abstract: BACKGROUND
  Despite many advances in nonpharmacologic management of ventricular arrhythmias, antiarrhythmic drugs remain important in both the acute conversion and chronic prevention of ventricular arrhythmias.
  
  
  METHODS
  Key trials related to antiarrhythmic drug use are reviewed, emphasizing the impact of recent discoveries. Sodium channel blockers are discussed with an emphasis on recently identified specialized uses. Beta blockers, amiodarone, sotalol, and dofetilide are discussed together in the context of structural heart disease, because they do not increase mortality in this group of patients. Other medications found to reduce ventricular arrhythmia burden are discussed last.
  
  
  CONCLUSIONS
  Since most patients with ventricular arrhythmias have structural heart disease, pharmacologic treatment is limited to amiodarone, d-,l-sotalol, and dofetilide (off-label indication), in conjunction with defibrillator implantation. While amiodarone has superior reduction in arrhythmias, its long-term extracardiac toxicities can cause significant morbidity. A trial of sotalol is reasonable if there are no contraindications, recognizing that over 20% of patients have to discontinue it because of adverse effects. Beta blockers are first line therapy for most patients. Genetic testing is particularly informative regarding treatment approach in long QT syndrome, Brugada syndrome, and catecholaminergic polymorphic VT. Research should continue to focus on developing more effective antiarrhythmic medications with less long-term toxicity.
authors.affiliation: a Mayo Clinic Arizona , Division of Cardiovascular Diseases , 5777 East Mayo Boulevard, Phoenix , AZ 85054 , USA.
authors.forename: J William
authors.initials: JW
authors.lastname: Schleifer
authors.affiliation: a Mayo Clinic Arizona , Division of Cardiovascular Diseases , 5777 East Mayo Boulevard, Phoenix , AZ 85054 , USA.
authors.forename: Dan
authors.initials: D
authors.lastname: Sorajja
authors.affiliation: a Mayo Clinic Arizona , Division of Cardiovascular Diseases , 5777 East Mayo Boulevard, Phoenix , AZ 85054 , USA.
authors.forename: Win-Kuang
authors.initials: WK
authors.lastname: Shen
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D004359:Drug Therapy, Combination; D006801:Humans; D026902:Potassium Channel Blockers / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D026941:Sodium Channel Blockers / Q000627:therapeutic use; D017180:Tachycardia, Ventricular / Q000188:drug therapy*; D014693:Ventricular Fibrillation / Q000188:drug therapy*
chemical_list: D000319:Adrenergic beta-Antagonists; D000889:Anti-Arrhythmia Agents; D026902:Potassium Channel Blockers; D026941:Sodium Channel Blockers
keywords: amiodarone; antiarrhythmic drugs; beta blockers; ventricular fibrillation; ventricular tachycardia