Antiarrhythmic drugs and devices for the management of ventricular tachyarrhythmia in ischemic heart disease

• Published in: The American journal of cardiology Vol. 82; no. 4; pp. 31I - 40I
• Main Authors: Reiffel, James A., Reiter, Michael J., Blitzer, Mark
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 20-08-1998; Elsevier Limited
• Subjects: Anti-Arrhythmia Agents - classification; Anti-Arrhythmia Agents - therapeutic use; Cardiac arrhythmia; Cardiovascular disease; Drug therapy; Humans; Medical equipment; Myocardial Ischemia - complications; Myocardial Ischemia - drug therapy; Tachycardia, Ventricular - drug therapy; Tachycardia, Ventricular - etiology; Ventricular Fibrillation - drug therapy
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/S0002-9149(98)00470-6

Ischemic heart disease is the most frequent cardiac abnormality in patients with sustained or nonsustained ventricular tachyarrhythmias. The goals of therapy in such patients are to decrease the severity and incidence of symptoms and prolong life. In this article, we review the current views on antiarrhythmic drug therapy and an implantable cardioverter-defibrillator (ICD) in patients with ischemic heart disease. The importance of β 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 β blocker, and the impact and limitations of current trials comparing the effectiveness of drug therapy with that of an ICD are all considered. Also discussed is the combined use of an antiarrhythmic drug and an ICD. In this approach sotalol is generally the agent of choice, with amiodarone the second choice.