Prophylactic lidocaine for myocardial infarction

Martí‐Carvajal, Arturo J; Simancas‐Racines, Daniel; Anand, Vidhu; Bangdiwala, Shrikant I.

doi:10.1002/14651858.cd008553.pub2

Cited by 26 publications

(13 citation statements)

References 129 publications

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“…2a and b). The dynamic pattern of these ST segments supports the diagnosis of MI 41, 47 . Intraoperative ventricular arrhythmias requiring intracardiac defibrillation were observed in 8 of 27 animals.…”

Section: Resultssupporting

confidence: 59%

A novel minimally invasive and reproducible large animal ischaemia-reperfusion-infarction model: methodology and model validation

Pius

Niort

Radcliffe

et al. 2023

Preprint

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Ischaemic heart disease remains a leading cause of premature mortality and morbidity. Understanding the associated pathophysiological mechanisms of cardiac dysfunction arising from ischaemic heart disease and the identification of sites of novel therapeutic intervention requires a preclinical model that reproduces the key clinical characteristics of myocardial ischaemia, reperfusion and infarction. Here we describe and validate a refined and minimally invasive translationally relevant approach to induce ischaemia, reperfusion and infarction in the sheep. The protocol uses clinical cardiology devices and approaches and would be readily adopted by researchers with access to standard fluoroscopic instrumentation. In addition to being minimally invasive, the major refinements associated with the described methodology are the implantation of an intracardiac defibrillator prior to coronary engagement and use of an antiarrhythmic medication protocol during the procedure. These refinements lead to a reduction of intraoperative mortality to 6.7 %. The model produces key characteristics associated with the 4thUniversal Definition of Myocardial Infarction including electrocardiographic changes, elevated cardiac biomarkers and cardiac wall motility defects. In conclusion, the model closely replicates the clinical paradigm of myocardial ischaemia, reperfusion and infarction in a translationally relevant large-animal setting and the applied refinements reduce the incidence of intraoperative mortality typically associated with preclinical myocardial infarction models.

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Section: Resultssupporting

confidence: 59%

A novel minimally invasive and reproducible large animal ischaemia-reperfusion-infarction model: methodology and model validation

Pius

Niort

Radcliffe

et al. 2023

Preprint

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“…Lidocaine has been found to not diminish the antiplatelet effects of ticagrelor, making it a promising non-opioid pain relief option. Furthermore, the use of lidocaine in patients with STEMI did not uncover an increased likelihood of bradyarrhythmia, tachyarrhythmia or neurotoxicity ( 35 ). A clinical study comparing intravenous acetaminophen and fentanyl for pain relief in patients with STEMI found no difference between the two.…”

Section: Discussionmentioning

confidence: 99%

Analgesic drug use in patients with STEMI: Current perspectives and challenges

Chen

Wang

et al. 2023

Front. Med.

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Therapy for patients with ST-elevation myocardial infarction (STEMI) has been a controversial topic since the introduction of thrombolytic agents in the 1980s. The use of morphine, fentanyl and lidocaine has increased substantially during this period. However, there is still limited evidence on their advantages and limitations. In this review, the clinical application, as well as future considerations of morphine, fentanyl and lidocaine in patients with ST segment elevation myocardial infarction were discussed.

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“…As sudden cardiac death is often precipitated by a brief monomorphic tachycardia that degenerates into VF (Milner et al., ; Panidis & Morganroth, ), a failure to flatten the dynamic restitution slope may limit the therapeutic potential of lidocaine and mexiletine in preventing a fatal arrhythmia. In this context, it is worth mentioning that although class Ib agents are generally regarded as safe antiarrhythmics (Frommeyer & Eckardt, ), they nevertheless reportedly failed to improve mortality in patients with acute myocardial infarction in recent clinical trials (Marti‐Carvajal, Simancas‐Racines, Anand, & Bangdiwala, ); hence the routine use of prophylactic lidocaine for the purpose of preventing VF in this setting is not currently recommended.…”

Section: Discussionmentioning

confidence: 99%

Effects of antiarrhythmics on the electrical restitution in perfused guinea‐pig heart are critically determined by the applied cardiac pacing protocol

Osadchii

2019

Experimental Physiology

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New Findings What is the central question of this study?Are modifications in the restitution of ventricular action potential duration induced by antiarrhythmic drugs the same when assessed with premature extrastimulus application at variable coupling intervals (the standard stimulation protocol) and with steady state pacing at variable rates (the dynamic stimulation protocol)? What is the main finding and its importance?With class I and class III antiarrhythmics, the effects on electrical restitution determined with the standard stimulation protocol dissociate from those obtained during dynamic pacing. These findings indicate a limited value of the electrical restitution assessments based on extrasystolic stimulations alone, as performed in the clinical studies, in estimating the outcomes of antiarrhythmic drug therapies. Abstract A steep slope of the ventricular action potential duration (APD) to diastolic interval (DI) relationships (the electrical restitution) can precipitate tachyarrhythmia, whereas a flattened slope is antiarrhythmic. The derangements in APD restitution responsible for transition of tachycardia to ventricular fibrillation can be assessed with cardiac pacing at progressively increasing rates (the dynamic stimulation protocol). Nevertheless, this method is not used clinically owing to the risk of inducing myocardial ischaemia. Instead, the restitution kinetics is determined with a premature extrastimulus application at variable coupling intervals (the standard stimulation protocol). Whether the two protocols are equivalent in estimating antiarrhythmic drug effects is uncertain. In this study, dofetilide and quinidine, the agents blocking repolarizing K+ currents, increased epicardial APD in perfused guinea‐pig hearts, with effects being greater at long vs. short DIs. These changes were more pronounced during dynamic pacing compared to premature extrastimulations. Accordingly, although both agents markedly steepened the dynamic restitution, there was only a marginal increase in the standard restitution slope with dofetilide, and no effect with quinidine. Lidocaine and mexiletine, selective Na+ channel blockers, prolonged the effective refractory period without changing APD, and increased the minimum DI that enabled ventricular capture during extrastimulations. No change in the minimum DI was noted during dynamic pacing. Consequently, although lidocaine and mexiletine reduced the standard restitution slope, they failed to flatten the dynamic restitution. Overall, these findings imply a limited value of the electrical restitution assessments with premature extrastimulations alone in discriminating arrhythmic vs. antiarrhythmic changes during drug therapies.

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Prophylactic lidocaine for myocardial infarction

Abstract: Analysis 1.9. Comparison 1: Lidocaine vs placebo or no intervention, Outcome 9: All-cause mortality (subgroup analysis according to non-suspected trials with industry bias compared with suspected trials with industry bias

Cited by 26 publications

References 129 publications

A novel minimally invasive and reproducible large animal ischaemia-reperfusion-infarction model: methodology and model validation

A novel minimally invasive and reproducible large animal ischaemia-reperfusion-infarction model: methodology and model validation

Analgesic drug use in patients with STEMI: Current perspectives and challenges

Effects of antiarrhythmics on the electrical restitution in perfused guinea‐pig heart are critically determined by the applied cardiac pacing protocol

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