Coronary artery disease and ventricular tachyarrhythmia: pathophysiology and treatment

Ventricular tachyarrhythmias are common consequences of coronary artery disease. During the prehospital phase of acute myocardial infarction (MI), ischemia-induced electrophysiological changes and genetic factors are responsible for their occurrence, but the precise pathophysiologic mechanisms are ill-understood. Primary percutaneous coronary interventions (PCIs) have decreased the incidence of ventricular tachyarrhythmias during subsequent stages, and future treatments ameliorating reperfusion injury may provide further progress. In the chronic phase, antiarrhythmic drug therapy targeted toward arrhythmogenic substrate has relatively limited value, but alternative approaches are still uncertain. By contrast, prompt arrhythmia termination by implantable cardioverter-defibrillators (ICDs) is highly effective, although risk-stratification algorithms in candidate patients are inadequate. This review explores current views in the pathophysiology and treatment of ventricular tachyarrhythmias at different clinical stages.