In an attempt to improve survival of patients with
coronary artery disease and high-grade ventricular ectopic activity, several studies using different
antiarrhythmic drugs were undertaken. A meta-analysis of all randomized controlled trials using type I antiarrhythmic agents showed that the treatment effect was much more likely to be adverse than beneficial. In contrast to these studies, the pooled results of major
secondary prevention trials using beta-blocking agents could demonstrate a significant reduction in the
sudden death rate by an average of 24% during observation periods of 9-36 months. In the beta-blocker trials, however, patients with
contraindications for this type of
drug, such as overt
congestive heart failure or
chronic obstructive lung disease, were excluded. In these patients a type III
antiarrhythmic drug, such as
amiodarone, may have a place, and in fact, the Basel Antiarrhythmic Study of
Infarct Survival, a prospective, controlled, randomized trial using low-dose
amiodarone as an antiarrhythmic agent, could demonstrate a 60% reduction in
sudden death rate and a 74% reduction in arrhythmic events incidence during the first year after
myocardial infarction. Therefore, in patients with repetitive ventricular ectopic activity after
myocardial infarction and adequate left ventricular function, a therapeutic attempt with beta-blockers without intrinsic
sympathomimetic activity seems advisable. Beside beta-
adrenergic blockade, low-dose
amiodarone is an alternative, especially in patients with impaired left ventricular function or other
contraindications for beta-blockers.