Perioperative management of patients with congenital or acquired disorders of the QT interval

Abstract

QT prolongation can be attributable to various causes that can be categorised as acquired or congenital. Arrhythmias related to QT prolongation can result in clinical presentations, such as syncope and sudden cardiac death. The perioperative period presents a number of issues that may affect a patient's risk of developing polymorphic ventricular tachycardia or torsades de pointes. Although most patients may have an unremarkable perioperative course, some may have complications; this review article aims to help clinicians avoid potential complications, and to help them address treatment for perioperative issues that may occur.

Clinical characterization and outcome of prolonged heart rate-corrected QT interval among children with syndactyly

“…Nevertheless, patients with prolonged QTc intervals might have a higher risk of fatal arrhythmia when undergoing surgery because many anesthetic agents have the potential to prolong the QT interval, especially when combined with other drugs or electrolyte disturbance. [ 23 , 24 ] In the present study, cardiac events did not occur during anesthesia and surgery, including the patient with TS. Nuzzi et al [ 17 ] report that there are also no cardiac events among 128 patients with syndactyly, including 1 patient with prolonged QT.…”

Anaesthetic management of a patient with Jervell and Langee Nielson Syndrome (a long QT variant) for cochlear implantation

“…Increasingly prolonged QTc values are at higher risk of potentially lethal arrhythmias. 1 Diagnostic evaluation for LQTS can be done using Schwartz score. 2 Score ≥3.5 indicates high probability of LQTS.…”

“…Prevalence of congenital LQTS is 1 in 2500 live births. 1 About 17 of LQTS susceptible genes have been recognised. Most common LQTS1 include 2 genetic variants, Romano Ward syndrome (RWS) and Jervell and Langee Nielson syndrome (JLNS).…”

Retrospective Evaluation of Demographic and Clinical Features of Patients with Preoperative Long QT Syndrome

“…LQTS hastalarının preoperatif, intraoperatif ve postoperatif yönetiminde değiştirilebilir risk faktörleri hayati önem taşımaktadır. Pre-operatif dönemde beta bloker tedavisi altında olan hastaların aksi gerekmedikçe beta bloker tedavilerinin aksatılmaması, majör işitsel uyaranlardan kaçınmak için sessiz operasyon odasının sağlanması, pre operatif anksiyetenin yönetimi ve postoperatif ağrı palyasyonu, QTc uzatıcı etkisinden dolayı peri-operatif hipotermiden kaçınılması, sempatik tonusu artırabileceğinden dolayı hipoksi ve hipokarbiden kaçınılması gerekliliği literatürde belirtilmektedir (2) . Hastaların intraoperatif yakın EKG ve QT monitörizasyonu hayati önem taşımaktadır.…”

“…Yüzeyel EKG'lerinde LQTS tanısı konan hastalarda ise belirgin hipotermiden kaçınılması, preoperatif ve intraoperatif katekolaminerjik deşarjdan kaçınılması, postoperatif efektif analjezinin uygulanması önem taşımaktadır. Anestezi indüksiyonunda ve idamesinde QT uzamasına yol açmayan ajanların kullanılması önerilmektedir (2) .…”