Empiric Therapy with β‐Blockers

The only class of drugs with significant effects on ventricular fibrillation and sudden death in humans is that of β‐blockers. The exact mechanisms for these prophyiactic effects are not knotvn but may be related to both ontiischemic or anliarrhythmic infiuences. It seems reasonable to suggest that one should use a β‐blocker with proven effect on total mortality and sudden cardiac death after myocardial infarction as prophylaxis. Therefore, propranolol, timolol. or metoprolol. should be instituted in order to improve prognosis when there are no conlraindications. In addition to possible effects on survival one would aiso expect to reduce the risk for new ischemic events with angina or reinfarction. In contrast, class I antiarrhythmic agents are useful for symptomatic ventricular arrhythmias but there is no proof for any effect on ventricular fibrillation and sudden cardiac death.