Dental treatment of patients with long QT syndrome.

BACKGROUND: Long QT syndrome (LQTS) is associated with life-threatening cardiac arrhythmias causing syncope and sudden cardiac death, frequently precipitated by physical or psychological stress. TYPES OF STUDIES REVIEWED: The authors did a literature review of data published in peer-reviewed medical and dental journals. They also extracted epidemiologic information, correlations between genetic mutations and disease onset and progression, and data regarding outcomes of therapy from published peer-reviewed studies and the cohort population belonging to the International Long QT Syndrome Registry.
RESULTS: LQTS is diagnosed after an unexpected cardiac event or through QT interval prolongation on an electrocardiogram. Gene mutation identification in LQTS provides insight into respective proarrhythmogenic factors and indicated therapeutic regimens. beta-blockers are the initial treatment for two of the three major forms of LQTS. Patients refractory to beta-antiadrenergic therapy may benefit from one or more of the following: cardiac pacemakers, implanted cardioverter defibrillators and left cardiac sympathetic denervation.
CONCLUSIONS: Clinical studies are needed to investigate the safety of treating patients in an ambulatory setting. CLINICAL IMPLICATIONS: Preventive measures are recommended, including evaluation by a cardiac specialist before any dental intervention, use of anxiolytic protocols, avoidance of drugs that prolong the QT interval, and provision of treatment in a setting in which medical emergencies can be managed expeditiously. Dental treatment in a hospital and use of a general anesthetic administered by anesthesiologists are recommended for procedures in which anxiety and adrenergic stimulation would not be suppressed sufficiently in an ambulatory environment.