Kommentar zu den „ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death – executive summary“

[Current treatment of tachycardia]

Tachycardias including atrial fibrillation often require hospitalisation. A diagnostic algorithm from the surface ECG allows discrimination between supraventricular and ventricular tachycardias. For acute treatment, only a few antiarrhythmic drugs such as adenosine, ajmaline and amiodarone, and in case of hemodynamic instability electrocardioversion are required. For long-term treatment catheter ablation is the option of choice for almost all patients with supraventricular tachycardias, atrial flutter, idiopathic ventricular tachycardias and for many patients with symptomatic atrial fibrillation. Chronic antiarrhythmic drug therapy is less often used. In patients with ventricular tachyarrhythmias in the setting of severe structural heart disease, risk stratification must be performed and ICD therapy is often indicated. Anticoagulant therapy according to risk score analysis is often indicated in patients with atrial fibrillation.

[Recurrent failed ICD therapy of ventricular tachycardia]

Implantable cardioverter defibrillators (ICD) are used as standard therapy to prevent sudden cardiac death in heart failure patients. Today, physicians in emergency and intensive care medicine are often confronted with problems of ICD therapy in these patients. We report a case of a patient suffering from recurrent ventricular tachycardia (VT) requiring antiarrhythmia treatment with amiodarone. With an increasing drug loading, the VT cycle length was progressively prolonged resulting in a slow VT undetectable for the ICD. Subsequently, the patient was scheduled for VT ablation after which the patient became free of arrhythmia recurrences.