In this issue of The Journal, Nygaard et al1 report a very high incidence of serious adverse experiences with antiarrhythmic drugs during the utilization of what has become the "state-of-the-art" approach to the treatment of patients with life-threatening ventricular arrhythmias. This experience is not unique to this group of investigators, is certainly not due to misuse of these agents, and may be found embodied in many other reports that have emphasized the antiarrhythmic efficacy of these agents.2 The conclusions and warnings of these investigators warrant repetition, emphasis, and elaboration.
First, as mentioned by the authors, it should be emphasized that these results, as alarming as they are, actually underestimate the magnitude of the problem. Many patients were exposed to the drugs for short periods, limiting the occurrence of chronic toxic reactions. Furthermore, the authors have not attempted to report the incidence of aggravation of arrhythmia by the drugs.
Woosley RL. Risk / Benefit Considerations in Antiarrhythmic Therapy. JAMA. 1986;256(1):82-84. doi:10.1001/jama.1986.03380010086032