LIDOCAINE PROPHYLAXIS IN CORONARY REVASCULARIZATION PATIENTS - A RANDOMIZED, PROSPECTIVE TRIAL

Life-threatening ventricular ectopy can occur after cardiac operations . The actual incidence of ventricular ectopy and the ability to preven t it by the routine prophylactic use of lidocaine hydrochloride have n ot been established. We performed a double-blind, randomized, prospect ive trial involving 109 patients undergoing elective coronary artery r evascularization. Patients received either lidocaine (n = 54) or a pla cebo (n = 55) after separation from bypass. A Holter monitor was affix ed to each patient for subsequent review, and bedside intensive-care m onitors with alarms were used for ''real-time'' surveillance. The code was broken when potentially malignant ventricular ectopy or side effe cts attributable to the study drug were noted. Three lidocaine patient s and 2 placebo patients were dropped from the study because of hemody namic instability or bleeding. Of the remaining 104 patients, the code was broken in 12 (24%) of the 51 in the lidocaine group (9 for ectopy and 3 for mental status changes) and 10 (19%) of the 53 in the placeb o group (all for ectopy) (p = not significant). Twenty-four-hour Holte r monitor evaluation demonstrated occasional ventricular ectopy in all patients and nonsustained ventricular tachycardia in 28% in the lidoc aine group and 48% in the placebo group (p = not significant). The mea n number of runs of ventricular tachycardia per patient was 0.53 in th e lidocaine group and 1.6 in the placebo group (p = 0.035). There were no significant differences in terms of other ventricular ectopy, morb idity, or mortality. No ventricular fibrillation occurred in either gr oup. We conclude that although prophylactic administration of lidocain e may decrease the incidence of nonsustained ventricular tachycardia i n patients undergoing routine coronary revascularization, there is no apparent clinical benefit to such a strategy. Lidocaine should be used for treatment of high-grade ventricular ectopy rather than as prophyl axis.