ANTIARRHYTHMIC DRUGS AND DEVICES FOR THE MANAGEMENT OF VENTRICULAR TACHYARRHYTHMIA IN ISCHEMIC-HEART-DISEASE

Ischemic heart disease is the most frequent cardiac abnormality in pat ients with sustained or nonsustained ventricular tachyarrhythmias. The goals of therapy in such patients are to decrease the severity and in cidence of symptoms and prolong life. In this article, we review the c urrent views on antiarrhythmic drug therapy and an implantable cardiov erter-defibrillator (ICD) in patients with ischemic heart disease. The importance of beta blockade as part of the therapy is emphasized. In addition, the superiority of sotalol and amiodarone over class I drugs , the benefits of combined treatment with amiodarone and a beta blocke r, and the impact and limitations of current trials comparing the effe ctiveness of drug therapy with that of an ICD are all considered. Also discussed is the combined use of an antiarrhythmic drug and an ICD. I n this approach sotalol is generally the agent of choice, with amiodar one the second choice. (C)1998 by Excerpta Medica, Inc.