Prophylactic lidocaine in suspected acute myocardial infarction

Dunn, Heather; Kinney, C.D.; Campbell, Norman P.S.; Shanks, R. G.; Adgey, A. A. J.

doi:10.1016/0167-5273(84)90065-2

Cited by 17 publications

(2 citation statements)

References 1 publication

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“…There were 8 studies that were neutral for demonstrating arrhythmia suppression with lidocaine (LOE 1 581,583,586 -588 ; LOE 2 589,593 ; LOE 4. 590 There were 2 studies that showed harm (LOE 1). 580,592 One trial showed a statistically significant benefit in decreasing the incidence of VT using sotalol (LOE 1).…”

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confidence: 99%

Part 9: Acute Coronary Syndromes

Bossaert

O’Connor²,

Arntz³

et al. 2010

Circulation

103

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These experts reviewed 25 topics related to the acute initial management of acute coronary syndrome (ACS), which was further categorized as unstable angina, non-ST-elevation MI (UA/NSTEMI) and ST-elevation MI (STEMI). Topics were identified based on previous recommendations, emerging science, and clinical importance, using an iterative writing process involving all Task Force members. The Task Force reviewed the evidence specifically related to diagnosis and treatment of ACS in the out-ofhospital setting and the first hours of care in the in-hospital setting, typically in the emergency department (ED). The evidence review took place over several years, with ongoing refinement of recommendations being made as new evidence was published. The purpose of the review was to generate current, evidence-based treatment recommendations for healthcare providers who serve as the initial point of contact for patients with signs and symptoms suggestive of ACS.The following is a summary of the most important changes in recommendations for diagnosis and treatment of ACS since the last ILCOR review in 2005. 1,2• The history and physical examination, initial ECG, and initial serum biomarkers, even when used in combination, cannot be used to reliably exclude ACS in the prehospital and ED settings.• In contrast, chest pain observation protocols are useful in identifying patients with suspected ACS and patients who require admission or may be referred for provocative testing for coronary artery disease (CAD) to identify reversible ischemia. Such strategies also reduce cost by reducing unnecessary hospital admissions and improve patient safety through more accurate identification of NSTEMI and STEMI.• The acquisition of a prehospital 12-lead ECG is essential for identification of STEMI patients before hospital arrival and should be used in conjunction with pre-arrival hospital notification and concurrent activation of the catheter laboratory.• Nonphysicians can be trained to independently interpret 12-lead ECGs for the purpose of identifying patients with STEMI, provided that appropriate and reliable STEMI criteria are used. This skill is of particular value in the prehospital setting where paramedics may independently identify STEMI, thus mitigating over-reliance on ECG transmission.• Computer-assisted ECG interpretation can be used to increase diagnostic accuracy of STEMI diagnosis when used alone or in combination with ECG interpretation by a trained healthcare provider.• STEMI systems of care can be implemented to improve the time to treatment. The following measures have been shown to reduce the time to primary percutaneous coronary intervention (PPCI): institutional commitment, use of a team-based approach, arranging single-call activation of the catheterization laboratory by the emergency physician or prehospital provider, requiring the catheterization laboratory to be ready in 20 minutes, having an experienced cardiologist always available, and providing real-time data feedback.• Intravenous (IV) ␤-blockers should not be give...

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confidence: 99%

Part 9: Acute Coronary Syndromes

Bossaert

O’Connor²,

Arntz³

et al. 2010

Circulation

103

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“…This effect is most prominent in the presence of myocardial ischemia. Due to controversial experimental and clinical data, reporting both efficacy 39 , 57 , 58 and ineffectiveness 59 of lidocaine in preventing life‐threatening VA during acute myocardial infarction, the use of lidocaine has declined and the era of amiodarone has emerged at the same time. As pointed out by MacMahon et al, 6 in an overview of randomized, controlled trials of prophylactic lidocaine use in suspected myocardial infarction, “there was no evidence of any beneficial effect on early mortality.” Thus, a prophylactic use of lidocaine is no longer recommended.…”

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confidence: 99%

Lidocaine as an anti‐arrhythmic drug: Are there any indications left?

Güler,

Könemann,

Wolfes

et al. 2023

Clinical Translational Sci

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Lidocaine is classified as a class Ib anti‐arrhythmic that blocks voltage‐ and pH‐dependent sodium channels. It exhibits well investigated anti‐arrhythmic effects and has been the anti‐arrhythmic of choice for the treatment of ventricular arrhythmias for several decades. Lidocaine binds primarily to inactivated sodium channels, decreases the action potential duration, and increases the refractory period. It increases the ventricular fibrillatory threshold and can interrupt life‐threatening tachycardias caused by re‐entrant mechanisms, especially in ischemic tissue. Its use was pushed into the background in the era of amiodarone and modern electric device therapy. Recently, lidocaine has come back into focus for the treatment of acute sustained ventricular tachyarrhythmias. In this brief overview, we review the clinical pharmacology including possible side effects, the historical course, possible indications, and current Guideline recommendations for the use of lidocaine.

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

Zehender¹,

Kasper²,

Just³

1990

Clinical Cardiology

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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.

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Prophylactic lidocaine in suspected acute myocardial infarction

Cited by 17 publications

References 1 publication

Part 9: Acute Coronary Syndromes

Part 9: Acute Coronary Syndromes

Lidocaine as an anti‐arrhythmic drug: Are there any indications left?

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

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