Antiarrhythmic Prophylaxis in Acute Myocardial Infarction

Abstract

The mortality of patients hospitalized because of acute myocardial infarction has been lowered approximately from 30 per cent to 20 per cent through initial treatment in coronary-care units. Lives have been saved mainly by forestalling the development of catastrophic primary arrhythmias through prophylactic administration of antiarrhythmic drugs. This therapy is generally begun upon detection of minor dysrhythmias that are asymptomatic and hemodynamically innocuous but are considered premonitions of ventricular tachycardia and fibrillation. The appearance of frequent, multifocal, repetitive, or "R on T" premature ventricular contractions is the most widely accepted cue for starting a prophylactic lidocaine infusion. Unfortunately, ventricular fibrillation . . .