Beta blockers: Evidence versus wishful thinking

Catecholamines and ischemia play an important role in the induction of vent ricular tachyarrhythmias. Beta blockers antagonize the effect of catecholam ines and have anti-ischemic properties. Several controlled studies performe d in the early 1980s in patients after myocardial infarction have shown tha t beta-blocker therapy clearly decreases sudden and nonsudden cardiac death . Despite the lack of recent randomized trials, data from uncontrolled stud ies suggest that the beneficial effect of beta blockers is still present in the thrombolytic era. Thus, it is incomprehensible that today in the Unite d States and in mast parts of Europe, <40% of post-myocardial infarct;on pa tients are treated with beta blockers. Even in patients with documented sus tained ventricular tachycardias (VTs) or ventricular fibrillation (VF), cli nical studies indicate that beta blockers improve survival. Thus, even in t he thrombolytic era, beta blockers should be used as a basic therapy in pat ients who are at risk of sudden cardiac death. (C) 1999 by Excerpta Medico, Inc.