Post-infarction sustained ventricular tachycardias. The role of drugs and methods for assessing antiarrhythmic efficacy.

Sustained monomorphic ventricular tachycardia is the most important tachyarrhythmia post-infarction. It is re-entrant and is amenable to examination by programmed stimulation. Despite several shortcomings, this technique remains an important method for predicting the long term efficacy of antiarrhythmic drugs. Ventricular ectopic beat suppression and indirect tools for evaluating the electrophysiological conditions of the myocardium (signal averaging, heart rate variability, QT dispersion, etc.) have a useful but limited role for selecting and assessing therapy. Implantable cardioverter defibrillators, surgery and catheter ablation are important treatment options but antiarrhythmic drugs are the first line approach. Their efficacy is not high but for those in whom they work, they offer acceptable levels of reliability and safety.