Congestive heart failure and ventricular arrhythmia. Problems of treatment

This editorial discusses relationships between congestive heart failure and malignant ventricular arrhythmia. In spite of the existence of correlation between the severity of heart failure and the presence of high grade ventricular arrhythmia routine therapy does not affect quantity and quality of arrhythmia. On the other hand most antiarrhythmics can provoke deterioration of congestive heart failure and produce proarrhythmic events. In multicenter trials CAST and SWORD some class I and III medications have been shown to be associated with increased risk of mortality in congestive heart failure. Most beneficial results can be obtained with the help of class III antiarrhythmics with additional beta-blocking activity, such as amiodarone and sotalol. Special attention is fixed on interpretation of controversial results of recent trial of amiodarone (GESICA, CHF STAT, EMIAT, CAMIAT) and post myocardial infarction trial with sotalol. The conclusion is that amiodarone and sotalol are the best drugs in terms of improving survival of patients with congestive heart failure and ventricular arrhythmia not because of their antiarrhythmic properties but probably because of their beta-blocking effects and other mechanisms of action.