Effect of lidocaine on atrioventricular response via the accessory pathway in patients with Wolff-Parkinson-White syndrome

Abstract

Electrophysiologic effects of i.v. lidocaine were evaluated in 10 patients with Wolff-Parkinson-White (WPW) syndrome during atrial fibrillation (AF) (eight of 10) or programmed atrial stimulation (nine of 10). The shortest RR intervals during AF were 190-415 msec (mean 271.8 ± 64.5 msec) before lidocaine and decreased to 250.0 ± 85.4 msec (range 180-435 msec, p = NS) after the drug. In six of eight patients, the shortest RR interval decreased and in the remaining two patients it increased by 20 msec after lidocaine. After lidocaine, the average RR intervals during AF for all eight patients decreased from 351.1 ± 45.9 msec to 335.6 ± 68.0 msec (p = NS). After lidocaine, the RR interval shortened in five of eight patients, lengthened in two and did not change in one. In two of eight patients, acceleration of ventricular rate after lidocaine was accompanied by hemodynamic deterioration, necessitating DC cardioversion in one. The control effective refractory period of the accessory pathway (ERP-AP) was 300 msec or less in all patients, and lidocaine prolonged this variable in only one case. In the remaining patients, after lidocaine the ERP-AP either shortened (two of nine), did not change (two of nine) or atrial refractoriness precluded its determination. Similarly, during incremental pacing, the atrial cycle length that produced block in the AP shortened in five patients, lengthened in one and did not change in the others. In patients with WPW syndrome and relatively short ERP-AP (i.e., ≤ 300 msec), lidocaine generally has no significant effect or produces acceleration of ventricular response during AF. In patients with AF and a rapid ventricular rate due to antegrade conduction over the AP, lidocaine is unlikely to have beneficial effects and may be deleterious.