Routine prophylactic lidocaine administration in acute myocardial infarction. An idea whose time is all but gone?

E normous advances have been made in the overall treatment of acute myocardial infarction in the last three decades.1 Undoubtedly, the impact on mortality and morbidity has been substantial. The introduction of closed-chest DC cardioversion in the early 1960s promptly led to the development of the concept of acute coronary care, with the main focus on controlling arrhythmias.2 The concept found immediate validity when continuous ECG monitoring demonstrated arrhythmias in about 90% of patients with acute myocardial infarction.3 The fact that acute coronary occlusion in experimental animals and in humans leads to frequent and complex premature ventricular contractions (PVCs), often culminating in ventricular tachycardia (VT) and ventricular fibrillation (VF), was recognized early.4 Attempts at their prophylactic suppression