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Ann Thorac Surg 1993;55:1180-1184
© 1993 The Society of Thoracic Surgeons

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Articles

Lidocaine prophylaxis in coronary revascularization patients: A randomized, prospective trial

Department of Surgery, Anesthesia, and Medicine, Beth Israel Hospital, Harvard Medical School, and the Charles A. Dana Research Center, Boston, Massachusetts USA

Accepted for publication August 27, 1992.

^_* Address reprint requests to Dr Johnson, Division of Cardiothoracic Surgery, Beth Israel Hospital, 330 Broukline Ave, Dana 905, Boston, MA 02115.

Life-threatening ventricular ectopy can occur after cardiac operations. The actual incidence of ventricular ectopy and the ability to prevent it by the routine prophylactic use of lidocaine hydrochloride have not been established. We performed a double-blind, randomized, prospective trial involving 109 patients undergoing elective coronary artery revascularization. Patients received either lidocaine (n = 54) or a placebo (n = 55) after separation from bypass. A Holter monitor was affixed to each patient for subsequent review, and bedside intensive-care monitors with alarms were used for "real-time" surveillance. The code was broken when potentially malignant ventricular ectopy or side effects attributable to the study drug were noted. Three lidocaine patients and 2 placebo patients were dropped from the study because of hemodynamic 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 placebo group (all for ectopy) (p = not significant). Twenty-four-hour Holter monitor evaluation demonstrated occasional ventricular ectopy in all patients and nonsustained ventricular tachycardia in 28% in the lidocaine group and 48% in the placebo group (p = not significant). The mean number of runs of ventricular tachycardia per patient was 0.53 in the lidocaine group and 1.6 in the placebo group (p = 0.035). There were no significant differences in terms of other ventricular ectopy, morbidity, or mortality. No ventricular fibrillation occurred in either group. We conclude that although prophylactic administration of lidocaine may decrease the incidence of nonsustained ventricular tachycardia in 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 prophylaxis.

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