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This article reviews current knowledge about lidocaine, with reference to its chemistry, metabolism, electrophysiology, hemodynamic effects, antiarrhythmic uses, pharmacokinetics, and side effects. The critical importance of blood levels and their relation to lidocaine's antiarrhythmic and toxic effects is noted, with special emphasis given to patients with compromised clearance due to heart failure. On the basis of this information, we present our current approach to the clinical use of lidocaine in the treatment of ventricular arrhythmias, with particular reference to patients with acute myocardial infarction.

The Clinical Pharmacology of Lidocaine as an Antiarrhythymic Drug