Effect of Intravenous Lidocaine, Used to Attenuate Pain With Propofol Injection, on Defibrillation Threshold Testing

Summary: The purpose is to observe the incidence of successful defibrillation on the first
attempt during implantation of an implantable cardioverter-defibrillator (ICD) among
patients who receive a standard dose of intravenous lidocaine (for attenuation of pain
associated with propofol injection) versus patients who do not receive an intravenous
lidocaine dose.

During implantation of an ICD, defibrillation threshold (DFT) testing is performed. DFT is
calibrated as the lowest energy delivered by the ICD that will successfully terminate
malignant arrhythmia. Lidocaine, a routine anesthetic agent, is also identified as an
antiarrhythmic drug. Experimentally, lidocaine has been shown to increase thresholds during
DFT' testing due to the drugs dual effect. The rationale behind this project is that the
lidocaine may yield falsely elevated DFT, resulting in higher calibration of the ICD device.
This alteration can affect ICD battery and overall ICD life. Comparisons between study
groups may elucidate effects of IV lidocaine on DFT.

Inclusion Criteria:

- Any person referred to the Hahnemann University Hospital Electrophysiology Laboratory
for a clinically indicated ICD implant

Exclusion Criteria:

- Any person under the age of 18 years

- Inability to give an informed consent

- Allergy to lidocaine

- Receiving lidocaine treatment for pain or arrhythmia

- Contraindication for DFT testing

- Not consenting for DFT testing

- Receiving energy other than 10-12.5 joules as initial DFT test

- Implant of ICD on the right side

- DFT not planned to be performed during ICD implant

- Epicardial placement of ICD leads

- Use of single coil ICD lead

- Subpectoral ICD implantation

- Cephalic cutdown used for central venous access

- Require more than 3mg/kg of 1% SQ lidocaine for local anesthesia

- Pregnant women or prisoners