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The FDA has asked the manufacturers of the selective serotonin reuptake inhibitor (SSRI) antidepressant citalopram (Celexa, and others) to revise the labeling of the drug to include new warnings about the risk of QT interval prolongation.

Implantable cardioverter defibrillators (ICDs) are widely used in patients at risk for sudden cardiac death (SCD) because these devices have been highly successful in terminating life-threatening ventricular arrhythmias and in increasing survival.

The drugs of choice for treatment of common cardiac arrhythmias are listed in Tables 1 and 2. Some drugs are recommended for indications that have not been approved by the FDA.

Sudden cardiac arrest has a survival rate of about 6% without immediate defibrillation. Automated external defibrillators (AEDs) can be found in many public locations such as shopping malls, office buildings and schools. Some patients may ask their physicians whether they should purchase an AED for personal use. One device has been FDA-approved for sale over the counter (HeartStart Home Defibrillator - Philips). Purchase of all other AEDs for public places or home use requires authorization from a physician.

Ever-increasing specialization has made it difficult for many physicians to keep up with therapeutic standards in intensive-care units (ICUs). This issue of Treatment Guidelines offers current recommendations for use of cardiovascular drugs in the ICU for treatment of hypertensive emergencies; shock, cardiac arrest or decompensated heart failure; and ventricular arrhythmias.

There is no longer any doubt that an implantable cardioverter defibrillator (ICD) can reliably terminate most life-threatening ventricular tachyarrhythmias. The remaining question is who should get one. Guidelines prepared by an American College of Cardiology/American Heart Association task force have recently been published (G Gregoratos et al, Circulation 2002; 106:2145).

The FDA has added a "black box" warning about the risks of QT prolongation and the potentially fatal torsades de pointes (TdP) ventricular tachycardia to the labeling of droperidol (Inapsine - Akorn), an antiemetic used mostly in anesthesia. The Canadian Health Protection Branch has issued a similar warning. Some anesthesiologists have written to The Medical Letter to express their displeasure with these warnings.

Recent studies suggest that timely use of automated external defibrillators operated by laypersons with minimal training can save lives. Purchase of these devices for public places or home use requires authorization from a physician.