Use of the newer antiarrhythmic drugs in patients with supraventricular tachyarrhythmias: Let's not throw out the baby with the bath water

Although recent advances have expanded the therapeutic choices for patients with supraventricular tachyarrhythmias, most of these patients will still require either short or long term treatment with antiarrhythmic drugs. Unfortunately, some practitioners have reacted to recent reports emphasizing the hazards of antiarrhythmic drug therapies by adopting an attitude of avoidance of these therapies. Although critical analyses of available data indicate that many antiarrhythmic drugs may have an unfavourable risk-benefit balance in patients with low risk arrhythmias who also have atherosclerotic heart disease and/or congestive heart failure, the same cannot be said for patients with high risk arrhythmias, for patients without atherosclerotic heart disease or congestive heart failure, or for patients whose symptoms require antiarrhythmic therapy to prevent physical and emotional disability despite a small risk of therapy. These patients are not benefits by the prevalent nihilistic attitude of antiarrhythmic drug avoidance. The purpose of this review is to provide an electophysiologic background for the rational selection of antiarrhythmic drug therapy for patients with supraventricular tachyarrhythmias with an accent oi the newer agents that have been demonstrated to be useful for this purpose.