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REVIEW ARTICLES

Management of ventricular arrhythmias

A trial-based approach

^a Section of Clinical Cardiac Electrophysiology, Department of Internal Medicine (Cardiology Division), The University of Texas Southwestern Medical Center, Dallas, Texas, USA
^b The Dallas Veterans Affairs Medical Center, Dallas, Texas, USA

Manuscript received September 15, 1998; revised manuscript received April 9, 1999, accepted May 16, 1999.

Reprint requests and correspondence: Mohamed H. Hamdan, Division of Cardiology (111A), Dallas VA Medical Center, 4500 S. Lancaster Road, Dallas, Texas 75216

Sudden cardiac death accounts for approximately 300,000 deaths annually in the U.S., and most of these are secondary to ventricular tachycardia (VT) and fibrillation in patients with coronary artery disease. Most patients with cardiac death die before reaching the hospital, which brought about a tremendous amount of research focused at identifying patients at high risk. Several trials were initiated to test the effectiveness of various therapeutic measures in these high-risk patients. A history of myocardial infarction, depressed left ventricular function and nonsustained VT have all been identified as independent risk factors for future arrhythmic death. Similarly, patients with a history of sustained VT or a history of sudden cardiac death are a high-risk group and should be aggressively evaluated and treated. The purpose of this article is to discuss risk stratification and primary prevention of sustained ventricular arrhythmias. We also review the recent secondary prevention trials and discuss the options available in the management of patients with sustained ventricular arrhythmias.

Abbreviations and Acronyms   AVID = Antiarrhythmics Versus Implantable Defibrillators   CABG-PATCH = The Coronary Artery Bypass Graft Patch Trial   CAMIAT = Canadian Amiodarone Myocardial Infarction Arrhythmia Trial   CASH = Cardiac Arrest Study—Hamburg   CHF = Congestive heart failure   CHF-STAT = Survival Trial of Antiarrhythmic Therapy in Congestive Heart Failure   CIDS = Canadian Implantable Defibrillator Study   EMIAT = European Myocardial Infarct Amiodarone Trial   GESICA = Grupo de Estudio de la Sobrevida en la Insuficiencia Cardiaca en Argentina   ICD = implantable cardioverter-defibrillator   MADIT = The Multicenter Automatic Defibrillator Implantation Trial   MI = myocardial infarction   MUSTT = Multicenter Unsustained Tachycardia Trial   PVC = premature ventricular contraction   SAECG = signal-averaged electrocardiography   SWORD = Survival with Oral d-Sotalol   VF = ventricular fibrillation   VT = ventricular tachycardia

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