Ventricular arrhythmias and sudden cardiac death

The evaluation of a patient at risk for ventricular arrhythmias and CAD begins with a thorough medical history and the standard ECG, followed by an assessment of LVEF and the presence of ischemia. The SAECG, HRV, microvolt TWA, and invasive EPS should be used in particular subgroups of patients to assist the clinician in risk stratification for VT, VF, and SCD. Amiodarone is the superior antiarrhythmic agent in reducing the recurrence of VT/VF and subsequent ICD shocks. In addition, amiodarone has been shown to reduce arrhythmic death, but has fallen short in reducing total mortality. At present, patients who have a severely reduced LVEF (≤30%) and a history of MI are at extremely high risk for SCD and require an ICD. Aggressive risk stratification of patients is crucial in reducing the incidence of SCD. Understanding the role of pharmacotherapy and device therapy alike in the treatment of these patients will decrease future arrhythmic events and death. © 2006.