Is It Safe for Patients With Cardiac Channelopathies to Undergo Routine Dental Care? Experience From a Single-Center Study

Autor(es):Mostrar menos -

Guimaraes Oliveira, Ana Carolina ^[1] ; Itagiba Neves, Itamara Lucia ^[1] ; Sacilotto, Luciana ^[2] ; Sangiorgi Olivetti, Natalia Quintella ^[2] ; dos Santos-Paul, Marcela Alves ^[1] ; Pedroso Montano, Tania Cristina ^[1] ; Alencar Carvalho, Cintia Maria ^[1] ; Wu, Tan Chen ^[2] ; Grupi, Cesar Jose ^[3] ; Barbosa, Silvio Alves ^[3] ; Pastore, Carlos Alberto ^[3] ; Samesima, Nelson ^[3] ; Hachul, Denise Tessariol ^[2] ; Scanavacca, Mauricio Ibrahim ^[2] ; Neves, Ricardo Simoes ^[1] ; Costa Darrieux, Francisco Carlos ^[2]

Afiliação do(s) autor(es)

^[1] Univ Sao Paulo, Fac Med, Hosp Clin HCFMUSP, Inst Coracao, Unidade Odontol, Sao Paulo - Brazil

^[2] Univ Sao Paulo, Fac Med, Hosp Clin HCFMUSP, Inst Coracao, Nucleo Clin Cirurg Arritmias Cardiac, Sao Paulo - Brazil

^[3] Univ Sao Paulo, Fac Med, Hosp Clin HCFMUSP, Inst Coracao, Unidade Eletrocardiog, Sao Paulo - Brazil

• Tipo de documento: Artigo Científico
• Fonte: JOURNAL OF THE AMERICAN HEART ASSOCIATION; v. 8, n. 15 AUG 6 2019.
• Citações Web of Science: 0

Resumo

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. (AU)

• Processo FAPESP: 13/24283-1 - Efeitos da anestesia local odontológica com adrenalina em portadores de canalopatias cardíacas
• Beneficiário: Francisco Carlos da Costa Darrieux
• Modalidade de apoio: Auxílio à Pesquisa - Regular