From the Guidelines
For electrical burns, the primary antiarrhythmic medication recommended is lidocaine, administered at 1-1.5 mg/kg IV bolus followed by an infusion of 1-4 mg/min if arrhythmias are present. Electrical burns can cause cardiac arrhythmias due to the current passing through the heart, disrupting normal electrical conduction. Continuous cardiac monitoring should be initiated immediately for all patients with significant electrical burns, particularly those with high-voltage injuries, transthoracic current path, or loss of consciousness. If ventricular arrhythmias develop, lidocaine is preferred because it stabilizes cardiac cell membranes by blocking sodium channels, reducing automaticity in damaged cardiac tissue. Amiodarone can be used as a second-line agent if lidocaine is ineffective, with a dose of 5-7 mg/kg over 1-2 hours, followed by 50 mg/hour to a maximum of 1.0 g over 24 hours 1. Beta-blockers should generally be avoided in the acute setting as they may worsen hemodynamic instability. Cardiac monitoring should continue for at least 24 hours for low-voltage injuries and 72 hours for high-voltage injuries, even in asymptomatic patients, as arrhythmias can develop with delay.
Some key points to consider when using antiarrhythmic medications for electrical burns include:
- The choice of antiarrhythmic medication depends on the type and severity of the arrhythmia, as well as the patient's underlying medical conditions.
- Lidocaine is generally the first-line treatment for ventricular arrhythmias, while amiodarone may be used as a second-line agent.
- Beta-blockers should be avoided in the acute setting due to the risk of worsening hemodynamic instability.
- Continuous cardiac monitoring is essential for patients with significant electrical burns, and should be continued for at least 24-72 hours depending on the severity of the injury.
It's also important to note that the management of electrical burns and associated arrhythmias requires a comprehensive approach, taking into account the patient's overall medical condition and the severity of the injury. The use of antiarrhythmic medications should be guided by the latest evidence-based guidelines, such as those published by the European Society of Cardiology 1 and the American College of Cardiology 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Antiarrhythmic Treatment for Electrical Burns
- Electrical burns can induce ventricular arrhythmias, which are potentially lethal 2, 3
- The risk of ventricular arrhythmias is lower for electrical injuries occurring between the upper limbs than for those occurring between the upper and lower limbs 2
- Amiodarone, a Class III antiarrhythmic drug, is effective in treating ventricular arrhythmias and has a low pro-arrhythmogenic effect 4, 5
- Lidocaine, in combination with amiodarone, can terminate refractory ventricular arrhythmias, especially in patients with a sufficient left ventricular ejection fraction (LVEF) 6
Monitoring and Treatment
- Patients with electrical injuries should be monitored for delayed arrhythmias 3
- 24-h hospitalization for monitoring of patients with electrical injuries of the upper limbs may be sufficient 2
- Amiodarone can be used as an intravenous formulation in hospitals to treat electrical storm, with side effects including hypotension and bradycardia 4
- Lidocaine can be used in combination with amiodarone to treat refractory ventricular arrhythmias, with a higher LVEF associated with a more favorable outcome 6