Background: Ventricular tachyarrhythmias are a common complication during balloon pulmonary valvuloplasty (BPV). Currently, information regarding efficacy of the antiarrhythmic lidocaine for their prevention is limited to the results of one study.
Objectives: To evaluate the effect of pre-emptive lidocaine continuous rate infusion (CRI), compared to placebo, on the incidence and severity of ventricular tachyarrhythmias in dogs undergoing BPV. Animals: Twenty-four client-owned dogs undergoing BPV for treatment of congenital pulmonary valve stenosis.
Methods: In this prospective, randomized, placebo-controlled, masked clinical study, dogs were randomized to receive lidocaine (2 mg/kg IV bolus followed by 80 mcg/kg/min CRI) or an equal volume of saline placebo during BVP. A standardized anesthetic protocol was used. Surface electrocardiograms were recorded continuously during the cardiac catheterization period (CCP) and later evaluated by a single masked observer. Several indicators of ventricular ectopy frequency and severity, as well as a novel composite ventricular ectopy severity score (CVESS; range of possible values, 0 - 13), were compared between treatment groups using a covariate or exposure variable for CCP duration. Data are presented as mean±SD.
Results: Twenty-four (13 lidocaine-treated, 11 saline-treated) dogs were included. No significant differences in total number of ventricular beats per hour, maximum instantaneous heart rate during ventricular tachycardia, instances of R-on-T, or instances of ventricular flutter were identified. Mean CVESS was not different between lidocaine- and saline-treated dogs (7.1±3.7 and 6.5±3.7, respectively; p = 0.75). Conclusions and clinical importance: Compared to placebo, pre-emptive lidocaine administration did not result in detectable differences in ventricular arrhythmia incidence or severity.
Learning Objectives:
Upon completion, participants will be able to summarize the rationale, methodology and outcomes of a randomized, blinded, placebo-controlled clinical trial evaluating prophylactic lidocaine use during balloon pulmonary valvuloplasty in dogs.
Upon completion, participants will be able to list potential risk factors for intraoperative ventricular arrhythmias in dogs undergoing catheter-based interventions for pulmonary valve stenosis.
Upon completion, participants will be able to identify the likely mechanism(s) underlying ventricular tachyarrhythmias in dogs with pulmonary valve stenosis that undergo balloon pulmonary valvuloplasty.
