Prevention of sudden cardiac death.

Tremendous strides have been made in recent years in the treatment and prevention of sudden cardiac death. Large-scale trials have identified several strategies that may be implemented to improve survival in patients susceptible to sudden cardiac death. In patients who have had a sustained ventricular tachyarrhythmia, the current therapy of choice is an implantable cardioverter defibrillator. For prophylaxis of sudden cardiac death in patients without a previous event, several approaches should be considered. Beta-blockers are an effective pharmacologic therapy in patients after myocardial infarction, and their efficacy has also been demonstrated in patients with congestive heart failure. Antiarrhythmic drugs are not efficacious as prophylactic agents to reduce mortality in these populations. The best therapeutic approach for prophylactic therapy to prevent sudden cardiac death appears to be the implantable cardioverter defibrillator; however, its use can be justified only in patients at high risk for developing sudden cardiac death. Further work is needed to identify the high-risk populations in which this therapy is warranted.