Prophylactic Lidocaine in Acute MI

To the Editor. — The excellent overview by MacMahon et al¹ on prophylactic lidocaine in suspected acute myocardial infarction includes one disturbing misquotation. The authors state: "With regard to survival after discharge from the hospital, nonfatal VF [ventricular fibrillation] following AMI [acute myocardial infarction] appears to be associated with a worse prognosis."² However, this was not the case in the GISSI trial, since an episode of primary ventricular fibrillation was shown to be a negative predictor of survival only in the hospital phase of infarction.^2,3 Indeed, after hospital discharge, the long-term prognosis of survivors was as good as for patients with comparable infarcts not complicated by primary ventricular fibrillation.

Nonetheless, we agree with MacMahon and coworkers that our data raise the possibility that a reduction in ventricular fibrillation following prophylactic lidocaine in patients with suspected acute myocardial infarction might result in a beneficial effect on in-hospital survival.