Conduction abnormalities and anaesthesia.
OBJECTIVE
Accurate identification of patients at risk for ventricular arrhythmias is critical to prevent sudden cardiac death. The perioperative period is usually regarded as one of risk for potential triggering conditions. This review focuses on the anaesthesiologic risk of inherited arrhythmias whose aetiology is a mutation in genes encoding cardiac ion channels in the absence of structural heart abnormalities.


RESULTS
Genetic analysis identifies the genes whose expressions generate ion channel and regulating or anchoring subunits; electrophysiology can study the role of each ion current during cardiac fibrillation and develop many tests for risk. There is, however, a great heterogeneity of clinical phenotype and many histological studies detecting structural heart alterations despite negative noninvasive evaluations.


CONCLUSIONS
For some ion channel diseases, a therapy has been established; for others, the therapy and risk stratification are still matters of concern, and it is necessary to evaluate the new tools and tests available. For the highly lethal complication of these 'channellopathies', anaesthesia should proceed with caution in the light of the characteristics of each arrhythmia to prevent complications.
Santambrogio
Luisa
L
Anesthesia and Critical Care Department, Civil Hospital, Legnano, Italy. salamina2003@libero.it
Braschi
Antonio
A
D000758:Anesthesia; D001281:Atrial Fibrillation / Q000503:physiopathology; D004594:Electrophysiology; D006321:Heart / Q000503:physiopathology; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D007473:Ion Channels / Q000502:physiology; D018570:Risk Assessment; D014693:Ventricular Fibrillation / Q000503:physiopathology
D007473:Ion Channels