Lidocaine in the early phase of acute myocardial infarction: The controversy over prophylactic or selective use

Abstract

Summary: In acute myocardial infarction, lidocaine is considered the drug of choice for the treatment of malignant ventricular arrhythmias. While initially a so-called "selective" treatment strategy prevailed, in which lidocaine was administered only after the onset of certain "warning arrhythmias," the prophylactic use of lidocaine in acute myocardial infarction has been gaining wider usage in intravenous and intramuscular application in recent years. Both therapeutic applications have been found to be problematic of late, which has led to increasingly restrictive use of lidocaine. While in selective treatment forms, the definition and prompt recognition of the socalled warning arrhythmias created especially acute problems, the prophylactic therapeutic use is problematic due to the Occurrence of sometimes serious side effects, which is to be expected as the size of the collective being treated increases. Both treatment forms also appear limited by the narrow preventive efficacy of lidocaine against malignant ventricular arrhythmias, especially against ventricular fibrillation. The current therapeutic recommendation for lidocaine in acute myocardial infarction should be limited to patients presenting with very frequent and complex ventricular arrhythmias, especially when these are elicited by an R-on-T phenomenon. Side effects and other therapeutic problems encountered when the therapeutic modality is switched or adjusted can be greatly reduced by careful dosing and selection of the optimal combination substances.

Evaluation of lidocaine treatment on frequency of cardiac arrhythmias, acute kidney injury, and hospitalization time in dogs with gastric dilatation volvulus

“…Although cardiac arrhythmias were not a risk factor for mortality, their relatively low postoperative occurrence in the study group might have contributed to a shorter hospitalization period, and consequently to a lower hospital‐related complication rate. The clinical significance of this decreased occurrence rate of cardiac arrhythmias in the lidocaine‐treated dogs is currently unknown; however, the beneficial effect of prophylactic lidocaine therapy in prevention ventricular arrhythmias has been reported previously in several studies in human patients with acute myocardial infarction and in rats with regional heart ischemia . In a randomized study of 212 human patients with myocardial infarction, prophylactic administration of lidocaine has led to a 9‐fold reduction in the risk of ventricular fibrillation compared to placebo .…”

“…The clinical significance of this decreased occurrence rate of cardiac arrhythmias in the lidocaine-treated dogs is currently unknown; however, the beneficial effect of prophylactic lidocaine therapy in prevention ventricular arrhythmias has been reported previously in several studies in human patients with acute myocardial infarction and in rats with regional heart ischemia. [53][54][55][56] In a randomized study of 212 human patients with myocardial infarction, prophylactic administration of lidocaine has led to a 9-fold reduction in the risk of ventricular fibrillation compared to placebo. 53 Additionally, the American Heart Association and American College of Cardiology have recommended that lidocaine should be administered prophylactically in human patients with acute myocardial ischemia and infarction.…”

“…[53][54][55][56] In a randomized study of 212 human patients with myocardial infarction, prophylactic administration of lidocaine has led to a 9-fold reduction in the risk of ventricular fibrillation compared to placebo. 53 Additionally, the American Heart Association and American College of Cardiology have recommended that lidocaine should be administered prophylactically in human patients with acute myocardial ischemia and infarction. 55 Adverse side effects of lidocaine during treatment of cardiac arrhythmias in people are quite common, and have been reported in 7-37% of all patients and include dizziness, giddiness, tremors, and vision loss.…”

“…53 These are usually related to its local anesthetic action, due to its lipophylic properties and high affinity to the central and peripheral nervous systems. 53 The reported side effects of lidocaine in dogs include gastrointestinal signs (eg, vomiting and diarrhea), seizures and cardiac arrhythmias. 45 Currently, lidocaine was not associated with any appreciable adverse side effect in the treated dogs.…”

Predicting drug‐induced slowing of conduction and pro‐arrhythmia: identifying the ‘bad’ sodium current blockers

“…The exact mechanism of the pro‐arrhythmic effect of flecainide remains elusive. On the other hand, the I Na blocking agent lidocaine (class Ib) has been extensively used in the clinic for many years, especially as an anaesthetic, and exhibits an excellent safety profile even in patients with myocardial infarction (Zehender et al. , 1990; Wyman et al.…”