Anesthetic Management of a Patient with Congenital Long QT Syndrome: A case report

Koo, Bon Nyeo; Kang, One Chul; Kim, Ki Beom; Park, Wyun Kon; Kil, Hae Keum

doi:10.4097/kjae.2004.46.6.743

Cited by 4 publications

(4 citation statements)

References 20 publications

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“…If these treatments are ineffective, defibrillation is required [Tounsi 2012]. In addition, patients may require temporary transvenous pacing, which is specifically effective in pause-dependent QT prolongation [Koo 2004]. Febrile infection has been identified as a predisposing factor for QT prolongation and torsades de pointes [Tounsi 2012].…”

Section: Discussionmentioning

confidence: 99%

Torsades de Pointes in Intravenous Drug Abuse–Associated Infective Endocarditis

Eapen

Firstenberg

2018

HSF

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Intravenous drug abuse rates in the United States have increased exponentially in recent years. Ohio is one of 5 states with the highest age-adjusted drug overdose death rates, with drug overdose causing 39.1 of every 100,000 deaths. In patients who survive, the associated morbidity poses a significant public health burden. Infective endocarditis, defined as an infection of the endocardium of the heart, is a potentially lethal consequence of bacteremia related to intravenous drug abuse. Methicillin-sensitive Staphylococcus aureus (MSSA) is the most commonly implicated organism and may affect the tricuspid valve. Indications for surgery include failure of medical management, worsening embolization, heart failure, and arrhythmias—typically bradyarrhythmias from infectious extension into the conduction system. Vegetation size and type of infection, such as drug-resistance pattern, fungal infection, and presence of prosthetic material, are becoming known risk factors for complications. Studies have demonstrated that early surgery tends to have a better prognosis than delayed intervention. Established guidelines for right-sided surgery are slowly evolving. Tricuspid valve surgery is becoming more common in these cases, but there is known risk for heart block owing to proximity of the conduction system to the tricuspid valve annulus. If patients develop complete heart block postoperatively, pacemaker placement may be indicated. There may be reluctance to implantation because of the risk of device infection with infective endocarditis. In addition, many may recover conduction as infection and edema resolve. Generally, bradyarrhythmias are well tolerated. However, we present 2 cases of torsades de pointes related to post-tricuspid-valve-replacement bradyarrhythmia. Torsades de pointes is a potentially lethal form of polymorphic ventricular arrhythmia associated with QT interval prolongation. Post-tricuspid-valve- replacement mortality may be secondary to induced lethal ventricular arrhythmias.

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Section: Discussionmentioning

confidence: 99%

Torsades de Pointes in Intravenous Drug Abuse–Associated Infective Endocarditis

Eapen

Firstenberg

2018

HSF

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“…Temporary transvenous pacing is an effective way of controlling TdP. Pacing is particularly effective in pause-dependent long QT syndrome [ 14 ]. If all of these treatments are ineffective, defibrillator should be carried out.…”

Section: Discussionmentioning

confidence: 99%

QT Prolongation Complicated with Torsades de Pointes in Prosthetic Mitral Valve Endocarditis: A Case Report

Tounsi

Abid

Akrout

et al. 2012

Case Reports in Medicine

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We present the case of a 49-year-old male patient with prosthetic mitral valve endocarditis associated with QT prolongation and torsades de pointes. He was asymptomatic until the end of January 2012, when he was admitted to our hospital emergency unit because of syncope, fever, and suspicion of endocarditis. Cardiologic evaluation was requested and the transthoracic (TTE) and transesophageal (TEE) echocardiograms revealed vegetations on the prosthetic mitral valve. All cultures were positive for methicillin-sensitive Staphylococcus aureus. The corrected QT (QTc) interval was markedly prolonged upon admission (QTc 540 ms). He experienced torsades de pointes (TdP) several times and he was recovered after bystander cardiopulmonary resuscitation. The clinical course and the long QTc interval with deep inverted T wave were completely normalized 4 weeks after. He continued on triple antibiotic therapy for 45 days with a good revolution. The clinical features and the possible mechanisms of QT prolongation (inflammation, infection) of this patient are discussed.

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“…Temporary transvenous pacing is an effective way of controlling TdP. Pacing is particularly effective in pause-dependent LQTS [ 15 ]. If all of these treatments are ineffective, defibrillator should be carried out.…”

Section: Discussionmentioning

confidence: 99%

Postanesthetic torsade de pointes in a patient with unrecognized long QT syndrome -A case report-

Lee

et al. 2011

Korean J Anesthesiol

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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.

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Anesthetic Management of a Patient with Congenital Long QT Syndrome: A case report

Cited by 4 publications

References 20 publications

Torsades de Pointes in Intravenous Drug Abuse–Associated Infective Endocarditis

Torsades de Pointes in Intravenous Drug Abuse–Associated Infective Endocarditis

QT Prolongation Complicated with Torsades de Pointes in Prosthetic Mitral Valve Endocarditis: A Case Report

Postanesthetic torsade de pointes in a patient with unrecognized long QT syndrome -A case report-

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