Premature ventricular contractions: Which ones require treatment?

Treatment of ventricular arrhythmias remains a difficult problem owing to our lack of understanding of etiology, prognosis, and efficacy of various antiarrhythmic agents. Lidocaine appears to prevent ventricular fibrillation during the CCU of myocardial infarction. Warning arrhythmias seen in the CCU do not in actuality accurately warn the clinician of risk of fibrillation. Secondary prevention of sudden death following infarction with antiarrhythmic agents may be of some value. There is little to suggest that drugs available in the United States are efficacious for this use. For the most part, treatment of outpatients with ventricular arrhythmias probably should be confined to those patients with symptomatic arrhythmias or to patients with complex ventricular arrhythmias and other objective evidence of cardiac disease.