Antiarrhythmic Drug Therapy for Sudden Cardiac Death in CHF Guided by the Sicilian Gambit

Abstract

Sudden cardiac death has been the leading cause of death in congestive heart failure (CHF) patients, and most but not all sudden deaths are caused by ventricular tachycardia/fibrillation. Another important issue related to the treatment of patients with CHF and arrhythmias is that conventional empirical antiarrhythmic therapy carries a substantial risk of worsening arrhythmias and heart failure. Target-based selection of antiarrhythmic drugs proposed by the Sicilian Gambit allows a more rational approach to patients with severely depressed left ventricular function. To achieve the more favorable goal of prevention of sudden death, the third Sicilian Gambit meeting proposed new strategies for refractory arrhythmias, that is, an "upstream" approach to antiarrhythmic therapy. The upstream approach is a strategy to prevent the evolution of the disease process to the point where arrhythmia occurs. In contrast, the "downstream" approach is the classical Sicilian Gambit approach of treating arrhythmias once they occur. Moro specifically, a variety of interventions, for example, prevention of ischemia, plaque rupture, hypertrophy, dilatation, and fibrosis, can be considered as upstream. These approaches are not in themselves antiarrhythmic therapy, but apparently can make ventricular fibrillation less likely. In conclusion, the search for downstream targets should be continued to directly suppress the evolution of life-threatening arrhythmias, but the possibility of exploring the upstream approach should also be continued. NR - 10 PU - SPRINGER-VERLAG TOKYO PI - TOKYO PA - 37-3, HONGO 3-CHOME BONKYO-KU, TOKYO, 113, JAPAN