What is your approach for de-escalation of antiarrhythmics for patients with a history of ventricular arrhythmias?

This is an important question. The answer depends on several factors including the type of arrhythmia being treated, the patient's underlying condition, drug intolerance and expense, and patients' expectations. Unfortunately, there is very little published information on this topic but as a general rule, I have routinely asked the question as to the necessity of drug continuation during each patient's visit and try to discuss the issue with her/him. When it is possible, it is an excellent idea to trim the drug program and try to combat the trend we have seen of gross polypharmacy.