Management of ventricular arrhythmias - Detection, drugs, and devices

Objective To review evaluation and treatment of patients with ventricular a rrhythmias, based on recent studies, with an emphasis on randomized control led trials. Data Sources MEDLINE search of English-language publications of ventricular arrhythmias and their references from 1966 through April 27, 1998. Referen ces to articles were also scanned to broaden the search. Study Selection Randomized controlled trials and all large nonrandomized tr ials of arrhythmias and arrhythmia therapy were reviewed. In addition, stud ies that led to changes in approach to patients with arrhythmias were revie wed. Data Extraction We reviewed articles jointly for pertinent studies and info rmation. Data Synthesis The goals of treatment of the patient with ventricular arrhy thmias are to suppress symptoms and prevent a fatal event. The steps in pro viding such therapy include defining the cardiac anatomy, assessing arrhyth mia risk through noninvasive or invasive testing, and prescribing treatment based on these results. Patients may be separated into high- and low-risk groups to help identify appropriate treatment. While low-risk groups may be nefit from reassurance or medications such as P-blockers or verapamil, high -risk groups have been more difficult to treat. Recent randomized trials of implantable cardioverter defibrillators for ventricular arrhythmias sugges t that they may provide better protection for high-risk patients than do an tiarrhythmic medications. Conclusions Treatment and understanding of risk from ventricular arrhythmia s have advanced substantially in recent years. Classifying patients as bein g at high or low risk for fatal arrhythmias allows the physician to identif y appropriate treatments for the high-risk patient without exposing the low -risk patient to unnecessary treatment-related risks.