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December 19, 1980

Prophylactic Lidocaine-Reply

JAMA. 1980;244(24):2729-2730. doi:10.1001/jama.1980.03310240021014

In Reply.—  We are puzzled by Dr Lebow's comments on prophylactic lidocaine. A good double-blind study has been performed, and it showed that prophylactic lidocaine was ineffective at reducing mortality from acute MI in the coronary care unit setting.1 Another study giving 300 mg of lidocaine hydrochloride intramuscularly by ambulance drivers in the field showed reduced prehospital mortality in the group that received lidocaine but no difference in mortality by the time of discharge.1 Certainly, ventricular fibrillation is a catastrophic arrhythmia, but in the study by Lie et al,2 the arrhythmia could be managed as it appeared. Harrison3 has chosen to take the position that other coronary care units might not be as effective at detecting and treating the arrhythmia and that, therefore, prophylaxis is desirable.3 One could offer the counter argument that if a coronary care unit is incapable of precise monitoring and rapid