Ventricular Arrhythmias.

Results of recent clinical trials allow an evidence-based approach to ventricular arrhythmias (VAs). The implantable cardioverter-defibrillator (ICD) has clearly established its role in the secondary prevention of VA and should be considered first-line therapy in patients surviving episodes of potentially lethal VAs. It has also been clearly shown that in these patients, antiarrhythmic drug selection by means of serial Holter recording or electrophysiologic study does not improve survival. Antiarrhythmic drug therapy (including amiodarone) as primary prevention in high-risk patients (eg, those who have experienced a myocardial infarction or who have heart failure) has thus far not reduced the mortality rate. In contrast, use of the ICD as a primary preventative strategy has reduced the mortality rate in patients after myocardial infarction who have reduced left ventricular function, nonsustained ventricular tachycardia, and inducible ventricular tachycardia during electrophysiologic study. Thus, patients fitting this clinical profile are best served by implantation of an ICD. Monomorphic ventricular tachycardia occurs rarely in patients without heart disease. These arrhythmias are best treated with catheter ablation therapy, a treatment with a high rate of success and a low rate of complications.