Is It Safe for Patients With Cardiac Channelopathies to Undergo Routine Dental Care? Experience From a Single‐Center Study
| Autor: | Luciana Sacilotto, Itamara Lucia Itagiba Neves, Tânia Cristina Pedroso Montano, Cíntia Maria Alencar de Carvalho, Mauricio Scanavacca, Ricardo Simões Neves, S A Barbosa, Carlos Alberto Pastore, Ana Carolina Guimaraes Oliveira, Denise Hachul, Francisco Darrieux, Nelson Samesima, Natália Olivetti, Marcela Alves dos Santos‐Paul, Cesar José Grupi, Tan Chen Wu |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Epinephrine Lidocaine Pilot Projects anesthesia Arrhythmias 030204 cardiovascular system & hematology arrhythmia Single Center Sudden Cardiac Death Contraindications Procedure 03 medical and health sciences 0302 clinical medicine Double-Blind Method medicine Humans Vasoconstrictor Agents Arrhythmia and Electrophysiology In patient Prospective Studies Anesthetics Local Dental Care Original Research Aged Brugada Syndrome Brugada syndrome business.industry Middle Aged channelopathies medicine.disease Dental care Long QT Syndrome 030220 oncology & carcinogenesis Ventricular Fibrillation Emergency medicine Female Cardiology and Cardiovascular Medicine business Cardiac deaths medicine.drug |
| Zdroj: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| ISSN: | 2047-9980 |
| Popis: | Background Brugada syndrome and long‐QT syndrome may account for at least one third of unexplained sudden cardiac deaths. Dental care in patients with cardiac channelopathies is challenging because of the potential risk of life‐threatening events. We hypothesized that the use of local dental anesthesia with lidocaine with and without epinephrine is safe and does not result in life‐threatening arrhythmias in patients with channelopathies. Methods and Results We performed a randomized, double‐blind pilot trial comparing the use of 2% lidocaine without a vasoconstrictor and with 1:100 000 epinephrine in 2 sessions of restorative dental treatment with a washout period of 7 days (crossover trial). Twenty‐eight–hour Holter monitoring was performed, and 12‐lead electrocardiography, digital sphygmomanometry, and anxiety scale assessments were also conducted at 3 time points. Fifty‐six dental procedures were performed in 28 patients (18 women, 10 men) with cardiac channelopathies: 16 (57.1%) had long‐QT syndrome, and 12 (42.9%) had Brugada syndrome; 11 (39.3%) of patients had an implantable defibrillator. The mean age was 45.9±15.9 years. The maximum heart rate increased after the use of epinephrine during the anesthesia period from 82.1 to 85.8 beats per minute ( P =0.008). In patients with long‐QT syndrome, the median corrected QT was higher, from 450.1 to 465.4 ms ( P =0.009) at the end of anesthesia in patients in whom epinephrine was used. The other measurements showed no statistically significant differences. No life‐threatening arrhythmias occurred during dental treatment. Conclusions The use of local dental anesthesia with lidocaine, regardless of the use of a vasoconstrictor, did not result in life‐threatening arrhythmias and appears to be safe in stable patients with cardiac channelopathies. Clinical Trial Registration URL: http://www.clinicaltrials.gov . Unique identifier: NCT03182777. |
| Databáze: | OpenAIRE |
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