MEDICAL-TREATMENT OF VENTRICULAR-TACHYCAR DIA

Despite the introduction of new therapeutic techniques such as radiofr equency ablation and the implantable defibrillator, the classical oppo sition of monomorphic ventricular tachycardia in apparently normal hea rts and that arising from documented cardiac disease remains useful. I n the first case, treatment is only symptomatic whereas, in the second , lethal progression to sudden death must be prevented. Generally spea king, in chronic post-infarct situations, betablockers are underused a lthough they have been shown beyond doubt to reduce cardiovascular mor tality. This is probably explained by the fear of possible haemodynami c decompensation in patients who often have left ventricular dysfuncti on. Nevertheless, different randomised studies of the use of betablock ers in cardiac failure have reported reduced mortality with no serious side effects. The use of betablockers is therefore advisable, and pos sible in patients with or without sustained ventricular tachycardia an d underlying cardiac disease. In cases at high risk of sudden death, a miodarone may be associated. Recent randomised studies (MADIT, AVID), comparing the use of implantable defibrillators with those of antiarrh ythmic therapy, have shown better results with the implantable defibri llator. However, in these studies, only about 10 % of patients receive d betablockers in the antiarrhythmic treatment groups. This factor has introduced some doubt as to the real benefit of implantable defibrill ators. Therefore, a randomised study comparing the efficacy of betablo ckers with amiodarone against implantable defibrillators is desirable in order to determine the respective indications of each of these two therapeutic modalities.