Document Detail

Declining incidence of ventricular fibrillation in myocardial infarction. Implications for the prophylactic use of lidocaine.
MedLine Citation:
PMID:  1516188     Owner:  NLM     Status:  MEDLINE    
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.
E M Antman; J A Berlin
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Circulation     Volume:  86     ISSN:  0009-7322     ISO Abbreviation:  Circulation     Publication Date:  1992 Sep 
Date Detail:
Created Date:  1992-10-06     Completed Date:  1992-10-06     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  764-73     Citation Subset:  AIM; IM    
Cardiovascular Division, Brigham and Women's Hospital, Boston, MA 02115.
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MeSH Terms
Lidocaine / therapeutic use*
Multivariate Analysis
Myocardial Infarction / complications*,  drug therapy
Randomized Controlled Trials as Topic
Reference Values
Risk Factors
Ventricular Fibrillation / epidemiology,  etiology*,  prevention & control
Reg. No./Substance:
Comment In:
Circulation. 1993 Jun;87(6):2067-9   [PMID:  8504527 ]
Circulation. 1992 Sep;86(3):1033-5   [PMID:  1516174 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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