USE OF THE NEWER ANTIARRHYTHMIC DRUGS IN PATIENTS WITH SUPRAVENTRICULAR TACHYARRHYTHMIAS - LETS NOT THROW OUT THE BABY WITH THE BATH WATER

Although recent advances have expanded the therapeutic choices for pat ients with supraventricular tachyarrhythmias, most of these patients w ill still require either short or long term treatment with antiarrhyth mic drugs. Unfortunately, some practitioners have reacted to recent re ports emphasizing the hazards of antiarrhythmic drug therapies by adop ting an attitude of avoidance of these therapies. Although critical an alyses of available data indicate that many antiarrhythmic drugs may h ave an unfavourable risk-benefit balance in patients with low risk arr hythmias who also have atherosclerotic heart disease and/or congestive heart failure, the same cannot be said for patients with high risk ar rhythmias, for patients without atherosclerotic heart disease or conge stive heart failure, or for patients whose symptoms require antiarrhyt hmic therapy to prevent physical and emotional disability despite a sm all risk of therapy. These patients are not benefits by the prevalent nihilistic attitude of antiarrhythmic drug avoidance. The purpose of t his review is to provide an electophysiologic background for the ratio nal selection of antiarrhythmic drug therapy for patients with suprave ntricular tachyarrhythmias with an accent oi the newer agents that hav e been demonstrated to be useful for this purpose.