Lidocaine as an Antiarrhythmic Agent

Lidocaine has been used in the treatment of 93 episodes of arrhythmias in 68 patients in a coronary care unit. Forty‐nine of the patients had acute myocardial infarction. A booster dose of 25, 50 or 100 mg was given initially. When effective, this injection was followed by intravenous infusion of 1/2–4 mg/min when a prolonged effect was desired. In this series lidocaine proved effective in the treatment of ventricular extrasystoles and tachycardia and facilitated cardioversion in some patients with ventricular tachycardia or fibrillation, whereas few cases of supraventricular arrhythmias could be controlled in this way. Side‐effects, especially hypotension, were rare and as a rule they subsided after brief discontinuation of the drug. This was true also in two cases of supraventricular tachycardia following lidocaine treatment. However, this drug might be incriminated as contributing to the death of two patients with myocardial infarction. Over quinidine and procainamide lidocaine has the advantages of a rapid onset of action and rapid elimination. Besides, deleterious circulatory side‐effects seem to be very rare.