title: Sevoflurane-associated torsade de pointes in a patient with congenital long QT syndrome genotype 2.
abstract: Although patients with congenital long QT syndrome (c-LQTS) are considered to be at high risk for anesthesia, few reports describe c-LQTS genotype-specific considerations for anesthesia. We describe a case of torsade de pointes (TdP) caused by sevoflurane in a patient with c-LQTS genotype 2 (LQT2). A 39-year-old woman diagnosed with c-LQTS was scheduled for an elective therapeutic abortion. Immediately after starting the operation, the patient developed TdP. Since pulseless ventricular tachycardia was sustained despite intravenous injection of lidocaine, defibrillation was performed. Analysis of the electrocardiogram revealed that the corrected QT interval before anesthesia was 530 ms and 2.0% sevoflurane markedly prolonged the corrected QT interval to 693 ms. Postoperative studies revealed a mutation in the KCNH2 gene. Anesthesiologists should note that patients with LQT2 could be more susceptible to volatile anesthetics than are those with other major genotypes. Genotype-specific management of anesthesia may reduce the risk of developing TdP during the perioperative period.
authors.affiliation: Department of Anesthesiology, University of Occupational and Environmental Health, School of Medicine, Yahatanishiku, Kitakyushu 807-8555, Japan.
authors.forename: Mika
authors.initials: M
authors.lastname: Kumakura
authors.affiliation: Division of Operative Medicine, University of Occupational and Environmental Health, University Hospital, Yahatanishiku, Kitakyushu 807-8555, Japan. Electronic address: kojihara@med.uoeh-u.ac.jp.
authors.forename: Koji
authors.initials: K
authors.lastname: Hara
authors.affiliation: Department of Anesthesiology, University of Occupational and Environmental Health, School of Medicine, Yahatanishiku, Kitakyushu 807-8555, Japan.
authors.forename: Takeyoshi
authors.initials: T
authors.lastname: Sata
mesh_terms: D000032:Abortion, Therapeutic; D000328:Adult; D018685:Anesthetics, Inhalation / Q000009:adverse effects*; D004562:Electrocardiography; D005260:Female; D005838:Genotype; D006801:Humans; D008133:Long QT Syndrome / Q000150:complications* / Q000151:congenital / Q000235:genetics; D008738:Methyl Ethers / Q000009:adverse effects*; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular; D000077149:Sevoflurane; D016171:Torsades de Pointes / Q000139:chemically induced* / Q000209:etiology
chemical_list: D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane
keywords: Congenital long QT syndrome; Genotype 2; Torsade de pointes; Volatile anesthetics