Circulation, Vol 86, 764-773, Copyright © 1992 by American Heart Association
EM Antman and JA Berlin
BACKGROUND. The purposes of the present investigation were 1) to track the
incidence of primary ventricular fibrillation (VF) in the control and
lidocaine-treated groups in the randomized control trials (RCTs) of
lidocaine prophylaxis against primary VF in acute myocardial infarction,
with particular emphasis on the time frame of the randomized trial, and 2)
to estimate the number of patients who must receive lidocaine currently to
prevent one episode of VF. METHODS AND RESULTS. The following variables
from RCTs published between 1969 and 1988 were entered into logistic
regression models to predict the percent of patients developing VF: year of
publication of the RCT, method of data analysis used in the RCT, route and
technique of lidocaine administration, duration of monitoring for VF, and
exclusion criteria before randomization (congestive heart
failure/cardiogenic shock, ventricular tachycardia/VF, or
bradycardia/atrioventricular block). Year of publication was a significant
predictor of VF in both the control and lidocaine groups (p less than or
equal to 0.002) even after adjusting for other covariates. Based on a
univariate logistic regression model with year as the predictor variable,
it was estimated that the incidence of primary VF in the control group fell
from 4.51% in 1970 to 0.35% in 1990 and from 4.32% down to 0.11% for the
lidocaine group over the same time period. Thus, about 400 patients would
currently need prophylaxis with lidocaine to prevent one episode of VF.
CONCLUSIONS. Present estimates of the risk:benefit ratio of lidocaine
prophylaxis should consider the low risk of VF in control patients and the
large number who need lidocaine prophylaxis to prevent one episode of VF.
When added to the previously reported trend toward excess mortality in
lidocaine-treated patients, these data argue against the routine
prophylactic use of lidocaine in patients with acute myocardial infarction.
ARTICLES
Declining incidence of ventricular fibrillation in myocardial infarction. Implications for the prophylactic use of lidocaine
Cardiovascular Division, Brigham and Women's Hospital, Boston, MA 02115.
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