Defibrillation in acute myocardial

DINAMIT = Defibrillator in Acute Myocardial Infarction Trial. 

The Defibrillator in Acute Myocardial Infarction Trial (DINAMIT) enrolled nearly 700 patients with recent MI, ranging from 6 to 40 days (median 7 days), EF < 36%, and reduced heart rate variability but without NYHA class IV symptoms, sustained VT within 48 h of MI, or surgical or percutaneous 3-vessel revascularization [34]. Patients were randomized to ICD therapy versus conventional therapy and at 1 year, there was no difference in total mortality with more arrhythmic deaths in the control arm and more nonarrhythmic deaths in the ICD arm. Thus, there appears to be no benefit to ICD therapy in the immediate post-MI period. An interpretation of the negative result of both of these trials is that significant recovery of LV function may have occurred in the... 

Arguably, ICDs for primary prevention has greater benefit for the entire population than ICDs for secondary prevention. Several key primary prevention trials have been completed M IT, MUSTT, CABG-Patch (Coronary Artery Bypass Graft surgery), MADIT II, DINAMIT (Defibrillator in Acute Myocardial Infarction Trial), DEFINITE (Defibrillators in Non-Ischemic Cardiomyopathy Treatment Evaluation), SCD-HeFT, CAT (CArdiomyopathy Trial), and AMIOVERT (AMIOdarone VERsus implanv cardioverTer-defibrillator) trials (Table 14.4) (54,119,172-174). 

ACLS advanced cardiac life support AED automatic external defibrillator AMI acute myocardial infarction CPC cerebral performance category CPR cardiopulmonary resuscitation D5W dextrose 5% in water ECC emergency cardiovascular care ECG electrocardiogram GCS Glasgow Coma Scale IV intravenous... 

Some of the beneficial effects of fish oils after acute myocardial infarction have been attributed to an antidysr-hythmic effect on the heart (5). However, the results of a randomized trial in 200 patients with implantable cardioverter defibrillators are at variance with this the rate of cardioversion was higher in those taking fish oils 1.8 g/day than in a control group who took olive oil (6). The lack of benefit and the suggestion that fish oil supplementation may increase the risk of ventricular tachycardia or ventricular fibrillation in some patients with implantable cardioverter defibrillators can reasonably be interpreted as evidence that the routine use of fish oil supplementation in patients with implantable cardioverter defibrillators and recurrent ventricular dysrhythmias should be avoided. 

Lidocaine can cause dysrhythmias and hypotension. The dysrhythmias that have been reported include sinus bradycardia, supraventricular tachycardia (11), and rarely torsade de pointes (12). There have also been rare reports of cardiac arrest (2) and worsening heart failure (13). Lidocaine can also cause an increased risk of asystole after repeated attempts at defibrillation (14). Lidocaine may increase mortality after acute myocardial infarction, and it should be used only in patients with specific so-called warning dysrhythmias (that is frequent or multifocal ventricular extra beats, or salvos) (15). 

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