Brief review: Anesthetic implications of long QT syndrome in pregnancy

• Published in: Canadian journal of anesthesia 2007-07, Vol.54 (7), p.561
• Main Authors: Drake, Elizabeth, Preston, Roanne, Douglas, Joanne
• Format: Article
• Language: English
• Subjects: Bibliographic literature; Cardiac arrhythmia; Drug therapy; Long QT syndrome
• ISSN: 0832-610X; 1496-8975
• DOI: 10.1007/BF03022321

To review the effects of the long QT syndrome (LQTS) in the parturient and the current anesthetic management of patients with LQTS. 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. 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. An understanding of LQTS and the associated risk factors contributing to dysrhythmias is important for anesthesthesiologists caring for parturients with LQTS. 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. 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. 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 charg