Arrhythmia prophylaxis after acute myocardial infarction: a decade of controversy.
Primary ventricular fibrillation continues to be a major complication of acute myocardial infarction occurring in 5-9% of patients in the coronary care unit and in a higher percentage of pre-hospital admissions. Prophylactic anti-arrhythmic drugs can prevent primary ventricular fibrillation. Lidocaine has been used for this purpose and can be administered safely and effectively in most patients by following well-established programs based on pharmacokinetic and pharmacodynamic data. The in-hospital mortality for patients with primary ventricular fibrillation exceeds that of matched controls not having the arrhythmia, and many studies show a higher 1-, 3-, and 5-year mortality. Other studies have failed to confirm these long-term results and have produced controversy among cardiologists. I continue to recommend prophylactic antiarrhythmic drugs for all patients with acute infarction, especially in those undergoing early interventional therapy.
Harrison
D C
DC
University of Cincinnati Medical Center, Ohio 45267-0663.
D000208:Acute Disease; D001145:Arrhythmias, Cardiac / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D009203:Myocardial Infarction / Q000150:complications*