title: Lidocaine increases the proarrhythmic effects of monophasic but not biphasic shocks.
abstract: BACKGROUND
  Lidocaine increases monophasic shock defibrillation energy requirement (DER) values but does not alter biphasic shock DER values. However, the mechanism of this drug/shock waveform interaction is unknown. It may be that lidocaine increases the proarrhythmic actions of monophasic shocks but not biphasic shocks. Thus, lidocaine may increase monophasic shock DER values by increasing myocardial vulnerability to shock-induced ventricular fibrillation.
  
  
  RESULTS
  Area of myocardial vulnerability (AOV), defined by a two-dimensional grid according to shock strength (y-axis) and shock coupling interval (x-axis), was assessed for biphasic shocks (n = 11) and monophasic shocks (n = 13) in intact swine hearts. Shocks were randomly delivered during right ventricular pacing at 10 shock strengths (50 to 500 V) and five coupling intervals (160 to 240 msec). AOV was defined as the number of points within the test grid that induced ventricular fibrillation. AOV, upper limit of vulnerability (ULV), and DER values were determined at baseline and during systemic infusion of lidocaine (10 mg/kg/hour). Lidocaine increased AOV, ULV, and DER values by 35%, 23%, and 36%, respectively, for monophasic shocks. However, lidocaine did not alter AOV, ULV, or DER values for biphasic shocks.
  
  
  CONCLUSIONS
  Lidocaine increases the AOV to monophasic shocks, which is directly related to changes in ULV and DER values. This implies that lidocaine increases the proarrhythmic activity of monophasic shocks but not biphasic shocks. This may explain why lidocaine increases monophasic shock DER values.
authors.affiliation: University of Georgia College of Pharmacy, Medical College of Georgia, and Augusta VA Medical Center, USA. jjsims@pharmacy.wisc.edu
authors.forename: J J
authors.initials: JJ
authors.lastname: Sims
authors.forename: A W
authors.initials: AW
authors.lastname: Miller
authors.forename: M R
authors.initials: MR
authors.lastname: Ujhelyi
mesh_terms: D000818:Animals; D000889:Anti-Arrhythmia Agents / Q000494:pharmacology*; D002304:Cardiac Pacing, Artificial; D004554:Electric Countershock / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D004562:Electrocardiography / Q000187:drug effects; D006439:Hemodynamics / Q000187:drug effects; D008012:Lidocaine / Q000494:pharmacology*; D026941:Sodium Channel Blockers; D013552:Swine; D014693:Ventricular Fibrillation / Q000209:etiology*
chemical_list: D000889:Anti-Arrhythmia Agents; D026941:Sodium Channel Blockers; D008012:Lidocaine