Is there a role for antiarrhythmic drugs in patients with implantable defibrillators?

With remarkable advancement in technology and clinical research, implantable cardioverter defibrillators (ICDs) have replaced antiarrhythmic drugs as the preferred modality for both primary and secondary prevention of arrhythmic deaths. However, concomitant use of antiarrhythmics in patients with ICDs remains common, often for prevention or reduction of appropriate and inappropriate shocks caused by ventricular and supraventricular arrhythmias, respectively. The role of empiric antiarrhythmic therapy in this patient population remains less clearly defined, with conflicting information from various small randomized trials. Use of antiarrhythmic drugs in the ICD patient population not only can cause potentially serious side effects but can also interact or interfere with the ICD device function. In addition, the effect on survival in patients with ICDs is not well characterized. Given the many potential side effects, drug-device interactions, unclear survival effect, and lack of convincing clinical data supporting its use, empiric antiarrhythmic therapy in the ICD patient population cannot be recommended at this time.