Lidocaine is used intravenously to treat cardiac arrest that’s caused by a ventricular arrhythmia in people who don’t respond to defibrillation. It may help improve the chance of survival.

A heart arrhythmia is when your heart beats at an abnormal rate or with an abnormal rhythm. It’s thought that up to 5% of people in the United States have a heart arrhythmia.

Many arrhythmias aren’t serious, but some can cause your heart to stop beating. The medication lidocaine is often administered intravenously (through an IV) to treat people whose heart has stopped beating due to ventricular arrhythmia and who don’t respond to defibrillation.

In this article, we look at how and when lidocaine is used to treat a heart arrhythmia.

Lidocaine is used to treat cardiac arrest caused by a ventricular arrhythmia. Cardiac arrest is when your heart stops beating suddenly. Ventricular fibrillation is a common cause of cardiac arrest.

There are 2 main types of ventricular arrhythmias:

  • Ventricular tachycardia: Ventricular tachycardia is an abnormally fast heartbeat of 100 bpm for more than 3 heartbeats.
  • Ventricular fibrillation: Ventricular fibrillation is considered the most serious arrhythmia. It happens when the lower chambers of your heart quiver uncontrollably instead of beating normally. When this happens, your heart can’t pump hard enough to move blood through your body.

What is lidocaine?

Lidocaine is a medication that’s used as an anesthesia. Doctors often inject lidocaine into the skin before surgery to block pain. Lidocaine cream may be used to treat pain associated with minor injuries like scrapes or insect bites.

Lidocaine may also be used to treat ventricular arrhythmia. When lidocaine is used to treat ventricular arrhythmia, it’s administered through an IV.

The recommended dose of lidocaine for treating ventricular arrhythmia is 1.0 to 1.5 milligrams per kilogram of body weight for the first dose and 0.5 to 0.75 milligrams per kilogram for a second dose if needed.

American Heart Association recommendations

The American Heart Association (AHA) includes lidocaine in its 2018 recommendations for treating cardiac arrest caused by ventricular fibrillation or ventricular tachycardia that doesn’t respond to defibrillation. Another drug called amiodarone is commonly used for the same purpose.

According to the AHA, lidocaine or amiodarone may be most useful when another person is present at the time of cardiac arrest since the time to drug administration may be quicker.

According to research, people who receive intravenous lidocaine or amiodarone have higher survival rates than people who receive a placebo. But there’s no difference in survival between these two drugs.

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Why is lidocaine not used for atrial arrhythmias?

Lidocaine is largely ineffective at treating arterial arrhythmia. Using It to treat arterial arrhythmia could potentially cause problems with ventricular activity.

Lidocaine is generally safe, and toxicity is rare. It can occasionally cause life threatening side effects.

Possible side effects of lidocaine, when it’s used to treat an arrhythmia, may include:

Side effects may happen more often in older adults and people with heart failure or significant liver dysfunction.

Many medications are used to prevent or treat ventricular arrhythmias. They can be broadly classified into the following categories:

CategoryExample drugsDescription
Predominantly potassium channel blockers Amiodaron, sotalol
Amiodarone is often used in the same way as lidocaine. Sotalol is the second-line drug for managing premature ventricular contraction in people who don’t respond to amiodarone.
Predominantly sodium channel blockers Lidocaine, quinidineThese medications have been used for a long time to prevent sudden death caused by ventricular arrhythmias.
Calcium channel blockersVerapamil diltiazemVerapamil diltiazem may be effective at treating fascicular ventricular arrhythmia, but is generally not used for other types of arrhythmia.
Drugs affecting receptors of the autonomic systemBeta-blockers, adenosineBeta-blockers are among the first-line medications for preventing ventricular arrhythmia in people with coronary heart disease.

Hyperpolarization-activated cyclic nucleotide-gated channel blockers
Researchers are looking into whether ivabradine can reduce ventricular arrhythmia. Research is still in the early stages.

About amiodarone and procainamide

In a 2022 study, researchers found no significant difference in outcomes among people with ventricular arrhythmias treated with lidocaine or amiodarone.

Some research suggests that procainamide may be more effective than lidocaine for stopping sudden ventricular tachycardia, but other research suggests that people who received procainamide are less likely to survive hospitalization.

Lidocaine is a medication administered through an IV to treat cardiac arrest caused by ventricular arrhythmias that don’t respond to defibrillation. Doctors use a medication known as amiodarone for the same purpose.

Lidocaine is used in emergencies to improve the chances of survival. Doctors don’t prescribe lidocaine for long-term use.