[Arterial hypertension and cardiac arrhythmias].

VENTRICULAR ARRHYTHMIAS

Different factors--like hypertrophy, fibrosis, ischemia and apoptosis increase the risk of ventricular arrhythmias and sudden arrhythmic death. ACE inhibitors and Angiotensin receptor antagonists offer a curative therapeutic approach. Beta-blocker are strongly recommended. Amiodarone may be used for symptomatic arrhythmia suppression--but with no proven favourable prognostic effect. The use of class-1 antiarrhythmic drugs is obsolete in the presence of left ventricular hypertrophy and heart failure. Implantable cardioverter/defibrillators (ICD) have been proven to have a positive effect on survival in secondary and primary prevention of sudden cardiac death, and so has cardiac synchronization in severe cardiac dysfunction and widened QRS complex. Atrial fibrillation (AF): Arterial hypertension represents the main risk factor for AF. Patients' age, left ventricular hypertrophy, left atrial dilatation and angiotensin-II activation play an important role in the induction and maintenance of AF. Angiotensin-receptor and beta-blockers seem to be efficacious in AF suppression and also on the regression of hypertrophy. The use of antiarrhythmic agents (AA) is limited because of their relatively low long-term efficacy and pro-arrhythmia properties. Best results may be achieved with class 1C AA drugs in patients with no or minimal structural heart disease. In all other cases amiodarone is suitable but is limited by its side effects. In patients with no or only a few symptoms rate control may be sufficient, but if there are symptoms interventional left atrial ablation of pulmonary veins should be attempted as a real curative strategy.