Ventricular Arrhythmias: Antiadrenergic Therapy for the Patient with Coronary Artery Disease

Patients who have had a recent myocardial infarction (MI) are at high risk of ventricular arrhythmias that often cause sudden cardiac death. It is believed that sympathetic overactivity in the peri-infarction period may alter the electrophysiology and structure of the myocardium, thus placing these patients at risk of developing rhythm disturbances. A number of pharmacologic and nonpharmacologic therapies have been shown to reduce the risk of post-MI mortality, including sudden cardiac death. β-Adrenergic blockers are recommended for all post-MI patients without contraindications because of overwhelming clinical evidence of their benefit in reducing mortality in this patient population. Recent clinical trials of implantable cardioverter defibrillators have provided compelling support that they are effective in both the primary and secondary prevention of sudden cardiac death. In addition, several studies have shown that combination therapy with β-blockers and implantable cardioverter defibrillators have synergistic effects that optimize the benefits of both therapies.