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Incidence of ventricular fibrillation after aortic cross-clamp release using lignocaine cardioplegia
1Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, University of Sydney, N.S.W.
Insights
Lignocaine cardioplegia significantly reduced reperfusion ventricular fibrillation during cardiac surgery. However, it also increased the incidence of atrio-ventricular block requiring pacing, though this was usually transient.
Area of Science:
- Cardiac Surgery
- Cardiology
- Pharmacology
Background:
- Ventricular fibrillation post-aortic de-clamping is common in cardiac surgery.
- Prolonged ventricular fibrillation can lead to myocardial ischemia.
Purpose of the Study:
- To evaluate the efficacy of lignocaine cardioplegia in minimizing reperfusion ventricular fibrillation.
- To assess the impact of lignocaine cardioplegia on other cardiac events.
Main Methods:
- A double-blind, prospective, randomized trial involving 141 patients undergoing first-time coronary artery surgery.
- Patients received either lignocaine (100 mg/l) in cardioplegia or standard cardioplegia.
- Incidence of reperfusion ventricular fibrillation and atrio-ventricular block were recorded.
Main Results:
- Lignocaine cardioplegia significantly reduced reperfusion ventricular fibrillation from 63% to 42%.
- A higher proportion of patients receiving lignocaine showed spontaneous defibrillation (30% vs 11%), though not statistically significant.
- The incidence of atrio-ventricular (A-V) block requiring ventricular pacing was significantly higher in the lignocaine group (44% vs 20%).
Conclusions:
- Lignocaine cardioplegia is effective in reducing reperfusion ventricular fibrillation during cardiac surgery.
- The increased incidence of transient A-V block in the lignocaine group warrants consideration, potentially due to additive effects with procaine.
- Further research may explore optimal lignocaine dosage or alternative strategies to mitigate A-V block.
Abstract:
The occurrence of ventricular fibrillation after aortic de-clamping during cardiac surgery is common, and if prolonged may contribute to myocardial ischaemia. The use of lignocaine cardioplegia to minimize reperfusion ventricular fibrillation was studied in 141 patients undergoing first time coronary artery surgery in a double blind prospective randomized trial: 71 patients received lignocaine 100 mg/l in their cardioplegia, whereas a control group of 70 patients received cardioplegia without lignocaine. Lignocaine cardioplegia reduced significantly the incidence of reperfusion ventricular fibrillation from 63% to 42%. Of those patients developing reperfusion ventricular fibrillation, a higher proportion receiving lignocaine cardioplegia underwent spontaneous defibrillation (30% vs 11%) though this was not statistically significant. The incidence of atrio-ventricular (A-V) block necessitating ventricular pacing to separate from cardiopulmonary bypass was significantly higher in the lignocaine treated group (44%) than in the control group (20%): this may have been due to the additive effect of procaine in the cardioplegia solution. In the majority of cases this A-V block was transient and had resolved prior to the completion of surgery.