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Favorable safety experience of local dental anesthesia in ICD recipients with channelopathies
  • +15
  • Ana Carolina Oliveira,
  • Itamara Neves,
  • Luciana Sacilotto,
  • Natália Olivetti,
  • Savia Bueno,
  • Gabrielle Pessente,
  • Marcela Paul,
  • Tânia Montano,
  • Cíntia Carvalho,
  • Cesar Grupi,
  • Sílvio Barbosa,
  • Carlos Alberto Pastore,
  • Nelson Samesima,
  • Tan Wu,
  • Denise Hachul,
  • Mauricio Scanavacca,
  • Ricardo Neves,
  • Francisco Darrieux
Ana Carolina Oliveira
Universidade de Sao Paulo Faculdade de Medicina Hospital das Clinicas Instituto do Coracao
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Itamara Neves
Universidade de Sao Paulo Faculdade de Medicina Hospital das Clinicas Instituto do Coracao
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Luciana Sacilotto
Universidade de Sao Paulo Faculdade de Medicina Hospital das Clinicas Instituto do Coracao
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Natália Olivetti
Universidade de Sao Paulo Faculdade de Medicina Hospital das Clinicas Instituto do Coracao
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Savia Bueno
Universidade de Sao Paulo Faculdade de Medicina Hospital das Clinicas Instituto do Coracao
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Gabrielle Pessente
Universidade de Sao Paulo Faculdade de Medicina Hospital das Clinicas Instituto do Coracao
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Marcela Paul
Universidade de Sao Paulo Faculdade de Medicina Hospital das Clinicas Instituto do Coracao
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Tânia Montano
Universidade de Sao Paulo Faculdade de Medicina Hospital das Clinicas Instituto do Coracao
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Cíntia Carvalho
Universidade de Sao Paulo Faculdade de Medicina Hospital das Clinicas Instituto do Coracao
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Cesar Grupi
Universidade de Sao Paulo Faculdade de Medicina Hospital das Clinicas Instituto do Coracao
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Sílvio Barbosa
Universidade de Sao Paulo Faculdade de Medicina Hospital das Clinicas Instituto do Coracao
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Carlos Alberto Pastore
Universidade de Sao Paulo Faculdade de Medicina Hospital das Clinicas Instituto do Coracao
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Nelson Samesima
Universidade de Sao Paulo Faculdade de Medicina Hospital das Clinicas Instituto do Coracao
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Tan Wu
Universidade de Sao Paulo Faculdade de Medicina Hospital das Clinicas Instituto do Coracao
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Denise Hachul
Universidade de Sao Paulo Faculdade de Medicina Hospital das Clinicas Instituto do Coracao
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Mauricio Scanavacca
Universidade de Sao Paulo Faculdade de Medicina Hospital das Clinicas Instituto do Coracao
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Ricardo Neves
Universidade de Sao Paulo Faculdade de Medicina Hospital das Clinicas Instituto do Coracao
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Francisco Darrieux
Universidade de Sao Paulo Faculdade de Medicina Hospital das Clinicas Instituto do Coracao
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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.