Programmed Ventricular Stimulation: Not Dead
How easy it is to make people believe a lie, and how hard it is to undo that work again!
— Mark Twain in Eruption
Medicine, like most other human endeavors, goes through fads. These fads are often initiated by persuasive, well-meaning persons who have incomplete grasp of fundamental pathophysiology. Because ideas underlying fads may sound plausible, the fad is perpetuated and accepted as gospel until a randomized controlled trial or other well-designed study proves the concept faulty. One example of this phenomenon is seen in the evolution of efforts to prevent sudden cardiac death in survivors of acute myocardial infarction (MI). Widespread study of sudden cardiac death (SCD) was aided by development of technology permitting real-time ECG monitoring, resulting in proliferation of the CCU in the 1960s and 1970s. Patients who developed primary ventricular fibrillation (VF) with acute MI in the CCU were often observed to exhibit progressively frequent and "complex" ventricular ectopy in the minutes leading up to VF. At the same time, randomized trials demonstrated that antiarrhythmic agents such as lidocaine, procainamide and quinidine could reduce the occurrence of VF in this setting.
- sudden cardiac death, arrhythmia
- risk stratification
- electrophysiology test
- myocardial infarction
- Received December 23, 2013.
- Accepted December 27, 2013.