Lidocaine Infusion: An Antiarrhythmic With Neurologic Toxicities

Abstract

As a renowned local anesthetic agent of choice, lidocaine is also a class 1b antiarrhythmic agent that is primarily used for the treatment of ventricular arrhythmias. Although lidocaine systemic toxicity is rare, it may be life-threatening; thus, its early identification and management are of vital importance. This case report details the clinical scenario of intravenous lidocaine administration to a patient at high risk of toxicity in a 64-year-old patient, who initially presented with sustained monomorphic ventricular tachycardia received lidocaine and subsequently developed neurologic manifestations of lidocaine toxicity, including altered mental status and seizure. The patient was treated promptly with benzodiazepine and discontinuation of lidocaine as the offending agent, with complete resolution of adverse effects.

Keywords: antiarrhythmic; lidocaine infusion; neurotoxic; seizure; ventricular tachycardia.

Figure 1. Ventricular fibrillation

Figure 2. Implantable cardioverter-defibrillator interrogation findings