Abstract Background Dental
anesthetic management in
implantable cardioverter defibrillator (ICD) recipients with cardiac
channelopathies (CCh) can be challenging due to the potential
risk of
life-threatening arrhythmias and appropriate ICD
therapies during procedural
time. Objectives The present study assessed the hypothesis that the use of local
dental anesthesia with 2%
lidocaine with 1100,000
epinephrine or without a
vasoconstrictor can be safe in selected ICD and CCh
patients, not resulting in
life-threatening events (LTE).
Methods 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.
Statistical analysis carried out the paired
Student's t test and the Wilcoxon signed-rank test. In all cases, a significance level of 5% was adopted. All
patients were in stable condition with no recent events before
dental care. Results Twenty-four consecutive
procedures were performed in 12
patients (9
women, 3
men) with CCh and ICD 7 (58.3%) had
long QT syndrome (LQTS), 4 (33.3%)
Brugada syndrome (BrS), and 1 (8.3%) Catecholaminergic polymorphic
ventricular tachycardia (CPVT). Holter
analysis showed no increased
heart rate (HR) or sustained arrhythmias.
Blood pressure (BP), electrocardiographic changes and
anxiety measurement showed no statistically significant differences. No LTE occurred during dental
treatment, regardless of the type of
anesthesia. Conclusion
Lidocaine administration, with or without
epinephrine, can be safely used in selected CCh-ICD
patients without LTE. These preliminary findings need to be confirmed in a larger
population with ICD and CCh.