Is primary antiarrhythmic drug therapy for ventricular arrhythmias obsolete?

Sudden cardiac death (SCD) remains a major public health threat. Patients with aborted SCD have a high incidence of recurrent life-threatening ventricular arrhythmias. Antiarrhythmic drug approaches dominated early attempts to prevent SCD; however, several trials with sotalol and amiodarone revealed an unacceptably high rate of recurrent arrhythmic events. With the advent of the implantable cardioverter defibrillator (ICD), the primary role of antiarrhythmic drug therapy for the secondary prevention of SCD has been called into question. Two recently completed trials, the Antiarrhythmics Versus Implantable Defibrillators (AVID) trial and the Canadian Implantable Defibrillator Study (CIDS), confirm the superiority of the ICD over the best medical therapy for saving lives.