Beta-blockers and amiodarone for the primary prevention of sudden cardiac death.

Sudden cardiac death remains a major public health care problem, generally occurring in patients with ventricular dysfunction. Beta-blockers, already of proven benefit for patients after myocardial infarction, have recently been shown to improve functional status and mortality outcomes in patients with heart failure. Amiodarone, a potent antiarrhythmic drug, was recently studied in a number of randomized clinical trials involving patients with heart failure and patients after myocardial infarction. Routine use of amiodarone cannot be recommended in these patient groups, but serious adverse outcomes were not observed. When antiarrhythmic drug therapy is required, amiodarone is the drug of choice for patients with structural heart disease.