Antiarrhythmic agents vs implantable cardioverter-defibrillators in the prevention of sudden cardiac death: finally resolved issue?
Authors:
M. Táborský; P. Heinc; V. Doupal
Authors‘ workplace:
I. interní klinika FN Olomouc
Published in:
Kardiol Rev Int Med 2010, 12(Supplementum): 26-31
Overview
The first reference to the relationship between ventricular fibrillation and coronary artery disease is dated to as early as 1779. The magnitude of the problem of sudden cardiac death have been recognized by the medical profession in the 1960s when the first coronary care units had been established where arrhythmias could be monitored and prompt defibrillation could be delivered. In 1980, Mirowski implanted the first implantable cardioverter defibrillator to a patient. Several randomized studies, mainly in patients with coronary artery disease and left ventricular dysfunction or in patients with documented malignant arrhythmias, showed that the implantable cardioverter defibrillator is superior to antiarrhythmic drug therapy in preventing sudden death. Trials on antiarrhythmic drugs were disappointing. Sodium channel blockers and ‘pure’ potassium channel blockers actually increase mortality, calcium channels blocker have no effect, and, although amiodarone reduces arrhythmic death, it had no effect on the total mortality in 2 large trials. It is only the beta-blockers that had been proven to reduce the incidence of sudden cardiac death. Drugs that prevent ischemic events, or lessen their impact, such as the angiotensin-converting enzyme inhibitors, statins, and aldosterone antagonists, all reduce the incidence of sudden cardiac death.
Keywords:
coronary artery disease – ventricular fibrillation – implantable cardioverter defibrillator (ICD) – antiarrhythmic drug
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Paediatric cardiology Internal medicine Cardiac surgery CardiologyArticle was published in
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