Clinical role of antiarrhythmic drugs in the prevention of Sudden Death

Hon Chi Lee, Kristin T L Huang

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

The role of antiarrhythmic drugs for prevention of sudden cardiac death has changed dramatically in the past 20 years. Though antiarrhythmics were once considered first-line therapy for the prevention of sudden death, clinical trials that demonstrated the proarrhythmia effects of Class I antiarrhythmics and others that established the superiority of implantable cardioverter defibrillator (ICD) implantation over amiodarone have driven ICD therapy to supplant antiarrhythmics as the standard of care in patients at high risk for sudden death. Based on current evidence, there is no role for Class I antiarrhythmics as the primary therapy for prevention of sudden death, and most Class III antiarrhythmics, including amiodarone, do not improve survival. Yet antiarrhythmic drugs remain frequently used. They may be clinically important in specific subsets of patients, such as in those with only moderate reductions in LV function, Brugada Syndrome, LQT Syndrome, or catecholaminergic polymorphic VT. Moreover, due to the negative impact of ICD shocks on quality of life, antiarrhythmics have become an important and widely used adjunctive therapy in patients with ICDs. Amiodarone, d,l-sotalol, and azimilide may help reduce both appropriate and inappropriate ICD therapies, and β-blockers and antiarrhythmics are used to treat electrical storm. Concerns that some antiarrhythmics may increase defibrillation threshold (DFT) and render ICD therapy ineffective may be allayed in light of advancements in ICD technology. Nevertheless, further investigation into this and other potential adverse interactions between antiarrhythmics and ICDs is needed.

Original languageEnglish (US)
Title of host publicationElectrical Diseases of the Heart
PublisherSpringer-Verlag London Ltd
Pages501-524
Number of pages24
Volume2
ISBN (Print)9781447149781, 1447149777, 9781447149774
DOIs
StatePublished - Jul 1 2013

Keywords

  • Antiarrhythmic drugs
  • Appropriate and inappropriate ICD shocks
  • Clinical trials
  • ICD
  • Primary prevention
  • Secondary prevention
  • Sudden death

ASJC Scopus subject areas

  • Medicine(all)

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  • Cite this

    Lee, H. C., & Huang, K. T. L. (2013). Clinical role of antiarrhythmic drugs in the prevention of Sudden Death. In Electrical Diseases of the Heart (Vol. 2, pp. 501-524). Springer-Verlag London Ltd. https://doi.org/10.1007/978-1-4471-4978-1_33