Sevoflurane prolonged the QTc interval and increased transmural dispersion of repolarization in a patient with long QT syndrome 3: a case report

Atsuhiro Kitaura,Seishi Kimura,Shinichi Nakao,Kei Houri,Shinichi Hamasaki,Takatoshi Tsujimoto,Mayuka Matsushima

doi:10.1186/s40981-017-0093-6

Abstract

We report that sevoflurane not only caused marked QTc interval prolongation but also increased transmural dispersion of repolarization in a patient with long QT syndrome 3 (LQT3). A 16-year-old male with LQT3 underwent a shoulder operation. He experienced no episode of syncope or cardiac arrest, but his preoperative electrocardiography (ECG) showed marked QTc interval prolongation (631 ms) and Tp-e interval prolongation (126 ms). Anesthesia was induced with propofol and maintained with 2% sevoflurane and remifentanil. Although no lethal arrhythmias occurred in the perioperative period, not only the QTc interval but also Tp-e interval was further prolonged by sevoflurane. While sevoflurane has been recognized as a safe anesthetic in terms of QT interval prolongation, even in patients with long QT syndromes, we believe that sevoflurane might be avoided for poorly controlled LQT3 patients.

Highlights

Congenital long QT syndrome (LQTS) is a genetic disease characterized by a prolonged QT interval on electrocardiography (ECG), lethal arrhythmias, such as torsades de pointes (TdP) and ventricular fibrillation (VF), and higher chance of sudden cardiac death [1]
The most frequent LQTS subtypes are type 1 (LQT1), which accounts for 42% of all LQTS cases, type 2 (LQT2), which accounts for 45%, and type 3 (LQT3), which accounts for 5% [2]
We describe the anesthetic management of a patient with long QT syndrome 3 (LQT3), and in addition report the effects of sevoflurane, which inhibits delayed rectifier potassium channels [3, 4], on both the QTc interval and the interval between the peak and end of the T wave (Tp-e), a surrogate of ventricular transmural dispersion of repolarization [5, 6]

Summary

Background

Congenital long QT syndrome (LQTS) is a genetic disease characterized by a prolonged QT interval on electrocardiography (ECG), lethal arrhythmias, such as torsades de pointes (TdP) and ventricular fibrillation (VF), and higher chance of sudden cardiac death [1]. Case presentation A 16-year-old male (height, 166 cm; weight, 60 kg), who had been diagnosed with congenital long QT syndrome type (LQT 3) by ECG and genetic examination, was scheduled to undergo the removal of the implant in his right shoulder and had consulted a doctor in the pediatrics department of our hospital. He had not experienced any episode of syncope or cardiac arrest, and he had not been administered any medication due to the refusal of both himself and his mother. The patient’s intraoperative and post-operative courses were uneventful

Discussion

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Conclusions