Evaluation of intravenous lidocaine for the termination of sustained monomorphic ventricular tachycardia in patients with coronary artery disease with or without healed myocardial infarction

Prospective evaluations of intravenous lidocaine as therapy for sustained monomorphic ventricular tachycardia (VT) in the absence of acute myocardial infarction are lacking. Lidocaine has been promulgated as first-line therapy in patients with VT, but studies evaluating its efficacy in the electrophysiology laboratory suggest that it has poor effects in terminating or preventing induction of VT. Thus, this study sought to evaluate the clinical effectiveness of lidocaine in 3 cohorts with induced or spontaneous VT. One hundred twenty-eight patients with stable VT, occurring either spontaneously or induced at the time of electrophysiologic study either in the baseline state or at the time of pharmacologic testing, were evaluated. The response rate to lidocaine therapy as manifested by termination of VT was the primary goal of the study. Of these patients, 10 (8%) had termination of VT after lidocaine therapy. There were no significant differences in age, ejection fraction, VT cycle length, and mean dose of lidocaine between responders and 118 nonresponders. There were no serious side effects or adverse events (death, myocardial infarction, angina, or congestive heart failure). Lidocaine, although safe, is ineffective in terminating stable VT not associated with acute myocardial infarction.