[Possibilities and limitations of treatment for arrhythmia]

Abstract

Antiarrhythmic therapy for tachyarrhythmias is more effective, but at the same time more complicated, than it was a few years ago. This is equally true for the indication of therapy in general, for the decision to apply a particular therapeutic tool, and for the control of antiarrhythmic treatment itself. An effective, long-lasting control of cardiac arrhythmias requires carefully selected therapeutic approaches. Primary treatment aims at the underlying disease. The causal therapy must, of course, be directed to the conditions responsible for the disease, that is, for example, therapy for coronary artery disease, treatment of myocarditis, elimination of glycoside intoxication or electrolyte disturbances, normalization of thyroid dysfunction, or revision of an ineffective pacemaker. The symptomatic therapy for cardiac arrhythmias is subdivided into drug therapy, electro-therapeutic measures (cardiac pacemaker, implantable cardioverter/defibrillator, fulguration) and antiarrhythmic surgery or, in special cases even heart transplantation. In the pharmaceutical sector, progress has been made by introducing new antiarrhythmic substances, such as encainide and flecainide, tocainide, amiodarone, sotalol, and especially by the combination of antiarrhythmic agents. The combination of antiarrhythmic substances allows the use of smaller dosage of one or both of the drugs. Despite potential proarrhythmic effects with combination of antiarrhythmic agents, this risk seems to be lower by using reduced dosages. Thus, the conventional spectrum of antiarrhythmic therapy has to be reconsidered with respect to new approaches in the control of cardiac dysrhythmias.