Skip to main content
SpringerLink
Log in

The effects of lidocaine on the ventricular fibrillation threshold and primary ventricular fibrillation following acute experimental coronary occlusion

  • Original Contributions
  • Published:
Basic Research in Cardiology Aims and scope Submit manuscript

Summary

Experiments were performed on 39 anaesthetized open-chest dogs (BW 16–33 kg) to examine the effect of lidocaine on the frequency of primary ventricular fibrillation (VF) and the time course of the ventricular fibrillation threshold (VFT) (train of stimuli-method) following acute coronary artery occlusion, and also to study the effects of lidocaine on the VFT of non-ischaemic heart at different therapeutic and high non-therapeutic doses. At effective plasma levels of lidocaine usually reached in clinical therapy (130–480 μg/l) there was no measurable increase in VFT compared to control values. The drop in VFT following acute ligation of the left anterior descending coronary artery (LAD) was neither eliminated nor even merely diminished. After occlusion of the left circumflex coronary artery (CIR), the incidence of spontaneous VF was not reduced in comparison to a control group. With regard to the doses administered and the plasma levels of lidocaine achieved, only the application of clinically extremely high or toxic doses resulted in increases in VFT in the non-ischaemic heart.

Therefore it cannot be expected that there exists a protective effect of clinically recommended doses of lidocaine in preventing primary VF during the early phase of arrhythmia following acute coronary occlusion.

Zusammenfassung

Die Untersuchungen wurden an 39 narkotisierten Hunden mit offenem Thorax durchgeführt. Ziel der Experimente war es, die Wirkung von Lidocain auf die Häufigkeit primären Kammerflimmerns (KF) und den zeitlichen Verlauf der ventrikulären Flimmerschwelle (FS) (Methode der Impulsserienreizung) nach akutem Koronarverschluß zu prüfen und die Wirkung therapeutischer und hoher nichttherapeutischer Lidocaindosen auf die FS des nichtischämischen Herzens festzustellen. Lidocain bewirkte bei klinisch üblichen Plasmaspiegeln von 130–480 μg/l keinen meßbaren Anstieg der FS; der Abfall der FS nach akutem Verschluß des Ramus descendens der linken Herzkranzarterie (LAD) wurde weder verhindert noch abgeschwächt. Die Häufigkeit des primären KF nach akuter Okklusion des Ramus circumflexus der linken Herzkranzarterie (CIR) wurde durch Lidocain-Vorbehandlung der Tiere gleichfalls nicht vermindert. Ein Anstieg der FS des nichtischämischen Herzens ließ sich nur durch Applikation klinisch extrem hoher bzw. klinisch toxischer Dosierungen erreichen.

Eine wirksame Verhütung des frühen KF während der 1. Arrhythmiephase nach akutem Koronarverschluß ist daher von der prophylaktischen Applikation von Lidocain in klinisch empfohlener Dosierung nicht zu erwarten.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Literature

  1. Paul, O.: Myocardial infarction and sudden death. In: The myocardium: Failure and infarction. Ed. E. Braunwald, H. P. Publishing Co. Inc. New York, N.Y., p. 273 (1974).

    Google Scholar 

  2. Gyárfás, I.: Sudden death in AMI: a population study in Budapest. 7th Europ. Congr. of Cardiol., Amsterdam, 20.–25. 6. 1976. Abstract book I, p. 780 (1976).

  3. Fehmers, M. C. O., A. J. Dunning: Intramuscularly and orally administered lidocaine in the treatment of ventricular arrhythmias in acute myocardial infarction. Amer. J. Cardiol.29, 514 (1972).

    PubMed  Google Scholar 

  4. Webb, S. W., A. A. J. Adgey, J. F. Pantridge: Autonomic disturbances at onset of acute myocardial infarction. Brit. Med. J.1972/III, 89.

  5. Dunning, A. J., J. C. Ross, M. C. O. Fehmers: Feasibility of self-administration of lidocaine and atropine in the prehospital phase of acute myocardial infarction. Neth. J. Med.16, 178 (1973).

    PubMed  Google Scholar 

  6. Adgey, A. A. J., J. P. Allen, J. S. Geddes: Acute phase of myocardial infarction. Lancet1975/II, 501.

  7. Darby, S., M. A. Bennett, J. C. Cruickshank, B. L. Pentecost: Trial of combined intramuscular and intravenous lignocaine in prophylaxis of ventricular tachyarrhythmias. Lancet1972/I, 817.

  8. Lie, K. I., H. J. Wellens, F. J. van Capelle, D. Durrer: Lidocaine in the prevention of primary ventricular fibrillation. New Engl. J. Med.291, 1324 (1974).

