INTRODUCTION
Implantable cardioverter defibrillator (ICD)
detects ventricular
tachycardia (VT)
and ventricular
fibrillation (VF) and delivers therapy in the form of
overdrive antitachycardia
pacing (ATP),
low-energy cardioversion,
and high-energy
defibrillation1. It is
indicated for patients at high risk for malignant ventricular
tachyarrhythmias (primary prophylaxis) and in patients who have survived
from a malignant ventricular tachycardia (secondary
prophylaxis)2.
ICD remains an effective therapeutic option to prevent sudden death,
with favourable profile in the natural history of cardiac
channelopathies (CCh)3,
which are inherited cardiac ion channels disorders associated with
potential ventricular arrhythmias and sudden death in the presence of a
structurally normal
heart4,
5. The most prevalent CCh are congenital
long QT syndrome (LQTS), Brugada syndrome (BrS) and catecholaminergic
polymorphic ventricular tachycardia (CPVT), which account for
approximately one-third of unexplained sudden
deaths6,
7.
The treatment goal of CCh is to avoid arrhythmias and sudden death and
it remains a challenge. Beta-blockers for LQTS and CPVT, and quinidine
for BrS, have generally been used for therapeutic optimization,
minimizing repolarization changes and also reducing ventricular
arrhythmias. In cases of syncope, torsade de pointes or cardiac arrest
requiring cardiopulmonary resuscitation, ICD and/or cardiac sympathetic
denervation are often the treatment
choices8.
With increased awareness of genetic arrhythmogenic disorders, the rate
of ICD implantation in young adult population is also increasing.
Patients can be submitted to conventional (sub/supra pectoral) ICD
implantation or subcostal
approach9. The vast
majority of devices employ bipolar leads, resulting in less
susceptibility to electromagnetic interference
(EMI)2.
Many studies assessed if magnetic electrical and electromagnetic fields
from dental devices could affect cardiovascular implantable electronic
devices (CIEDs). Electric toothbrush, amalgamator, high- and low-speed
handpieces, endodontic heat carriers, electric pulp tester, apex
locators, wired curing light unit and piezoelectric unit do not altering
pacing function10-13.
Ultrasonic scalers and ultrasonic cleaning systems could interfere with
CIEDs, but those EMI events may not be clinically
significant14,
15. Unipolar electrosurgery units
produce electromagnetic disturbances that may possibly affect the
function of ICD by delivering an unintentional
shock10.
However, dental anesthetic management of patients with ICD are limited
to case reports16,
17. These patients demand adequate care
and analgesia because of the potential risk of life-threatening events
(LTE) such as sustained ventricular tachycardias, ICD therapies during
the intervention and arrhythmic
syncope18. It is
crucial to provide a wary dental treatment environment averting triggers
for arrhythmic events, such as emotional stress, auditory stimuli or
increased vagal tone19,
20. Dentists should obtain a detailed
medical history of patients with ICD and preferably with a cardiologist
background21.
It is important to emphasize that the use of local dental anesthesia in
ICD recipients requires basic knowledge in order to avoid eminent
complications in patients with risk of sudden cardiac death. In our
previous study22, the
use of local dental anesthesia with and without epinephrine in selected
stable patients with LQTS and BrS did not result in life-threatening
arrhythmias, though the maximum heart rate increased after the use of
vasoconstrictor during the anesthesia period. We decided to make a
subanalysis in cases with CCh and ICD recipients.
The aim of our study was to ascertain the safety of lidocaine 2% with
and without epinephrine 1:100,000 in patients with CCh and ICD.