THERAPEUTIC CONSEQUENCES OF NEWER STUDIES ADDRESSING THE PROBLEM OF MYOCARDIAL-ISCHEMIA AND VENTRICULAR ARRHYTHMIAS (REPRINTED FROM MYOCARDIAL-ISCHEMIA-AND-ARRHYTHMIA, 1994)

Direct evidence from pathologic-anatomical studies in victims of sudde n cardiac death has been given for acute ischemia (caused by either an acute thrombus, plaque fissuring or an organizing thrombus) to play a major role in the genesis of sudden cardiac death. Furthermore, indir ect data on the effects of drugs in the setting of acute myocardial in farction have demonstrated that treating patients with beta-blocking a gents is more beneficial than treating them with a pure antiarrhythmic drug such as lidocaine. Whereas lidocaine, which also reduces the inc idence of ventricular fibrillation in the setting of acute myocardial infarction, may produce an excess of mortality, beta-blockers reduce v entricular fibrillation and are associated with a prolonged survival. Further, indirect evidence on the role of ischemia in ventricular arrh ythmias is given in patients with chronic ischemic heart disease by se veral studies on coronary revascularization and by studies on antiarrh ythmic drugs versus beta-blockers in the same situation. In conclusion , there is clear evidence from studies of coronary revascularization a nd from studies on drug intervention in different patient populations with ischemic heart disease at risk for ventricular arrhythmias and/or for sudden cardiac death that ischemia plays an important role in the genesis of these arrhythmias.