Seipel L, Kühlkamp V
Abteilung Innere Medizin III, Medizinische Universitätsklinik Tübingen.
Z Kardiol. 1993;82 Suppl 5:155-61.
In principle, all antiarrhythmic drugs (classes 1-3) are useful in the treatment of ventricular tachyarrhythmias. In special cases even Ca-antagonists (class 4) can be effective. Holter monitoring and programmed ventricular stimulation are clinical tools for predicting efficacy and controlling proarrhythmic effects. However, only in a limited number of patients are the prerequisites given for testing with one or the other method. Using long-term tape recording the suppression of ventricular salvoes by an antiarrhythmic drug seems to predict a good prognosis. In the electrophysiological lab complete or partial suppression of inducibility of the arrhythmias during programmed stimulation under antiarrhythmic treatment has a high predictive value as far as recurrence during follow-up is concerned. Using Holter criteria the efficacy of antiarrhythmic drugs is higher than with programmed stimulation. However, invasive electrophysiological testing has a higher sensitivity, i.e., a low rate of false-positive results. As the results of two newer studies question the value of both methods, a definitive answer of the problem of optimal control of antiarrhythmic therapy cannot be given today.
