Síndrome de QT largo, Torsades des Pointes y anestesia

Torsades de pointes en un paciente con síndrome QT largo no conocido. Informe de caso Postanesthetic torsade de pointes in a patient with unrecognized long QT syndrome -A case report-. Lee JY, Lee JH, An EH, Song JG, Park PH. Korean J Anesthesiol. 2011 Apr;60(4):294-7. Epub 2011 Apr 26. Department of Anesthesiology and Pain Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. Abstract Torsade de pointes (TdP) is a devastating form of polymorphic ventricular arrhythmia associated with corrected QT (QTc) interval prolongation. TdP usually terminates spontaneously but frequently recurs and may degenerate to ventricular fibrillation. The present report describes a case of TdP in a patient being transferred to the postanesthetic care unit following an emergency laparoscopic appendectomy. The patient had undergone open heart surgery 1 week before. Retrospective electrocardiogram analysis revealed the patient had QTc and Tpeak-Tend interval prolongation that had gone unrecognized. We believe TdP may have been induced by accentuation of sympathetic nervous system during emergence from general anesthesia. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3092967/pdf/kjae-60-294.pdf    Síndrome de QT largo provocado por la inducción de anestesia general. Informe de caso Long QT syndrome provoked by induction of general anesthesia -A case report-. Kim HT, Lee JH, Park IB, Heo HE, Kim TY, Lee MJ. Department of Anesthesiology and Pain Medicine, Presbyterian Medical Center, Jeonju, Korea. Korean J Anesthesiol. 2010 Dec;59 Suppl:S114-8. Epub 2010 Dec 31. Abstract Long QT syndrome (LQTS) is an arrhythmogenic cardiovascular disorder resulting from mutations in cardiac ion channels. LQTS is characterized by prolonged ventricular repolarization and frequently manifests itself as QT interval prolongation on the electrocardiogram (ECG). A variety of commonly prescribed anesthetic drugs possess the adverse property of prolonging cardiac repolarization and may provoke serious ventricular tachyarrhythmia called 'torsades de pointes', ventricular fibrillation, and sudden death. We experienced a case of ventricular tachycardia and ventricular fibrillation after anesthetic induction and it came out into the open that anesthetic induction provoked long QT syndrome. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3030014/pdf/kjae-59-S114.pdf   Paro cardiaco intraoperatorio en síndrome QT largo adquirido Intraoperative cardiac arrest in acquired long QT syndrome. Dolenska S. Department of Anaesthetics, William Harvey Hospital, Kennington Road, Ashford, Kent TN24 8NU, UK. sylva.dolenska@ekht.nhs.uk Br J Anaesth.2009 Apr;102(4):503-5. Abstract A healthy female sustained a life-threatening arrhythmia and cardiac arrest while undergoing routine surgery under general anaesthesia. Resuscitation was prolonged but successful, with a complete neurological recovery. http://bja.oxfordjournals.org/content/102/4/503.full.pdf+html Anestesia para pacientes con síndrome QT largo congénito Anesthesia for patients with congenital long QT syndrome. Kies SJ, Pabelick CM, Hurley HA, White RD, Ackerman MJ. Department of Anesthesiology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA. Anesthesiology. 2005 Jan;102(1):204-10. Abstract Long QT syndrome is a malfunction of cardiac ion channels resulting in impaired ventricular repolarization that can lead to a characteristic polymorphic ventricular tachycardia known as torsades de pointes. Stressors, by increasing sympathetic tone, and drugs can provoke torsade de pointes, leading to syncope, seizures, or sudden cardiac death in these patients. Beta blockade, implantation of cardioverter defibrillators, and left cardiac sympathetic denervation are used in the treatment of these patients. However, these treatment modalities do not guarantee the prevention of sudden cardiac death. Certain drugs, including anesthetic agents, are known to contribute to QT prolongation. After reviewing the literature the authors give recommendations for the anesthetic management of these patients in the perioperative period. http://journals.lww.com/anesthesiology/pages/articleviewer.aspx?year=2005&issue=01000&article=00029&type=abstract

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