    PubMed  Google Scholar 

  9. Valentine, P. A., J. L. Frew, H. I. Mashford, J. G. Sloman: Lidocaine in the prevention of sudden death in the prehospital phase of acute infarction. New Engl. J. Med.291, 1327 (1974).

    PubMed  Google Scholar 

  10. Lie, K. I., K. I. Liem, W. J. Louridtz, M. J. Janse, A. F. Willebrands, D. Durrer: Efficacy of lidocaine in preventing ventricular fibrillation within 1 hour after a 300 mg intramuscular injection. Amer. J. Cardiol.42, 486 (1978).

    PubMed  Google Scholar 

  11. Stephenson, S. E., R. K. Cole, T. F. Parrish, F. M. Bauer, et al.: Ventricular fibrillation during and after coronary artery occlusion. Amer. J. Cardiol.51, 77 (1960).

    Google Scholar 

  12. Spear, J. F., E. N. Moore, G. Gerstenblith: Effect of lidocaine on the ventricular fibrillation threshold in the dog during acute ischaemia and premature ventricular contractions. Circulation46, 65 (1972).

    PubMed  Google Scholar 

  13. Borer, J. S., L. A. Harrison, K. M. Kent, R. Levy, R. E. Goldstein, S. E. Epstein: Beneficial effect of lidocaine on ventricular electrical stability and spontaneous ventricular fibrillation during experimental myocardial infarction. Amer. J. Cardiol.37, 860 (1976).

    PubMed  Google Scholar 

  14. Corbalan, R., R. L. Verrier, B. Lown: Differing mechanisms for ventricular vulnerability during coronary artery occlusion and release. Amer. Heart J.92, 223 (1976).

    PubMed  Google Scholar 

  15. Harris, A. S.: Delayed development of ventricular ectopic rhythms following experimental coronary occlusion. Circulation1, 1318 (1950).

    PubMed  Google Scholar 

  16. Meesmann, W., K. Stephan, R. R. Abendroth, U. Menken, V. Wiegand: Frühe Arrhythmien, insbesondere Kammerflimmern, nach akutem experimentellem Koronarverschluß und β-Rezeptorenblocker. In “β-Blockade 1977”. Ed. W. Mäurer, A. Schömig, R. Dietz, P. R. Lichtlen, p. 244 (Georg Thieme Publishing Stuttgart 1978).

    Google Scholar 

  17. Scherlag, B. J., N. El-Sherif, R. R. Hope, R. Lazzara: Characterization and localization of ventricular arrhythmias resulting from myocardial ischaemia and infarction. Circulat. Res.35, 372 (1974).

    PubMed  Google Scholar 

  18. Wit, A. L., P. L. Friedman: Basis for ventricular arrhythmias accompanying myocardial infarction: alteration in electrical activity of ventricular and Purkinje fibers after coronary artery occlusion. Arch. Int. Med.135 459 (1975).

    Google Scholar 

  19. Bigger, J. T., R. J. Dresdale, R. H. Heissenbüttel, F. M. Weld, A. L. Wit: Ventricular arrhythmias in ischaemic heart disease; mechanisms, prevalence, significance and management. Progr. Cardiovasc. Dis.19 255 (1977).

    Google Scholar 

  20. El-Sherif, N., R. R. Hope, B. J. Scherlag, R. Lazarra: Reentrant ventricular arrhythmias in the late myocardial infarction period. 2. Pattern of initiation and termination of reentry. Circulation55, 702 (1977).

    PubMed  Google Scholar 

  21. Meesmann, W., H. Gülker, B. Krämer, K. Stephan: Time course of changes in ventricular fibrillation threshold in myocardial infarction: characteristics of acute and slow occlusion with respect to the collateral vessels of the heart. Cardiovasc. Res.10, 466 (1976).

    PubMed  Google Scholar 

  22. Meesmann, W., F. W. Schulz, G. Schley, P. Adolphsen: Überlebensquote nach akutem experimentellem Koronarverschluß in Abhängigkeit von Spontankollateralen des Herzens. Z. ges. exp. Med.153, 246 (1970).

    Google Scholar 

  23. Gülker, H., B. Krämer, K. Stephan, W. Meesmann: Changes in ventricular fibrillation threshold during repeated coronary short-term occlusion and release. Basic Res. Cardiol.72, 547 (1977).

    PubMed  Google Scholar 

  24. Gianelly, R., J. O. von der Groeben, A. P. Spivall, D. C. Harrison: Effect of lidocaine on ventricular arrhythmias in patients with coronary heart disease. New Engl. J. Med.277, 1215 (1967).

