[Arrhythmias and heart failure].

Numerous factors contribute to the genesis of arrhythmias and sudden cardiac death in patients with congestive heart failure. Fibrosis of myocardium, ischemia, dilatation of the ventricles and atria, electrolyte imbalance, and neurohumoral factors are examples. Various drugs used in the treatment of congestive heart failure can also precipitate serious arrhythmias. The role of antiarrhythmics, including amiodarone, is still controversial. Judicious antiarrhythmic therapy involves weighing potential benefits of such therapy against risks, such as worsening heart failure or proarrhythmia. In patients with heart failure antiarrhythmic drugs should only be used for symptomatic arrhythmias. Low-dose beta-blockade offers a promising measure for the prevention of sudden cardiac death even in patients with symptomatic congestive heart failure.