CLINICAL-TRIALS OF ANTIARRHYTHMIC DRUGS IN PATIENTS WITH SUSTAINED VENTRICULAR TACHYARRHTHYMIAS

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, transcathete r or electrosurgical ablation, and the implantable cardioverter defibr illator. Data supporting the four pharmacologic approaches and data co mparing these approaches to one another and to the implantable cardiov erter defibrillator are reviewed. Support for primary therapy with a b eta-blocker is the weakest. Nevertheless, a role for concomitant beta- blockade is established. Comparisons of the invasive and noninvasive a pproaches suggest that, in drug-naive patients, the invasive approach is effective but the noninvasive approach is not, whereas in drug-resi stant patients, neither approach is adequate, Data suggesting that ami odarone is more effective than individualized drug therapy is not comp elling but is widely accepted. Given these uncertainties, many authori ties have embraced the implantable cardioverter defibrillator as the t herapy of choice. (C) 1997 Rapid Science Publishers.