Prevention

Why?

• Patients at risk of sudden cardiac death who receive class I antiarrhythmics are more likely to die. ^a

Class I anti-arrhythmic drugs increase mortality

Patient	Treatment	Comparison	Outcome	CER	OR (95% CI)	NNH (95% CI)
at risk of sudden cardiac death a	class I antiarrhythmic agent	control	death at months	5.0%	1.13 (1.01 to 1.27)	160 (79 to 2100)
myocardial infarction a	class I antiarrhythmic agent	control	death at months	5.0%	1.14 (1.01 to 1.28)	150 (76 to 2100)

Encainide and flecainide increase mortality

Patient	Treatment	Comparison	Outcome	CER	RRR (95% CI)	NNH (95% CI)
myocardial infarction, poor ejection fraction, and mildly symptomatic arrhythmias a	encainide or flecainide	placebo	death or cardiac arrest at 10 months	3.5%	-140% (-270% to -53%)	21 (14 to 40)

• Prophylactic lidocaine does not clearly reduce death or occurrence of ventricular fibrillation. ^a Lidocaine given only to patients with early ventricular arrhythmias is not clearly better than prophylactic lidocaine. ^d