Anesthetic management in patients with long QT and Brugada syndromes

Both long QT and Brugada syndrome are inherited arrhythmic conditions that can predispose patients to life-threatening ventricular arrhythmias. Managing the anesthesia for patients with either long QT or Brugada syndrome necessitates an understanding of potential drug-drug interactions with the underlying channelopathy. This review illustrates contemporary insight into managing such patients for the anesthesiologist.

Long QT, due to disorder of potassium or sodium ion channels, is associated with prolonged repolarization of the action potential phase. Medications that prolong the action potential should be avoided. In patients with long QT syndrome, each drug administered should be carefully reviewed to be certain it does not prolong the QT interval. Brugada syndrome is a result of a pathogenic sodium channel that results in potential ventricular arrhythmias. Medications that exacerbate the electrocardiographic changes of Brugada should be avoided.

Anesthesiologists need to be aware of proper management in children with known or suspected long QT or Brugada pathologies as well as the potential poly-pharmaceutical impact that exists on cardiac ion channels.