Beta blockers: evidence versus wishful thinking

Catecholamines and ischemia play an important role in the induction of ventricular tachyarrhythmias. Beta blockers antagonize the effect of catecholamines and have anti-ischemic properties. Several controlled studies performed in the early 1980s in patients after myocardial infarction have shown that β-blocker therapy clearly decreases sudden and nonsudden cardiac death. Despite the lack of recent randomized trials, data from uncontrolled studies suggest that the beneficial effect of β blockers is still present in the thrombolytic era. Thus, it is incomprehensible that today in the United States and in most parts of Europe, <40% of post-myocardial infarction patients are treated with β blockers. Even in patients with documented sustained ventricular tachycardias (VTs) or ventricular fibrillation (VF), clinical studies indicate that β blockers improve survival. Thus, even in the thrombolytic era, β blockers should be used as a basic therapy in patients who are at risk of sudden cardiac death.