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Brief review: Anesthetic implications of long QT syndrome in pregnancy

[Article de synthèse court : Implications anesthésiques du syndrome du QT long pendant la grossesse]

From the Department of Anesthesia, BC Women’s Hospital, Vancouver, British Columbia, Canada.

Address correspondence to: Dr. Elizabeth Drake, Department of Anesthesia, BC Women’s Hospital, 4500 Oak Street, Vancouver, British Columbia V6H 3N1, Canada. Phone: 604-875-2158; Fax: 604-875-2733; E-mail: edrake{at}cw.bc.ca

Purpose: To review the effects of the long QT syndrome (LQTS) in the parturient and the current anesthetic management of patients with LQTS.

Source: Relevant articles were obtained from a MEDLINE search spanning the years 1980–2006 and a PubMed search spanning the years 1949–2006. Bibliographies of retrieved articles were searched for additional articles.

Principal findings: The prevalence of LQTS in the developed world is one per 1,100 to 3,000 of the population. Clinically, LQTS is characterized by syncope, cardiac arrest and occasionally, by a history of seizures. The QT interval can also be prolonged by drugs, electrolyte imbalances, toxins and certain medical conditions. Long QT syndrome patients are at risk of torsades de pointes and ventricular fibrillation. Medical management aims to reduce dysrhythmia frequency. The LQTS is subdivided into different groups (LQT1–6) depending on the cardiac ion channel abnormality. Torsades can be precipitated by adrenergic stimuli such as stress or pain (LQT1 and 2), sudden noises (LQT2) or whilst sleeping (LQT3). Patients with LQTS require careful anesthetic management as they are at high risk of torsades perioperatively despite minimal data on the effects of anesthetic agents on the QT interval. While information on effects of LQTS in pregnancy is limited, the incidence of dysrhythmia increases postpartum. Isolated case reports of patients with LQTS women highlight several peripartum dysrhythmias.

Conclusion: An understanding of LQTS and the associated risk factors contributing to dysrhythmias is important for anesthesthesiologists caring for parturients with LQTS.