Last update:
11-Nov-2004

Patients at high risk for sudden cardiac death (SCD), who have no documented episodes of sustained ventricular tachycardia or ventricular fibrillation, but who have left ventricular dysfunction and asymptomatic episodes of non-sustained ventricular tachycardia, should undergo electrophysiological (EP) testing. If sustained ventricular tachycardia or fibrillation is induced the most appropriate treatment is the implantation of an automatic implantable cardiac defibrillator (AICD). According to the results of the most recent and complete study, the MUSTT, therapy with antiarrhythmic drugs is not recommended (other than β-blockers for patients after myocardial dysfunction or with heart failure). It may be possible to recommend amiodarone for patients at lower risk for SCD (with less severe left ventricular dysfunction, ejection fraction >35%), but this recommendation awaits confirmation from further studies. In survivers of an episode of SCD who have documented sustained ventricular tachycardia or fibrillation the implantation of an AICD is the treatment of choice. There are not enough data to suggest that antiarrhythmic drug therapy can be recommended to these patients, empiric or EP guided.

Key words: Coronary artery disease, Heart failure, Primary prevention, Secondary prevention, Sudden cardiac death.