Clinical trials of antiarrhythmic drugs in patients with sustained ventricular tachyarrhythmias

Abstract

Patients with sustained ventricular tachyarrhythmias in the absence of a reversible cause require long-term therapy. Six approaches may have value in this setting, including individualized drug therapy selected by the invasive approach, individualized drug therapy selected by the noninvasive approach, beta-blocking therapy, amiodarone, transcatheter or electrosurgical ablation, and the implantable cardioverter defibrillator. Data supporting the four pharmacologic approaches and data comparing these approaches to one another and to the implantable cardioverter defibrillator are reviewed. Support for primary therapy with a beta-blocker is the weakest. Nevertheless, a role for concomitant beta-blockade is established. Comparisons of the invasive and noninvasive approaches suggest that, in drug-naive patients, the invasive approach is effective but the noninvasive approach is not, whereas in drug-resistant patients, neither approach is adequate. Data suggesting that amiodarone is more effective than individualized drug therapy is not compelling but is widely accepted. Given these uncertainties, many authorities have embraced the implantable cardioverter defibrillator as the therapy of choice.