    PubMed  Google Scholar 

  25. Harrison, D. C., E. L. Alderman: Relation of blood levels to clinical effectiveness of lidocaine, in: Lidocaine in the treatment of ventricular arrhythmias, Ed.: D. B. Scott, D. Julian (Livingstone, Edinburgh, 1971).

    Google Scholar 

  26. Gerstenblith, G., J. F. Spear, E. N. Moore: Quantitative study of the effect of lidocaine on the threshold for ventricular fibrillation in the dog. Amer. J. Cardiol.30, 242 (1972).

    PubMed  Google Scholar 

  27. Schley, G., W. Meesmann, U. Wild, A. Wilde: Der Einfluß von Infarktgröße und Spontankollateralen auf die Flimmerschwelle des Herzens nach akutem experimentellem Koronarverschluß. Verh. dtsch. Ges. Kreislauff.39, 203 (1973).

    Google Scholar 

  28. Bloor, C. M., A. Ehsani, S. C. White, B. E. Sobel: Ventricular fibrillation threshold in acute myocardial infarction and its relation to myocardial infarct size. Cardiovasc. Res.9, 468 (1975).

    PubMed  Google Scholar 

  29. Meesmann, W., H. Gülker, B. Krämer, K. Stephan, U. Menken, V. Wiegand: Ventrikuläre Arrhythmien und Vulnerabilität des Herzens in der Frühphase nach akutem experimentellem Koronarverschluß und nach Reperfusion-mögliche Mechanismen. In: Herzrhythmusstörungen, 3. Wiener Symposion, 23–24th February, 1978. Ed.: H. Antoni, F. Bender, E. Gerlach, M. Schlepper, 27 (F. K. Schattauer Verlag Stuttgart 1979).

    Google Scholar 

  30. Moore, E. N., J. F. Spear: Ventricular fibrillation threshold. Arch. Int. Med.135, 446 (1975).

    Google Scholar 

  31. Abendroth, R. R., W. Meesmann, K. Stephan, G. Schley, H. Hübner: Effects of the β-blocking agent atenolol on arrhythmias especially ventricular fibrillation and ventricular fibrillation threshold after acute experimental coronary artery occlusion. Z. Kardiol.66, 341 (1977).

    PubMed  Google Scholar 

  32. Menken, U., V. Wiegand, P. Bucher, W. Meesmann: Prophylaxis of ventricular fibrillation after acute experimental coronary occlusion by chronic β-adrenoceptor blockade with atenolol. Cardiovasc. Res.13, 588 (1979).

    PubMed  Google Scholar 

  33. Bucher, P., H. Dallmer, M. Derks, W. Meesmann: Prophylaxis of ventricular fibrillation following acute coronary occlusion by chronic oral application of the beta-adrenoceptor blocking agent atenolol in conscious dogs. Pflügers Archiv Suppl. to Vol. 377, R2.

  34. Matta, R. J., R. L. Verrier, B. Lown: The repetitive extrasystole as an index of vulnerability to ventricular fibrillation. Amer. J. Physiol.230, 1461 (1976).

    PubMed  Google Scholar 

  35. Allen, J. D., J. F. Pantridge, R. C. Shanks: Effects of lignocaine, propranolol and bretylium on ventricular fibrillation threshold. Amer. J. Cardiol.28, 555 (1971).

    PubMed  Google Scholar 

  36. Kniffen, F. J., T. E. Lomas, N. L. Nobel-Allen, B. R. Lucchesi: The comparative antiarrhythmic actions of lidocaine and its quaternary derivate. Methyl-Lidocaine. Circulation49, 264 (1974).

    Google Scholar 

  37. Kostis, J. B., M. J. Goodkind, S. Gotzoyannis, N. H. Gerber, P. T. Kuo: Effect of lidocaine on the atrial fibrillation threshold. Amer. Heart J.94, 764 (1977).

    PubMed  Google Scholar 

  38. Schnittger, I., I. C. Griffin, R. J. Hall, P. J. Melfin, R. A. Winkle: Effects of Tocainide on ventricular fibrillation threshold. Amer. J. Cardiol.42, 76 (1978).

    PubMed  Google Scholar 

  39. Lee, K. T., W. M. Lee, J. Han, J. Jermonlych, M. B. Bishop, B. G. Goel: Experimental model for study of “sudden death” from ventricular fibrillation or asystole. Amer. J. Cardiol.32, 62 (1973).

    PubMed  Google Scholar 

  40. Asokan, S. K., T. L. Crews, P. E. Cudey jr., M. J. Frank: Effects of lidocaine on potassium, sodium and water in ischaemic myocardium. Cardiovasc. Res.6, 482 (1972).

