Lack of effectiveness of lidocaine for sustained, wide QRS complex tachycardia.
Records of 31 episodes of sustained, wide QRS complex tachycardia treated with IV boluses of lidocaine in 20 consecutive patients were reviewed. Most of the episodes were managed in the emergency department. Patient ages ranged from 18 to 91 years (mean +/- SD, 64 +/- 17), and 17 of 20 were men. All but three had coronary artery disease. Although 19 of 20 patients were admitted with a diagnosis of "rule out acute myocardial infarction," only two had this diagnosis confirmed. Seventeen patients had ventricular tachycardia, and three had wide QRS complex supraventricular tachycardia. Patients were given one to three boluses of lidocaine totaling 75 to 400 mg (127 +/- 64 mg). Termination of the tachycardia was temporally related to lidocaine administration in only six of 31 episodes (19%) occurring in five of 20 patients. In three of these five patients, lidocaine was given again for a recurrence of the tachycardia and was ineffective. A similarly low efficacy was seen in 20 episodes initially managed in the hospital compared with 11 episodes initially managed by paramedics. Thus, although lidocaine is widely considered the drug therapy of first choice for sustained wide QRS complex tachycardia, it was not usually effective in our study. Patients presenting to the ED with this rhythm disturbance rarely prove to have acute myocardial infarction. Although this small retrospective study should not be the basis for a change in standard medical practice, the recommendation of lidocaine as initial therapy for such patients should be reexamined.
Armengol
R E
RE
Department of Medicine, Evanston Hospital, Northwestern University Medical School, Illinois 60201.
Graff
J
J
Baerman
J M
JM
Swiryn
S
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004341:Drug Evaluation; D004562:Electrocardiography; D004630:Emergencies; D005260:Female; D006801:Humans; D008012:Lidocaine / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013610:Tachycardia / Q000175:diagnosis / Q000188:drug therapy*
D008012:Lidocaine