Pharmacologic Management of Arrhythmia in Heart Failure

Arrhythmia confers a substantial risk of mortality and morbidity in patients with heart failure (HF). The treatment goals of arrhythmia in HF patients are to improve prognosis and quality of life. Sudden cardiac death (SCD), which is primarily caused by ventricular tachycardia (VT)/fibrillation (VF), accounts for approximately one-third of all deaths in HF patients. Implantable cardioverter-defibrillator (ICD) is useful for preventing SCD, but the improvement of outcome is limited in patients with advanced HF. Beta-blockers reduces SCD and improves survival. Amiodarone is potentially effective to prevent VT/VF. Intravenous nifekalant, a pure class III antiarrhythmic drug, or intravenous amiodarone is useful in the emergency treatment of VT/VF. Recently, short-acting intravenous beta-blocker such as landiolol can be tried. Atrial fibrillation (AF) frequently occurs in HF patients and leads to clinical and hemodynamic deterioration. They also increase a risk of HF deterioration. Amiodarone is safely used in HF patients. In AF patients with congestive, landiolol can also be used to control the ventricular rate as an intravenous infusion. In conclusions, standard pharmacologic therapy for HF including beta-blockers should be optimized to prevent arrhythmia as well as mortality. In emergency and acute care settings, short-acting beta-blocker may have an important role in management of arrhythmia and HF.