[Therapy of arrhythmias in clinical practice].

The primary care physician should be cautious and restrictive in the treatment of cardiac arrhythmias and adhere to the well established modalities only. For supraventricular arrhythmias digitalis, verapamil, quinidine and betablocking agents are the drugs of choice. In atrial fibrillation oral anticoagulants and in some cases aspirin seem to be beneficial for the prevention of stroke in selected subgroups of patients. Criteria for their use are outlined in Tables 1 and 2. Ventricular arrhythmias in healthy persons generally should not be treated. In patients with coronary artery disease and severely compromised left ventricular function amiodarone is very effective for the treatment of complex ventricular arrhythmias. If other antiarrhythmics are to be used, the advice of a cardiologist is strongly recommended, as proarrhythmic effects are particularly common in severe cardiac conditions. Severely symptomatic patients with recurrent ventricular tachycardia and syncope should be offered invasive evaluation in order to determine effective medical or surgical treatment.