Effects of lidocaine and procainamide on normal and abnormal intraventricular electrograms during sinus rhythm

C. G. Schmitt, A. H. Kadish, F. E. Marchlinski, J. M. Miller, A. E. Buxton, M. E. Josephson

Research output: Contribution to journalArticle

21 Scopus citations

Abstract

The effect of lidocaine (n = 6) and procainamide (n = 12) on electrogram characteristics from electrically normal right ventricular and electrically abnormal left ventricular endocardial sites was determined in 18 patients with prior myocardial infarction. Bipolar electrograms were recorded during sinus rhythm with No. 6F catheters positioned at a left ventricular abnormal site (electograms fulfilling two of the following criteria: amplitude <3 mV, duration >70 msec, or an amplitude to duration ratio < .046) and normal sites at the right ventricular apex (RVA) and right ventricular outflow tract (RVOT). All electrograms were recorded from the same location before and after intravenous lidocaine or procainamide administered to obtain mean serum concentrations of 4.2 ± 0.6 and 9.42 ± 2 μg/ml respectively. Lidocaine and procainamide had no significant effect on sinus cycle length or electrogram amplitude. After lidocaine, no significant change in QRS width (112 ± 23 vs 114 ± 24 msec), left ventricular electrogram duration (76 ± 21 vs 78 ± 15 msec), or right ventricular electrogram duration (RVA 33 ± 9 vs 33 ± 10 msec, RVOT 31 ± 9 vs 33 ± 11 msec) was noted during sinus rhythm. At a paced cycle length of 600 msec, there was also no change in the paced QRS duration (197 vs 198 msec), the RVA electrogram duration (30 vs 32 msec), the RVOT electrogram duration (49 vs 52 msec), or the left ventricular electrogram duration (102 vs 108 msec). In contrast, after procainamide, QRS width prolonged from 110 ± 31 to 127 ± 33 msec (p < .001), and electrogram duration increased significantly (p < .001) at the left ventricular site (84 ± 17 to 101 ± 23 msec), the RVA (32 ± 11 to 38 ± 13 msec), and the RVOT (37 ± 12 to 44 ± 15 msec). Similarly, at a pacing cycle length of 600 msec, QRS duration increased from 194 to 226 msec (p < .001), RVA electrogram duration increased from 32 to 36 msec (p < .05), RVOT electrogram duration increased from 34 to 39 msec, and left ventricular electrogram duration increased from 86 to 108 msec. The observations that lidocaine had no effect on local electrogram duration and procainamide prolonged indexes of conduction in both normal and chronically infarcted myocardium to the same degree are consistent with, but do not establish with certainty, the hypothesis that the ionic basis for impulse propagation is similar in normal and infarcted tissue.

Original languageEnglish (US)
Pages (from-to)1030-1037
Number of pages8
JournalCirculation
Volume77
Issue number5
DOIs
StatePublished - 1988

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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