Ventricular arrhythmias. Preventing sudden death with drugs and ICD devices

Abstract

Sudden cardiac death occurs most frequently in persons age 50 to 60, and serious ventricular arrhythmias are the cause of death in most cases. The underlying substrate is usually CAD, either a healed infarction or an acute ischemic event. Early studies using antiarrhythmic drugs to improve post-MI survival led instead to increased mortality, casting doubt on this approach. A cascade of studies using newer antiarrhythmic drugs showed some promise in selected patients post MI. Another approach--using implantable defibrillators--may show greater benefit than antiarrhythmic drugs in patients at serious risk, but the widespread implantation of these devices may be cost-prohibitive. Management of serious ventricular arrhythmias is guided by the individual patient's comorbidities, cardiac function, history of ischemia, and perceived risk of sudden death.