MEDICAL ANTIARRHYTHMIC THERAPY FOR VENTRICULAR ARRHYTHMIAS IN THE POST-CAST ERA

This review provides a 20-year perspective on the most significant reports on antiarrhythmic drug therapy of ventricular arrhythmias, with particular reference to the CAST trials. The following conclusions are drawn: 1. Based on the CAST trials and other studies investigating the effectiveness of antiarrhythmic agents during the last 20 years, prophylactic treatment with antiarrhythmic class I, III and IV drugs after myocardial infarction is not indicated. 2. Betablockers without intrinsic sympathomimetic activity are effective in the prevention of reinfarction and sudden cardiac death. 3. The effectiveness of amiodarone as secondary prophylaxis is currently under investigation in several multicenter trials. 4. Antiarrhythmic intervention is indicated in patients with hemodynamically compromising ventricular tachycardia or ventricular fibrillation, irrespective of spontaneous ventricular arrhythmias. Effective treatment with arrhythmic agents can be achieved in approximately half of the patients. Arrhythmia surgery, implantable cardioverters/defibrillators, or heart transplantation are possible alternative treatment modalities.