What Should the Study Design Be to Test New Antiarrhythmic Drugs in Patients with Acute Myocardial Infarction, Digitalis Toxicity and Other Acute Problems

摘要: In the setting of acute myocardial infarction largest single use antiarrhythmic drug therapy is for prevention ventricular fibrillation. this efficacy cannot be judged in a patient and can only inferred from well controlled clinical trials. Traditionally lidocaine has been most widely utilized indication. We learn about potential flaws to avoided trials by examining previously performed infarction. Table 1 summarizes some larger series evaluating setting. None these studies were able show beneficial effect preventing fibrillation until study Lie et al. The pitfalls all (except that coworkers) may listed as follows: 1. Most based on assumption warning arrhythmias identified patients at risk therefore endpoint was suppression arrhythmias. They permitted placebo treated or control crossover once occurred. 2. There inadequate knowledge pharmacokinetics lidocaine. This resulted several problems: a. No initial loading bolus. b. Inadequate maintenance infusion rate. c. Failure achieve document therapeutic plasma concentrations. 3. In many instances there delay arrival hospital institution so period highest had passed.