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Management of Patients with Life‐Threatening Ventricular Tachyarrhythmias in the Defibrillator Era : The Need to Differentiate
Author(s) -
STEINBECK G.,
HABERL R.,
HOFFMAN E.
Publication year - 1997
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.1997.tb06122.x
Subject(s) - medicine , amiodarone , intensive care medicine , ventricular tachycardia , implantable cardioverter defibrillator , catheter ablation , sudden cardiac death , cardiology , intervention (counseling) , defibrillation , disease , randomized controlled trial , ablation , atrial fibrillation , psychiatry
Patients with a history of sustained ventricular tachyarrhythmias form an extremely inhomogeneous group with respect to presenting arrhythmia, underlying cardiac disease, and therefore, risk of dying suddenly. Eor subgroups such as ventricular tachycardia in the absence of underlying cardiac disease, radiofrequency catheter ablation offers cure. In others, implantation of a cardioverter defibrillator already appears to have gained the therapy of first choice, leaving only a secondary role to antiarrhythmic drugs. It must be emphasized however, that these new therapeutic strategies have their pros and cons like the older, seemingly outfashioned approaches of noninvasively or invasively guided antiarrhythmic drug therapy or empiric amiodarone treatment. Until the advent of controlled randomized trials comparing the implantable cardioverter defibrillator (ICD) with the best other, usually medical form of treatment, physicians must continue to base their individual therapeutic decisions on circumstantial published and personal experience. In doing so, the recent achievements of catheter ablation and defibrillator implantation have definitely improved patient care, but have not made antiarrhythmic drugs jobless. With all the alternatives at hand, it remains a challenging task to weigh the benefits and risks of the various approaches against each other in an attempt to tailor the antiarrhythmic intervention to the very individual need of the patient.