Traitement médical des troubles du rythme

Abstract

Antiarrhythmic drugs are useful to prevent recurrence of arrhythmias. Maintenance of sinus rhythm after cardioversion for atrial fabrillation is a main goal. In patients with recurrence of persistant atrial fibrillation, rate slowing medication is an alternative. Anticoagulant drugs are necessary to prevent thromboembolic complications. Non pharmacological approach, such as catether ablation or implantable cardiac defibrillator, is prefered in others arrhythmias. Radiofrequency ablation is the first choice therapy for isthmus-dependant atrial flutter and supraventricular tachycardia such as atrionodal reentries and accessory pathways. Ventricular arrhythmias are often associated with impaired left ventricular function. A precise evaluation of the causal cardiomyopathy (ischemic, dilated or hypertrophic) is required to propose the best strategy between medical regimen alone and implantation of a defibrillator. Combination of both reduces the numbers of inappropriate shocks. Some inherited arrhythmogenic diseases with structurally normal hearts, are at high risk of sudden death. Beta-blockers are indicated in long QT syndrome and catecholergic ventricular polymorphic tachycardia whereas implantable defibrillator is better to prevent sudden death in high risk patients with Brugada syndrome.