[Long QT Syndrome and Anaesthesia]

Overview

Journal Anaesthesist

Specialty Anesthesiology

Date 2006 Feb 1

PMID 16447035

Citations 7

Authors

S Rasche

T Koch

M Hubler

Affiliations

Soon will be listed here.

Abstract

The long QT syndrome (LQTS) is a rare, congenital or acquired disease, which may lead to fatal cardiac arrhythmias (torsade de pointes, TdP). In all LQTS subtypes, TdPs are caused by disturbances in cardiac ion channels. Diagnosis is made using clinical, anamnestic and electrocardiographic data. Triggers of TdPs are numerous and should be avoided perioperatively. Sufficient sedation and preoperative correction of electrolyte imbalances are essential. Volatile anaesthetics and antagonists of muscle relaxants should be avoided and high doses of local anaesthetics are not recommended to date. Propofol is safe for anaesthesia induction and maintenance. The acute therapy of TdPs with cardiovascular depression should be performed in accordance with the guidelines for advanced cardiac life support and includes cardioversion/defibrillation and magnesium. Torsades de pointes may be associated with bradycardia or tachycardia resulting in specific therapeutic and prophylactic measures.

Citing Articles

[Perioperative treatment of patients with long QT syndrome].

Kronauer T, Friederich P Anaesthesist. 2015; 64(8):625-37.

PMID: 26260197 DOI: 10.1007/s00101-015-0067-x.

[Long QT syndrome. History, genetics, clinical symptoms, causes and therapy].

Kronauer T, Friederich P Anaesthesist. 2015; 64(8):586-95.

PMID: 26250931 DOI: 10.1007/s00101-015-0068-9.

[Perioperative monitoring of the QT interval].

Pfizenmayer H, Friederich P Anaesthesist. 2010; 59(7):633-5.

PMID: 20461349 DOI: 10.1007/s00101-010-1723-9.

Pharmacogenomics of anesthetic drugs in transgenic LQT1 and LQT2 rabbits reveal genotype-specific differential effects on cardiac repolarization.

Odening K, Hyder O, Chaves L, Schofield L, Brunner M, Kirk M Am J Physiol Heart Circ Physiol. 2008; 295(6):H2264-72.

PMID: 18835916 PMC: 2614544. DOI: 10.1152/ajpheart.00680.2008.

QTc interval prolongation in children with Turner syndrome: the results of exercise testing and 24-h ECG.

Dalla Pozza R, Bechtold S, Urschel S, Netz H, Schwarz H Eur J Pediatr. 2008; 168(1):59-64.

PMID: 18392639 DOI: 10.1007/s00431-008-0709-y.

References

Ackerman M, Khositseth A, Tester D, Hejlik J, Shen W, Porter C . Epinephrine-induced QT interval prolongation: a gene-specific paradoxical response in congenital long QT syndrome. Mayo Clin Proc. 2002; 77(5):413-21. DOI: 10.4065/77.5.413. View

Furushima H, Niwano S, Chinushi M, Yamaura M, Taneda K, Washizuka T . Effect of atropine on QT prolongation and torsade de pointes induced by intracoronary acetylcholine in the long QT syndrome. Am J Cardiol. 1999; 83(5):714-8. DOI: 10.1016/s0002-9149(98)00976-x. View

Michaloudis D, Fraidakis O, Petrou A, Gigourtsi C, Parthenakis F . Anaesthesia and the QT interval. Effects of isoflurane and halothane in unpremedicated children. Anaesthesia. 1998; 53(5):435-9. DOI: 10.1046/j.1365-2044.1998.00376.x. View

Cucchiaro G, Rhodes L . Unusual presentation of long QT syndrome. Br J Anaesth. 2003; 90(6):804-7. DOI: 10.1093/bja/aeg138. View

Annila P, Yli-Hankala A, Lindgren L . Effect of atropine on the QT interval and T-wave amplitude in healthy volunteers. Br J Anaesth. 1993; 71(5):736-7. DOI: 10.1093/bja/71.5.736. View

