Antiarrhythmic treatment: an overview.

Atrial and ventricular arrhythmias cause significant morbidity and mortality. Abnormalities of impulse generation, e.g., abnormal automaticity or triggered activity, or abnormalities of impulse conduction, e.g., atrioventricular block or reentry, are the prime mechanisms of atrial or ventricular arrhythmias. The ventricular arrhythmias are of special interest because they are a key element in sudden cardiac death, the number 1 public health problem in the U.S. Electrocardiographic recording or provocative testing, e.g., exercise or programmed ventricular stimulation, are used to detect and classify ventricular arrhythmias. Drugs with different mechanisms of action are being rapidly developed to combat cardiac arrhythmias. Ventricular arrhythmias can be defined as benign, potentially malignant or malignant. Benign ventricular arrhythmias require no drug treatment; potentially malignant arrhythmias are subject to drug prophylaxis; and the malignant ventricular arrhythmias require aggressive therapy with drugs, surgery or electronic devices. The management of the malignant ventricular arrhythmias should be evaluated by 1 of 2 programmatic approaches: electrophysiologic or Holter/exercise. Both are complex, costly and inconvenient, but both are excellent for identifying effective treatment for malignant ventricular arrhythmias.