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April 9, 1982

Should Prophylactic Antiarrhythmic Drug Therapy Be Used in Acute Myocardial Infarction?

Author Affiliations

From the Cardiology Division, Stanford University School of Medicine, Stanford, Calif.

JAMA. 1982;247(14):2019-2021. doi:10.1001/jama.1982.03320390079053

FOLLOWING acute myocardial infarction, death generally results from two pathophysiological processes. In the period early after infarction, electrical processes such as primary ventricular fibrillation (fibrillation unassociated with heart failure or cardiogenic shock) accounts for the largest percentage of deaths. These deaths occur primarily in the first 24 hours after infarction and occur with a higher frequency during the first four hours from the onset of chest pain and with decreasing frequency through the next 20 hours. Later deaths from acute myocardial infarction may also be electrical. However, a mechanical process, defined as cardiogenic shock, congestive heart failure, or both owing to extensive necrosis of muscle and loss of the mechanical function of the heart, may account for many of these deaths. The final common pathway for many of these pump failures is also ventricular fibrillation (defined as secondary ventricular fibrillation).

Unlike primary ventricular fibrillation, a significant fraction of deaths in