Roden D, LAZZARA R, Rosen M, Schwartz P, Towbin J, Vincent G . Multiple mechanisms in the long-QT syndrome. Current knowledge, gaps, and future directions. The SADS Foundation Task Force on LQTS. Circulation. 1996; 94(8):1996-2012. DOI: 10.1161/01.cir.94.8.1996. View

Whyte S, Booker P, Buckley D . The effects of propofol and sevoflurane on the QT interval and transmural dispersion of repolarization in children. Anesth Analg. 2004; 100(1):71-77. DOI: 10.1213/01.ANE.0000140781.18391.41. View

Kasten G . Amide local anesthetic alterations of effective refractory period temporal dispersion: relationship to ventricular arrhythmias. Anesthesiology. 1986; 65(1):61-6. DOI: 10.1097/00000542-198607000-00010. View

Haverkamp W, Rolf S, Eckardt L, Monnig G . [Long QT syndrome and Brugada syndrome. Drugs, ablation or ICD?]. Herz. 2005; 30(2):111-8. DOI: 10.1007/s00059-005-2676-7. View

10.

Behl S, Wauchob T . Long QT syndrome: anaesthetic management at delivery. Int J Obstet Anesth. 2005; 14(4):347-50. DOI: 10.1016/j.ijoa.2005.04.005. View

11.

Friederich P, Solth A, Schillemeit S, Isbrandt D . Local anaesthetic sensitivities of cloned HERG channels from human heart: comparison with HERG/MiRP1 and HERG/MiRP1 T8A. Br J Anaesth. 2003; 92(1):93-101. DOI: 10.1093/bja/aeh026. View

12.

Tzivoni D, Banai S, Schuger C, Benhorin J, Keren A, Gottlieb S . Treatment of torsade de pointes with magnesium sulfate. Circulation. 1988; 77(2):392-7. DOI: 10.1161/01.cir.77.2.392. View

13.

Knudsen K, Beckman Suurkula M, Blomberg S, Sjovall J, Edvardsson N . Central nervous and cardiovascular effects of i.v. infusions of ropivacaine, bupivacaine and placebo in volunteers. Br J Anaesth. 1997; 78(5):507-14. DOI: 10.1093/bja/78.5.507. View

14.

Egawa H, Okuda Y, Kitajima T, Minami J . Assessment of QT interval and QT dispersion following stellate ganglion block using computerized measurements. Reg Anesth Pain Med. 2001; 26(6):539-44. DOI: 10.1053/rapm.2001.25935. View

15.

Zhang L, Timothy K, Vincent G, Lehmann M, Fox J, Giuli L . Spectrum of ST-T-wave patterns and repolarization parameters in congenital long-QT syndrome: ECG findings identify genotypes. Circulation. 2000; 102(23):2849-55. DOI: 10.1161/01.cir.102.23.2849. View

16.

Clancy C, Tateyama M, Kass R . Insights into the molecular mechanisms of bradycardia-triggered arrhythmias in long QT-3 syndrome. J Clin Invest. 2002; 110(9):1251-62. PMC: 151612. DOI: 10.1172/JCI15928. View

17.

Cheng J, Kodama I . Two components of delayed rectifier K+ current in heart: molecular basis, functional diversity, and contribution to repolarization. Acta Pharmacol Sin. 2004; 25(2):137-45. View

18.

Guler N, Kati I, Demirel C, Bilge M, Eryonucu B, Topal C . The effects of volatile anesthetics on the Q-Tc interval. J Cardiothorac Vasc Anesth. 2001; 15(2):188-91. DOI: 10.1053/jcan.2001.21949. View

19.

Tamargo J . Drug-induced torsade de pointes: from molecular biology to bedside. Jpn J Pharmacol. 2000; 83(1):1-19. DOI: 10.1254/jjp.83.1. View

20.

Darbar D, Roden D, Ali M, Yang T, Wathen M . Images in cardiovascular medicine. Himalayan T waves in the congenital long-QT syndrome. Circulation. 2005; 111(11):e161. DOI: 10.1161/01.CIR.0000159092.92366.CD. View