Differential Utility of Antiarrhythmic Agents

Sudden cardiac death (SCD), which is recognized as the most common cause of death in adults, in 80% of cases results from a ventricular tachyarrhythmia that subsequently degenerates into ventricular fibrillation. Ventricular arrhythmias have been identified as a major factor in predicting a high risk of SCD and can be classified as benign, potentially lethal, or lethal. This system is based on the likelihood that the rhythm type predicts the occurrence of sudden death. Antiarrhythmic agents are employed to eliminate ventricular arrhythmias and their sequelae, particularly hemodynamic consequences. Many physicians use these drugs with the additional hope of preventing sudden death, although to date no data support such use. This article details the comparative utility of commonly available antiarrhythmic agents in terms of their safety and efficacy, and defines the bases for the recommendations of an algorithm that can be used to choose among the various drugs.