FAQ of the Week: Lidocaine’s role in the treatment of ventricular tachycardia (VT)

At my hospital, intense discussions take place regarding lidocaine’s role in the treatment of ventricular tachycardia (VT). Some say it has no role, and others say it has benefit in specific clinical situations. Who is correct?

Lidocaine (Xylocaine, Nervocaine, LidoPen, Duo-Trach), is a local anesthetic and a class Ib antiarrhythmic agent that increases the electrical stimulation threshold of the ventricle, suppressing the automaticity of conduction through the tissue. Class Ib agents particularly shorten the action potential. 

Lidocaine may be useful in patients with VT due to ischemia. Therefore, depending on the cause of the ventricular tachycardia, either side may be correct.