Lidocaine, a class IB antiarrhythmic, is most effective for which clinical scenario?

• A Acute termination of atrial fibrillation
• B Prevention of AV-nodal reentrant tachycardia
• C Rate control in atrial flutter
• D Treatment of ventricular arrhythmias in the setting of myocardial ischemia ✓

Explanation

Lidocaine is a class IB sodium channel blocker with preferential activity on depolarized or ischemic tissue. It is used for ventricular arrhythmias, particularly in acute MI or cardiac surgery. It has minimal effect on atrial tissue (ineffective for AF or AV-nodal arrhythmias). Its use has declined in favor of amiodarone in many guidelines but remains relevant in specific settings.

Reference: Katzung Basic and Clinical Pharmacology, 15th ed.

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