Anti-arrhythmia agents in the prevention of sudden cardiac death after myocardial infarct

Heart rhythm disturbances represent one of the most important causes of cardiovascular mortality and, in particular, sudden cardiac arrhythmic death. The persistent actuality of arrhythmias is currently characterized by: 1) better knowledge of pathogenetic mechanisms of arrhythmias and their modulating factors, 2) improved diagnostic possibilities of arrhythmias, 3) availability of a large number of effective antiarrhythmics, as well as of nonpharmacologic therapeutic approaches too. Despite the narrowing spectrum of indications to pharmacologic treatment, both chronic and prophylactic antiarrhythmic therapies have nor become less complicated, but on the contrary they are even more problematic. The most actual and at the same time most controversial question of everyday clinical practice is the long-term antiarrhythmic prevention of sudden cardiac death. The author's aim is to review: 1) survey of studies which have influenced in a more decisive manner the management of patients after myocardial infarction and preventive antiarrhythmic therapy, 2) current antiarrhythmic prevention of sudden cardiac death, 3) the importance of programmed ventricular stimulation regarding the antiarrhythmic therapy and risk stratification in patients after myocardial infarction.