Comprehensive treatment plan for the prevention of primary ventricular fibrillation in acute myocardial infarction.

Abstract This report of 1,165 cases of acute myocardial infarction outlines a method for preventing primary ventricular fibrillation In patients with this lesion. The plan of prevention begins in the emergency room, with every patient suspected of having myocardial Infarction receiving an intravenous bolus injection of lidocaine, 75 mg, followed by a 2 mg/min infusion controlled by an infusion pump. If administration of lidocaine is ineffective (19 percent of cases), procainamide is given intravenously in a dose of 100 mg every 5 minutes, repeated as necessary to a maximum of 1 g and followed by an infusion of 2 to 6 mg/min. Ventricular tachycardia is rapidly converted to sinus rhythm by either drug or electrical therapy. Monitoring by telemetry is continued after the patient's discharge from the coronary care unit. A new episode of sustained chest pain requires the reinstitution of prophylactic lidocaine therapy. Important precautions to control the toxic effects of these intravenous medications can be achieved in the community hospital where the nursing staff makes the decision to increase the dose of lidocaine or to substitute procainamide. There has been no recognized mortality from the use of these drugs as outlined. With this total system of care, the prevalence rate of primary ventricular fibrillation has been decreased from 6.5 percent (9 of 139 cases) to 0.3 percent (3 of 1,026 cases) and no deaths have occurred.