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

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).

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.

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).

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.