[Can sudden death be prevented by drugs?]

Abstract

Sudden cardiac death continues a major health problem. It is the leading cause of mortality in patients with coronary artery disease. In patients with the most malignant forms of ventricular tachyarrhythmias (ventricular tachycardia with syncope or aborted sudden death), anti-arrhythmics have been shown to be effective in preventing recurrences of these arrhythmias when tested according to a systematic protocol. Empiric therapy, on the other hand, is ineffective and dangerous because of the limited efficacy and the pro-arrhythmic potency of all anti-arrhythmic drugs. Asymptomatic ventricular arrhythmias, especially complex forms, after myocardial infarction characterize patients at increased risk for sudden cardiac death. In this situation most anti-arrhythmics do not improve prognosis. Amiodarone is so far the only anti-arrhythmic drug which has been shown to be beneficial in postinfarct patients, whereas Flecainide and Encainide were deleterious in a population at relatively low risk. Beta blocking agents, however, are effective in reducing mortality and incidence of sudden cardiac death in patients after myocardial infarction.