What is the clinical evidence from this study?

Study design: Other. Population: Acute myocardial ischemia (n=29). Intervention: Lidocaine vs. Control conditions. Primary outcome: Incidence of ventricular fibrillation (VF).

What question did this study set out to answer?

To determine how lidocaine modifies myocardial excitation patterns and affects the incidence of ventricular arrhythmias during acute coronary artery occlusion.

January 1, 1986Journal of Cardiovascular Pharmacology

Relationship Between an Arrhythmogenic Action of Lidocaine and Its Effects on Excitation Patterns in Acutely Ischemic Porcine Myocardium

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Key result

Lidocaine injection dose-dependently increased the incidence of ventricular fibrillation during acute myocardial ischemia, occurring in 15 of 17 pigs at 5 mg/kg compared to 4 of 45 control occlusions.

Why the study?

Does lidocaine affect the incidence of ventricular fibrillation and excitation patterns in acutely ischemic porcine myocardium?

Population

29 open-chest anesthetized pigs undergoing left anterior descending coronary artery occlusion for 6-min…

Comparison

Lidocaine injection at doses of 2.5, 5.0, or… vs Control conditions (occlusions without lidocaine)

Design

Preclinical

Authors

DCD. Leigh CarsonDalhousie University RCRené CardinalHôpital du Sacré-Cœur de Montréal PSP. SavardUniversity of Toronto

Discussion

Member takes

Implication

May increase VF risk in acute ischemia; challenges antiarrhythmic assumptions and leaves open human translation.

Key Points

To determine how lidocaine modifies myocardial excitation patterns and affects the incidence of ventricular arrhythmias during acute coronary artery occlusion.
Subjected 29 open-chest anesthetized pigs to 6-minute left anterior descending coronary artery occlusions separated by 30 minutes of reperfusion under control conditions and following intravenous lidocaine at 2.5, 5.0, or 10.0 mg/kg.
Continuously recorded 63 unipolar electrograms and a surface electrocardiogram during atrial pacing and spontaneous ventricular arrhythmias.
Ventricular fibrillation occurred in 4 of 45 control occlusions, 2 of 5 pigs given 2.5 mg/kg lidocaine, 15 of 17 pigs given 5.0 mg/kg lidocaine, and 3 of 3 pigs given 10.0 mg/kg lidocaine.
Activation time in ischemic myocardium during atrial pacing prior to ventricular fibrillation at 5 mg/kg lidocaine was delayed by 30 ± 17 ms beyond preocclusion values, compared with 18 ± 11 ms at the equivalent control time and 33 ± 18 ms at the end of control occlusions (mean ± SD; n = 8).
During ventricular tachycardia with lidocaine, conduction slowed or blocked in ischemic areas and slowed in nonischemic regions, culminating in circus movement involving nonischemic tissue at the onset of ventricular fibrillation.

Structured PICO

Does lidocaine affect the incidence of ventricular fibrillation and excitation patterns in acutely ischemic porcine myocardium?

Population

29 open-chest anesthetized pigs subjected to 6-minute periods of left anterior descending coronary artery occlusion.

Intervention

Lidocaine injection at doses of 2.5, 5.0, or 10.0 mg/kg i.v.

Comparator

Control conditions (occlusions without lidocaine)

Outcome

Incidence of ventricular fibrillation (VF) and changes in excitation patterns (activation time)surrogate

In a porcine model of acute myocardial ischemia, lidocaine paradoxically increased the incidence of ventricular fibrillation by further slowing conduction in ischemic areas.

Cite This Study

Carson et al. (1986) studied Acute myocardial ischemia (n=29). Lidocaine vs. Control conditions was evaluated on Incidence of ventricular fibrillation (VF). Lidocaine injection dose-dependently increased the incidence of ventricular fibrillation during acute myocardial ischemia, occurring in 15 of 17 pigs at 5 mg/kg compared to 4 of 45 control occlusions.

synapsesocial.com/papers/6a9df7c82cea25e31b90d30e https://doi.org/10.1097/00005344-198601000-00019

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Relationship Between an Arrhythmogenic Action of Lidocaine and Its Effects on Excitation Patterns in Acutely Ischemic Porcine Myocardium

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Relationship Between an Arrhythmogenic Action of Lidocaine and Its Effects on Excitation Patterns in Acutely Ischemic Porcine Myocardium

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Also Consider