Canadian Journal of Anesthesia

, Volume 54, Issue 7, pp 561–572 | Cite as

Brief review: Anesthetic implications of long QT syndrome in pregnancy

Review Articles/Brief Reviews

Abstract

Purpose

To review the effects of the long QT syndrome (LQTS) in the parturient and the current anesthetic management of patients with LQTS.

Source

Relevant articles were obtained from a MEDLINE search spanning the years 1980–2006 and a PubMed search spanning the years 1949–2006. Bibliographies of retrieved articles were searched for additional articles.

Principal findings

The prevalence of LQTS in the developed world is one per 1,100 to 3,000 of the population. Clinically, LQTS is characterized by syncope, cardiac arrest and occasionally, by a history of seizures. The QT interval can also be prolonged by drugs, electrolyte imbalances, toxins and certain medical conditions. Long QT syndrome patients are at risk of torsades de pointes and ventricular fibrillation. Medical management aims to reduce dysrhythmia frequency. The LQTS is subdivided into different groups (LQT1-6) depending on the cardiac ion channel abnormality. Torsades can be precipitated by adrenergic stimuli such as stress or pain (LQT1 and 2), sudden noises (LQT2) or whilst sleeping (LQT3). Patients with LQTS require careful anesthetic management as they are at high risk of torsades perioperatively despite minimal data on the effects of anesthetic agents on the QT interval. While information on effects of LQTS in pregnancy is limited, the incidence of dysrhythmia increases postpartum. Isolated case reports of patients with LQTS women highlight several peripartum dysrhythmias.

Conclusion

An understanding of LQTS and the associated risk factors contributing to dysrhythmias is important for anesthesthesiologists caring for parturients with LQTS.

Objectif

Passer en revue les effets du syndrome du QT long (LQTS) chez les parturientes ainsi que la prise en charge actuelle des patientes souffrant du LQTS.

Source

Les articles pertinents ont été obtenus d’une recherche sur MEDLINE allant de 1980 à 2006 et d’une recherche sur PubMed couvrant la période allant de 1949 à 2006. Les bibliographies des articles trouvés ont été analysées afin de trouver des articles supplémentaires sur le sujet.

Constatations principales

Dans les pays développés, la prévalence du LQTS est de un cas sur 1100 à 3000 personnes. Le LQTS est cliniquement caractérisé par des syncopes, un arrêt cardiaque et, occasionnellement, par des antécédents de convulsions. L’intervalle QT peut également être prolongé par des médicaments, des déséquilibres électrolytiques, des toxines et certains états de santé. Les patients souffrant du LQTS sont à risque de torsades de pointes et de fibrillation ventriculaire. La prise en charge médicale vise à réduire la fréquence des dysrythmies. Le LQTS se divise en plusieurs sous-groupes (LQT1-6) selon l’anormalité du canal ionique cardiaque. Les torsades peuvent être précipitées par des stimuli adrénergiques tels que le stress ou la douleur (LQT1 ou 2), les bruits soudains (LQT2) ou pendant le sommeil (LQT3). Les patients souffrant du LQTS nécessitent une prise en charge anesthésique prudente, étant donné qu’ils présentent un risque élevé de torsades avant, pendant et après la chirurgie et ce, malgré le peu de données disponibles concernant les effets des agents anesthésiques sur l’intervalle QT. Bien que les informations au sujet des effets du LQTS sur la grossesse soient limitées, il a été observé que l’incidence de la dysrythmie augmente en post-partum. Des rapports de cas isolés de patientes souffrant du LQTS soulignent de nombreuses dysrythmies périnatales.

Conclusion

Une meilleure compréhension du LQTS et des facteurs de risques associés contribuant aux dysrythmies est importante pour les anesthésiologistes traitant les parturientes souffrant du LQTS.

[Article de synthèse court: Implications anesthésiques du syndrome du QT long pendant la grossesse]

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Copyright information

© Canadian Anesthesiologists 2007

Authors and Affiliations

  • Elizabeth Drake
    • 1
  • Roanne Preston
    • 1
  • Joanne Douglas
    • 1
  1. 1.Department of AnesthesiaBC Women’s HospitalVancouverCanada

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