Hemodynamic Consequences and Clinical Outcomes With Intravenous Lidocaine Infusion in Patients With Atrial Fibrillation

Introduction Intravenous lidocaine is frequently used for refractory ventricular arrhythmia (VA). Atrial fibrillation (AF) is a common comorbidity in VA patients. Lidocaine poses theoretical risks of hemodynamic compromise and pro‐arrhythmia, including AF with rapid ventricular rates (RVR). Methods This observational study reviewed electronic medical records of AF patients receiving lidocaine for VA at University of Utah Hospital (April 2014–October 2023). Hemodynamic parameters and cardiovascular outcomes were analyzed. Results 192 patients (mean age 63.6 years, 79% male) with predominantly paroxysmal AF (71%) were included. 79% had heart failure (HF), 53% ischemic, with a mean ejection fraction 31.7%. There was no difference in heart rate (−0.6 ± 31.6; p = 0.4067), but systolic blood pressure and mean arterial pressure decreased on lidocaine vs baseline (−4.7 ± 22.6; p = 0.0367 and −4.8 ± 18.6; p = 0.0013, respectively). A single patient had AF with RVR attributed to lidocaine with no significant difference in AF with RVR on baseline vs lidocaine ECG (16, 9% vs 8, 6%; p = 0.3957). Peak lidocaine levels (median 4.3 mcg/mL; IQR 3.0–5.8 mcg/mL) were not correlated with RVR ( p = 0.9662). Adverse effects occurred in 7%, mainly central nervous system effects, with no clinically significant hypotension or worsening HF. In‐hospital mortality was 31%. Ischemic cardiomyopathy vs non‐ischemic cardiomyopathy was associated with increased mortality ( p = 0.0162). Conclusion Lidocaine for VA in AF patients had mild hemodynamic impacts without clinically significant hypotension or worsening HF. The risk of AF pro‐arrhythmia was low. Lidocaine use was associated with a high‐risk population with high in‐hospital mortality.