Ventricular tachycardia and sudden cardiac death.

As we approach the new millennium, treatment of survivors of cardiac arrest and prevention of sudden cardiac death (SCD) are the two most important problems confronting contemporary cardiology practice. Sudden cardiac death occurs as a result of ventricular tachycardia (VT) degenerating into ventricular fibrillation (VF). Several major arrhythmia treatment trials completed during the last decade have significantly changed the way we treat patients with ventricular arrhythmias. In patients with sustained VT and aborted SCD, only treatment with implantable cardioverter defibrillator (ICD) has been shown to significantly increase survival. Amiodarone and sotalol, though very useful in the treatment of VT and VF, do not improve survival as significantly as ICD therapy. Use of Class I antiarrhythmics may adversely affect survival. Primary prevention of SCD in patients with a recent myocardial infarction (MI) and in patients with cardiomyopathy and congestive heart failure (CHF) is limited by our inability to accurately identify patients at risk of SCD. Among the many tests available to identify patients at risk of SCD, decreased left ventricular ejection fraction (LVEF) and presence of non-sustained VT appear to be most useful. To date, only beta adrenoceptor blockers have been shown to improve survival in post-MI patients as well as in patients with cardiomyopathy and CHF. Use of amiodarone is controversial in these patients. Treatment with ICD of post-MI patients with decreased LVEF and inducible sustained VT at electrophysiology study improves survival.