Patients with recurrent malignant ventricular arrhythmias - Therapeutic challenge

Patients with malignant refractory ventricular arrhythmias present a unique therapeutic challenge. In recent years, this challenge has become even more complex due to the wide spread use of implantable cardiac defibrillators. If, in the past, a majority of the patients succumbed due to these arrhythmias, today, due to the defibrillators, they survive and then need further treatment. The defibrillators treat the arrhythmias when they occur but in most cases do not prevent their initiation. In many cases we need to resort to other modalities. We present three patients who exemplify various options of dealing with this complex issue.