EFFECTS OF LIDOCAINE, AJMALINE, AND DILTIAZEM ON VENTRICULAR DEFIBRILLATION ENERGY-REQUIREMENTS IN ISOLATED RABBIT HEART

The majority of patients with implanted cardioverter defibrillators (I CD) require antiarrhythmic (AR) drugs. ARs may increase defibrillation energy requirements. This study investigated the effects of lidocaine , ajmaline, and diltiazem on ventricular defibrillation energy needs. In 24 isolated rabbit hearts, the 50 and 80% successful defibrillation en energy (ED50, ED80) was calculated in four phases: predrug baselin e condition (phase 1), and phases 2, 3, and 4 with increasing concentr ations of lidocaine, ajmaline, diltiazem (n = 18). Control experiments (n = 6) with only Tyrode's solution infusion indicated that the prepa ration was stable over time. Defibrillation energy requirements signif icantly (p < 0.05) increased with all ARs. Low, medium, and high lidoc aine concentrations increased ED50 and ED80 to 146, 223, and 312% and 139, 207, and 285%, respectively. Ajmaline increased ED50 and ED80 to 133, 175, and 251% and 135, 208, and 285%, respectively. Diltiazem inc reased ED50 and ED80 by 175, 236, and 334% and 158, 212, and 286%, res pectively. The results of this study demonstrate a dose-dependent incr ease in defibrillation energy requirements by using lidocaine, diltiaz em, and ajmaline. In patients with ICDs, administration of these drugs might cause a critical increase in defibrillation energy requirements , resulting in device failure.