MANAGEMENT AND PROPHYLAXIS OF LIFE-THREATENING ARRHYTHMIAS - RECENT ACHIEVEMENTS

Patients resuscitated from ventricular fibrillation or haemodynamicall y compromising ventricular tachycardias have an unfavourable clinical outcome. Moreover, there is no evidence that the prognosis can be impr oved by empirical use of antiarrhythmic therapy. Therapy guided by ele ctrophysiological stimulation or long-term ECG identifies a subgroup o f patients with a better outcome (in whom arrhythmias are suppressed) and a subgroup with a bad prognosis (in whom arrhythmias are not suppr essed). However, this does not say that antiarrhythmic drugs actually improve the outcome. It may simply identify patients with an intrinsic ally good prognosis, regardless of whether they receive drug treatment . Because retrospective trials have reported that empiric administrati on of amiodarone provides long-term control in two-thirds or more of p atients with refractory ventricular tachyarrhythmias, a direct compari son with other drugs guided by electrophysiological testing or long-te rm ECG was performed (CASCADE-study). Six-years survival was 41% under amiodarone versus 20% with other drugs. Even those conventionally tre ated patients, whose inducible arrhythmias were suppressed, had a tren d toward a worse prognosis compared to those who were inducible and tr eated empirically with amiodarone. However, the high recurrence rate o f arrhythmic events demonstrates the limitation of any antiarrhythmic drug,irrespective of the drug used and irrespective of whether it is g iven empirically or in a study.