Non-Drug Therapies of Arrythmias

Antiarrhythmic drug therapy is rarely indicated in patients with benign arrhythmias except to relieve debilitating symptoms (e.g.- syncope, dizziness)

Because drug suppression of lethal arrhythmias is only successful in a minority of patients and because the risk of untoward effects (including death) is high, a variety of surgical procedures have been developed:

• Radiofrequency (RF) catheter ablation has recently replaced surgical ablation in nearly all cases of ablation for cardiac arrhythmias. It is now a first-line therapy and highly effective in treating:

  • Wolff-Parkinson-White syndrome

  • AV nodal reentry

  • Atrial ectopic tachycardia

• RF ablation is also useful in treating:

  • Atrial fibrillation

  • Several types of monomorphic ventricular tachycardias

• Automatic implantable cardioverter/defibrillator devices (ICDs)

  • Can now be implanted without thoracotomy

  • Current generation devices terminate arrhythmias by anticardiac pacing, cardioversion, and defibrillation

  • Considered by some experts to be the therapy of first choice in patients with ventricular tachycardias based on a number of recent clinical trials comparing ICD therapy to antiarrhythmic drug therapy (both Class I and Class III drugs)

  • A significant fraction of patients receiving an ICD may still require antiarrhythmic drug therapy to decrease the frequency of arrhythmic episodes (to prolong battery life) and to reduce the number of inappropriate (energy-consuming and painful) shocks. Improvements in ICD design may reduce or eliminate the need for concurrent drug therapy.

Category: Cardiology Notes