Torsade de pointes in liver transplantation recipient after induction of general anesthesia: a case report

Chung, Eun Jin; Jeon, Yun Seok; Kim, Hyun Joo; Lee, Kook Hyun; Lee, Ji Won; Han, Kyoung Ah

doi:10.4097/kjae.2014.66.1.80

Cited by 11 publications

(7 citation statements)

References 16 publications

(26 reference statements)

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“…Although investigators evaluating the effect of prolonged QTc on mortality in cirrhotic patients have reported conflicting results, none has evaluated its effect on outcomes after OLT . Despite anecdotal reports of life‐threatening arrhythmias occurring in patients with prolonged QTc during OLT, it is certainly an uncommon occurrence. However, abnormal cardiac repolarization might indirectly contribute to mortality during stressful scenarios like surgery or infection.…”

Section: Discussionmentioning

confidence: 99%

Impact and persistence of cirrhotic cardiomyopathy after liver transplantation

Sonny

Ibrahim

Schuster

et al. 2016

Clinical Transplantation

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Cirrhotic cardiomyopathy causes variable degree of systolic and diastolic dysfunction (DD) and conduction abnormalities. The primary aim of our study was to determine whether pre-transplant DD and prolonged corrected QT (QTc) predict a composite of mortality, graft failure, and major cardiovascular events after liver transplantation. We also evaluated the reversibility of cirrhotic cardiomyopathy after transplantation. Adult patients who underwent liver transplantation at our institution from January 2007 to March 2009 were included. Data were obtained from institutional registry, medical record review, and evaluation of echocardiographic images. Among 243 patients, 113 (46.5%) had grade 1 DD, 16 (6.6%) had grade 2 DD, and none had grade 3 DD. The mean pre-transplant QTc was 453 milliseconds. After a mean post-transplant follow-up of 5.2 years, 75 (31%) patients satisfied the primary composite outcome. Cox regression analysis did not show any significant association between DD and the composite outcome (P=.17). However, longer QTc was independently associated with the composite outcome (HR: 1.01, 95% confidence interval: 1.00-1.02, P=.05). DD (P<.001) and left ventricular mass index (P=.001) worsened after transplantation. In conclusion, QTc prolongation appears to be associated with worse outcomes. Although DD did not impact outcomes, it significantly worsened after transplantation.

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Section: Discussionmentioning

confidence: 99%

Impact and persistence of cirrhotic cardiomyopathy after liver transplantation

Sonny

Ibrahim

Schuster

et al. 2016

Clinical Transplantation

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“…Similarly, halogenated volatile anesthetics (halothane, enflurane, isoflurane, desflurane, sevoflurane) are among the drugs that cause QTc interval prolongation, and they should therefore be avoided in anesthetic procedures in LQTS and liver cirrhosis patients, due to the increased risk of perioperative malignant ventricular arrhythmias [31]. Recently, Chung et al presented a case report on a patient with liver cirrhosis scheduled for emergency cadaveric donor liver transplantation who developed TdP after sevoflurane use during general anesthesia [32]. Di Micoli et al showed TdP in a patient with decompensated liver cirrhosis during amiodarone infusion because of new-onset atrial fibrillation [33].…”

Section: Discussionmentioning

confidence: 99%

QT Interval Prolongation and QRS Voltage Reduction in Patients with Liver Cirrhosis

Cichoż‐Lach¹,

Tomaszewski²,

Kowalik³

et al. 2015

Adv Clin Exp Med

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Background. Liver cirrhosis is associated with functional abnormalities of the cardiovascular system with coexisting electrocardiographic (ECG) abnormalities. Objectives.The aim was to analyze ECG changes in patients with cirrhosis, to evaluate whether alcoholic etiology of cirrhosis and ascites has an impact on ECG changes. Material and Methods. The study involved 81 patients with previously untreated alcoholic cirrhosis (64 patients with ascites, classes B and C according to the Child-Pugh classification; and 17 without ascites, categorized as class A); 41 patients with previously untreated cirrhosis due to chronic hepatitis C (HCV -30 patients with ascites, classes B and C; and 11 without ascites, class A); 42 with alcoholic steatohepatitis and 46 with alcoholic steatosis. The control group consisted of 32 healthy volunteers. Twelve-lead ECG recordings were performed and selected parameters were measured. Results. Significantly longer QT and QTc intervals and lower QRS voltage were found in patients with alcoholic and HCV cirrhosis compared to the controls. Significantly lower QRS voltage was found in subjects with ascites than in those without ascites. Removal of ascites significantly increased QRS voltage. Conclusions. In cirrhosis, irrespective of etiology, ECG changes involved prolonged QT and QTc intervals and reduced QRS voltage. Prolonged QT and QTc intervals were not related to the severity of cirrhosis or to the presence of ascites. However, low QRS voltage was associated with the presence of ascites. Removal of ascites reverses low QRS voltage (Adv Clin Exp Med 2015, 24, 4, 615-622).

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“…[ 1 ] Bal and Thuluvath observed no survival differences in patients with and without prolonged QTc interval, but life-threatening ventricular arrhythmia is reported consequent to a prolonged QTc interval in cirrhosis during stress. [ 1 2 3 4 ] In our recipient, pre-operative prolonged QTc interval (470 ms) increased to peak in neohepatic phase (625 ms). Multiple blood transfusions could have led to hypomagnesaemia at the cellular levels, contributing to rhythm disorder.…”

mentioning

confidence: 72%

“…Torsade de pointes is reported at varied stages (after anaesthetic induction, dissection phase, caval clamping in anhepatic or portal vein unclamping in neohepatic phase) of liver transplantation. [ 2 3 ] Amiodarone, 5-HT3 antagonists and sevoflurane may prove detrimental by aggravating QTc prolongation. [ 3 ] A list of known drugs to cause QTc prolongation is shown in Table 1 .…”

mentioning

confidence: 99%