Antiarrhythmic therapy in heart failure

It has been well established that death due to progressive heart failure constitutes a major risk in cardiac patients. However, the exact mechanism of death remains subject to controversy. While the contribution of arrhythmias alone is questioned, the widely accepted fact is that most patients finally die due to malignant arrhythmias [1, 2, 3]. Even more doubts arise around the problem of drug therapy directed to suppress arrhythmias in patients with impaired ventricular function. The results of the CAST trial that are presented in this book elsewhere have contributed to doubts regarding the value of non-discriminative prophylactic therapy againstspontaneous ectopy guided by Holter monitoring [4]. In contrast, results of the consensus trial have supported the assumption that improvement of LV function by means of afterload reduction can improve the clinical outcome either by hemodynamic improvement alone or by direct antiarrhythmic action [5].