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

Ana Carolina Guimarães Oliveira, Itamara Lucia Itagiba Neves, Luciana Sacilotto, Natália Quintella Sangiorgi Olivetti, Marcela Alves Dos Santos-Paul, Tânia Cristina Pedroso Montano, Cíntia Maria Alencar Carvalho, Tan Chen Wu, Cesar José Grupi, Sílvio Alves Barbosa, Carlos Alberto Pastore, Nelson Samesima, Denise Tessariol Hachul, Maurício Ibrahim Scanavacca, Ricardo Simões Neves, Francisco Carlos Costa Darrieux, Ana Carolina Guimarães Oliveira, Itamara Lucia Itagiba Neves, Luciana Sacilotto, Natália Quintella Sangiorgi Olivetti, Marcela Alves Dos Santos-Paul, Tânia Cristina Pedroso Montano, Cíntia Maria Alencar Carvalho, Tan Chen Wu, Cesar José Grupi, Sílvio Alves Barbosa, Carlos Alberto Pastore, Nelson Samesima, Denise Tessariol Hachul, Maurício Ibrahim Scanavacca, Ricardo Simões Neves, Francisco Carlos Costa Darrieux

Abstract

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. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT03182777.

Keywords: anesthesia; arrhythmia; channelopathies; epinephrine; lidocaine.

Figures

Figure 1
Figure 1
Central illustration with dental procedure study periods. BrS indicates Brugada syndrome; LQTS, long‐QT syndrome.
Figure 2
Figure 2
Mean values and respective SDs of maximum heart rate in each study period and comparison results. Bpm indicates beats per minute.

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