Prevention of Sudden Death in Post-MI Patients: What Is the Role of Non-Antiarrhythmic Drugs?
Ventricular arrhythmias have a relevant prognostic significance, particularly when associated with myocardial infarction, ischemic heart disease or congestive heart failure. Unfortunately, very effective antiarrhythmic drugs failed to improve prognosis as shown by the CAST studies. Moreover, their use has been limited by several hazardous side effects such as negative inotropic action and serious proarrhythmia. Furthermore, in ischemic heart disease, the electrophysiological mechanisms responsible for ventricular arrhythmias are complex (reentry, abnormal automaticity, delayed after-depolarization), variable and often interdependent. Besides, concomitant factors as sympathetic hypertone, hypokalemia and acidosis play a crucial role. Thus, clinical indications for antiarrhythmic therapy are still controversial and it could be reasonable to consider, when approaching ventricular arrhythmias, the treatment of concomitant factors and the use of drugs such as fibrinolytic agents, β-blockers and ACE inhibitors, that are not traditionally considered as antiarrhythmic agents.
KeywordsAcute Myocardial Infarction Angiotensin Convert Enzyme Ventricular Arrhythmia Acute Myocardial Infarction Angiotensin Convert Enzyme Inhibitor
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