What Now After CAST?

Abstract

Few studies have had as devastating an effect on cardio logical practice as the recent Cardiac Arrhythmias Suppression Trial (CAST). The trial was meant to test the efficacy of the newer anti arrhythmic in post myocardial infarction patients who had PVC’S and non-sustained ventricular tachycardia.Taking a cue from C&ST, others have looked at retrospective data and come out with results pointing a guiltyfinger at other classical drugs like guanidine. It may be that the entire edifice of anti arrythrnia treatment has been built on feeble foundations. There is apparently more to it than suppressing the ubiquitous PVC. The question now is what is the clinician to do? Weilfor one, there are still indications for anti- arrhythmic treatment in this group. Symptomatic supraventricular arrhythmias need management and should be treated. Survivors of ventricular fibrillation and sustained ventricular tachycardia still need appropriate treatment.A long shadow has been CAST on anti-arrhythmic. It shall be some time before this is cleared.