Value of antiarrhythmic drug therapy and the implantable cardioverter defibrillator in prolonging survival in patients with severe congestive failureWertigkeit antiarrhythmischer Arzneimitteltherapie und des implantierbaren Kardioverter-Defibrillators (ICD) bei der Verlängerung der Überlebenszeit schwer herzinsuffizienter Patienten

Congestive heart failure is a very common syndrome with an annual incidence of 400000 cases per year. It is also associated with a high mortality that approaches 50% at five years, with roughly one-third of these deaths being caused by cardiac arrhythmias. A variety of approaches have been taken in the treatment of congestive failure. Randomized trials have shown that the use of ACE inhibitors improves survival in congestive failure, with some trials also showing a reduction in sudden cardiac death. Other randomized trials have studied the role of amiodarone in the treatment of congestive failure. These trials, in general, have shown that total mortality is not effected by amiodarone but the sudden death risk is reduced. The role of beta blockers has recently gained attention in the Carvedolol trial which showed significant improvement with the use of a nonselective beta blocker. Finally, a variety of studies involving the use of the implantable cardioverter defibrillator are underway which will determine if the ICD can reduce the arrhythmic risk posed by the presence of congestive failure. Most experts think that the combined use of ACE inhibitors, beta blockers and likely the ICD as well will see a significant reduction in the mortality rate of patients with established congestive failure.