27. What would be the treatment for the below rhythm after a myocardial infarction?


A. Beta-blockers

B. Lidocaine

C. Amiodarone

D. Flecainide

E. No therapy is required

The ECG shows frequent premature ventricular contractions (PVCs) in a pattern of ventricular bigeminy. The prophylactic administration of lidocaine to suppress premature ventricular contractions or prevent ventricular tachycardia and ventricular fibrillation is not recommended. Likewise, the CAST trial demonstrated increased mortality using encainide, flecainide and moricizine to suppress premature ventricular contractions after an acute coronary syndrome. Beta-blockers may help to suppress PVCs, however intensifying a beta-blocker regimen due to PVCs is not required.