Favorable safety experience of local dental anesthesia in ICD recipients
with channelopathies
Abstract
Introduction - Dental anesthetic management in ICD recipients with CCh
can be challenging due to the potential risk of life-threatening
arrhythmias and appropriate ICD therapies during procedural time. We
assessed the hypothesis that the use of local dental anesthesia with 2%
lidocaine with 1:100.000 epinephrine or without a vasoconstrictor can be
safe in selected ICD and CCh patients, not resulting in life-threatening
events. Methods and Results - Restorative dental treatment under local
dental anesthesia was made in two sessions, with a wash-out period of 7
days (cross-over trial), conducting with a 28h - Holter monitoring, and
12-lead electrocardiography, digital sphygmomanometry, and anxiety scale
assessments in 3 time periods. Ventricular/supraventricular arrhythmias
frequency, device shocks, corrected QT interval and dynamic changes in
right precordial leads in BrS were also analyzed. All patients were in
stable condition with no recent events before the dental care.
Twenty-four consecutive procedures were performed in 12 patients (9
women, 3 men) with CCh and ICD: 7 (58.3%) had LQTS, 4 (33.3%) had BrS
and 1 (8.3%) had CPVT. Holter analysis did not demonstrated increased
heart rate or sustained arrhythmias. Blood pressure,
electrocardiographic changes and anxiety measurement showed no
statistically significant differences. No life-threatening events
occurred during dental treatment, regardless the type of anesthesia.
Conclusions - Lidocaine administration, with or without epinephrine, can
be safely used in selected CCh-ICD patients without life-threatening
events, as long as the protocol is followed. These preliminary findings
need to be confirmed in a larger population with ICD and CCh.