Ana Carolina Guimarães Oliveira et al. Itamara Lucia Itagiba Neves Luciana Sacilotto Natália Quintella Sangiorgi Olivetti … Savia Christina Pereira Bueno Gabrielle D’Arezzo Pessente Marcela Alves dos Santos-Paul Tânia Cristina Pedroso Montano Cíntia Maria Alencar de Carvalho Cesar José Grupi Sílvio Alves Barbosa Carlos Alberto Pastore Nelson Samesima Tan Chen Wu Denise Tessariol Hachul Maurício Ibrahim Scanavacca Ricardo Simões Neves Francisco Carlos da Costa Darrieux
Abstract
Background
Dental anesthetic management in implantable cardioverter defibrillator (ICD) recipients with cardiac channelopathies (CCh) can be challenging due to the potential risk of life-threatening arrhythmias and appropriate ICD therapies during procedural time.
Objectives
The present study assessed the hypothesis that the use of local dental anesthesia with 2% lidocaine with 1:100,000 epinephrine or without a vasoconstrictor can be safe in selected ICD and CCh patients, not resulting in life-threatening events (LTE).
Methods
Restorative dental treatment under local dental anesthesia was made in two sessions, with a wash-out period of 7 days (cross-over trial), conducting with a 28h – Holter monitoring, and 12-lead electrocardiography, digital sphygmomanometry, and anxiety scale assessments in 3 time periods. Statistical analysis carried out the paired Student’s t test and the Wilcoxon signed-rank test. In all cases, a significance level of 5% was adopted. All patients were in stable condition with no recent events before dental care.
Results
Twenty-four consecutive procedures were performed in 12 patients (9 women, 3 men) with CCh and ICD: 7 (58.3%) had long QT syndrome (LQTS), 4 (33.3%) Brugada syndrome (BrS), and 1 (8.3%) Catecholaminergic polymorphic ventricular tachycardia (CPVT). Holter analysis showed no increased heart rate (HR) or sustained arrhythmias. Blood pressure (BP), electrocardiographic changes and anxiety measurement showed no statistically significant differences. No LTE occurred during dental treatment, regardless of the type of anesthesia.
Conclusion
Lidocaine administration, with or without epinephrine, can be safely used in selected CCh-ICD patients without LTE. These preliminary findings need to be confirmed in a larger population with ICD and CCh.