    PubMed  Google Scholar 

  41. Lubbe, W. F., P. S. Daries, L. H. Opie: Ventricular arrhythmias associated with coronary artery occlusion and reperfusion in the isolated perfused rat heart: a model for assessment of antifibrillatory action of antiarrhythmic agents. Cardiovasc. Res.12, 212 (1978).

    PubMed  Google Scholar 

  42. Lubbe, W. F., O. L. Bricknell, C. Marzagao: Ventricular fibrillation threshold and vulnerable period in the isolated perfused rat heart. Cardiovasc. Res.9, 613 (1975).

    PubMed  Google Scholar 

  43. Pantridge, J. E.: Emergency treatment of cardiac arrhythmias in myocardial infarction, in: Lidocaine in the treatment of ventricular arrhythmias. Ed. D. B. Scott, D. G. Julian (Livingstone, Edinburgh, 1971).

    Google Scholar 

  44. Pentecost, B. L., J. V. de Giovanni, P. Lamb, P. J. Cadigan, K. L. Evemy, E. J. Flint: Influence of changing antiarrhythmic drug policy on incidence and outcome of ventricular fibrillation complicating myocardial infaraction. Brit. Heart J.43, 717 (1980).

    Google Scholar 

  45. Harrison, D. C.: Should Lidocaine be administered routinely to all patients after acute myocardial infarction? Circulation58, 581 (1978).

    PubMed  Google Scholar 

  46. Wiegand, V., M. Güggi, W. Meesmann, M. Kessler, F. Greitschus: Extracellular potassium activity changes in the canine myocardium after acute coronary occlusion and the influence of β-blockade. Cardiovasc. Res.13, 297 (1979).

    PubMed  Google Scholar 

  47. Engstfeld, G., H. Antoni, A. Fleckenstein: Die Restitution der Erregungsfortleitung und Kontraktionskraft des K+-gelähmten Frosch- und Säugetiermyokards durch Adrenalin. Pflügers Archiv273, 145 (1961).

    Google Scholar 

  48. Carmeliet, E., J. Veriecke. Adrenalin and the plateau phase of the cardiac action potential. Pflügers Archiv313, 300 (1969).

    Google Scholar 

  49. Ceremuczynski, L., J. Staszewska-Barczak, K. Herbaczynska-Cedro: Cardiac rhythm disturbances and the release of catecholamines after acute coronary occlusion in dogs. Cardiovasc. Res.3, 190 (1969).

    PubMed  Google Scholar 

  50. Wit, A. L., J. T. Bigger: Possible electrophysiological mechanisms for lethal arrhythmias accompanying myocardial ischaemia and infarction. Circulation Suppl. III to Vol.51–52 96 (1975).

    Google Scholar 

  51. Cranefield, P. F.: The conduction of the cardiac impulse: the slow response and cardiac arrhythmias (Futura Publishing Co. Mt. Kisko, New York, 1975).

    Google Scholar 

  52. Josephson, D., N. Sperelakis. Local anaesthetic blockade of Ca2+-mediated action potentials in cardiac muscle. Europ. J. Pharmacol.40, 201 (1976).

    Google Scholar 

  53. Brennan, F. J., A. L. Wit, P. F. Cranefield: Effects of lidocaine on slow response and depressed fast response action potentials of canine Purkinje fibers. J. Pharmacol. Exp. Therap. 204, 312 (1978).

    Google Scholar 

Download references

Author information

Author notes

  1. W. Meesmann M.D.

    Present address: Institut für Pathophysiologie, Universitäts-Klinikum Essen (GHS), Hufelandstraße 55, D-4300, Essen 1, FRG

Authors and Affiliations

  1. Institut für Pathophysiologie, Universitäts-Klinikum Essen (GHS), Hufelandstraße 55, D-4300, Essen 1, FRG

    B. Krämer & H. Gülker

Authors
  1. B. Krämer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. Gülker
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. W. Meesmann M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Dedicated to Prof. Dr. O. H. Arnold, Essen, to his 70th birthday

With 2 figures and 2 tables

Supported by the Landesamt für Wissenschaft und Forschung, Düsseldorf (FRG)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Krämer, B., Gülker, H. & Meesmann, W. The effects of lidocaine on the ventricular fibrillation threshold and primary ventricular fibrillation following acute experimental coronary occlusion. Basic Res Cardiol 76, 29–43 (1981). https://doi.org/10.1007/BF01908161

Download citation

  • Received:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01908161

Key words

Search

Navigation