Ventricular instability and sudden death in patients with heart failure: lessons from clinical trials

Nancy, France Various trials using non-antiarrhythmic drugs, antiarrhythmic agents and implantable-cardioverter defibrillators (ICDs) have been performed in order to decrease the incidence of sudden death and to improve survival in chronic heart failure (CHF). The present review addresses some of the key findings of those trials. First, it addresses the importance of considering the potential electrophysiological effects of non-antiarrhythmic drugs and of using angiotensin-converting e zyme inhibitors, beta-blockers and antialdosterone agents in the optimal management of patients with CHF. Second, it reviews the effects of the antiarrhythmic agent amiodarone on mortality and arrhythmic deaths in patients with depressed left ventricular function. Third, it assesses the evidence that patients with CHF and a history of sustained ventricular arrhythmias or resuscitation may benefit from ICD implantation. Finally, it outlines the growing role of ICD therapy in patients with CHF as a primary indication