The best of arrhythmias in 2000

The two major problems of rhythmology in the year 2000 were mainly therapeu tic : on the one hand, the treatment of atrial fibrillation and, on the oth er hand, the treatment of sudden arrhythmic death. These two subjects shoul d not mask the fermentation of ideas, techniques, and diagnostic and therap eutic suggestions which have made up one year of scientific literature in t his field. However, simple analysis of the articles published in the leadin g clinical review, the New England Journal of Medicine, shows that these tw o subjects are the main items. In the treatment of atrial fibrillation, Canadian investigators in the CTAF study, showed that amiodarone was more effective than Sotalol or Propafeno ne for the prevention of recurrences of atrial fibrillation in a population of 403 patients followed up for an average of 16 months. There were 35% of recurrences in the amiodarone group compared with 63% in the Sotalol and P ropafenone group. Two articles demonstrated the value of automatic external defibrillation in the prevention of sudden arrhythmic death, especially when used in a relat ively confined space such as an aeroplane or a casino. These two American P ublications showed the value of this approach for a rapid recovery after ve ntricular fibrillation, the rapidity being the only guarantee of a high sur vival rate after hospital discharge, about 40% in this series. These various studies should be placed in the perspective of the general ch anges in treatment of these two pathologies : the treatment of atrial fibri llation is becoming progressively more hybrid, the same patient being consi dered at different moments for pharmacological antiarrhythmic therapy, abla tion or pacing : arrhythmic sudden death is of increasing concern, either w ith curative treatment by external automatic defibrillation or by preventiv e therapy with the implantable defibrillator, the trend being towards "prop hylactic" indications in patients in whom the high risk of sudden death has been determined.