Treatment of ventricular arrhythmias in the post-CAST era: beyond device therapy

Some take home points from a recent review:

The CAST study changed our thinking about drug treatment of ventricular arrhythmias but it did not eliminate the practice altogether.

Drug treatment of ventricular arrhythmias is not indicated for prevention of sudden cardiac death but two indications remain: symptom control and prevention or treatment of tachycardia induced cardiomyopathy.

PVC burdens of more than 15% of heart beats as well as frequent runs of VT, even if asymptomatic, have been associated with the development of tachycardia induced cardiomyopathy.

There has been a shift toward safer drugs (e.g. beta blockers).

Some of the outflow tract and fasicular ectopic rhythms are amenable to ablation.

Outflow tract and fasicular tachycardias have characteristic morphology and their sites of origin can often be identified on the surface electrocardiogram.