Management of malignant ventricular arrhythmias and cardiac arrest

Sudden cardiac death continues to be a major health problem in the United S tates, accounting for similar to 400,000 deaths per year. The last 10 yrs h ave seen major advances in the primary and secondary prevention of this pro blem. In patients who have survived an episode of cardiac arrest, the AVID study conclusively established the superiority of the implantable cardiover ter defibrillator over empiric amiodarone. For patients with recurrent hemo dynamically destabilizing ventricular tachycardia and ventricular fibrillat ion, intravenous amiodarone has emerged as a potent therapeutic agent, espe cially when other agents such as lidocaine and procainamide have not been e ffective. Finally, recent work has focused on the risk stratification of pa tients for sudden cardiac death. Both the MADIT and MUSTT studies suggest t hat patients with coronary artery disease, reduced ejection fraction, and n onsustained ventricular tachycardia who are inducible to a sustained ventri cular arrhythmia at electrophysiology testing have improved survival with a n implantable cardioverter defibrillator.