P023: ANESTHETIC MANAGEMENT OF PATIENT WITH CONGENITAL LONG QT SYNDROME IN PATIENT UNDERGOING NON-CARDIAC SURGERY
Shayla A McMahon, DO; Tyler Chonis, MD; Jessica Alonso, MD; Omar Chahine, DO; Jackeline Porto, MD
HCA Kendall Hospital
Introduction: Long QT syndrome (LQTS) is an inherited cardiac channelopathy associated with delayed ventricular repolarization and an increased risk of malignant arrhythmias, including torsades de pointes. The perioperative period presents unique challenges for patients with LQTS due to physiologic stress, electrolyte shifts, and exposure to medications that may further prolong the QT interval. Although these patients frequently present for non-cardiac procedures, guidance on anesthetic management is largely based on expert opinion and case reports. We present a case of anesthetic management in a patient with known LQTS undergoing non-cardiac surgery, highlighting practical perioperative considerations.
Methods: We report the perioperative course of a 34-year-old woman with genetically confirmed congenital LQTS who presented for elective non-cardiac surgery under general anesthesia. Preoperative evaluation included review of baseline electrocardiography, arrhythmia history, and chronic medical therapy. Perioperative management focused on continuation of beta-blockade, correction of electrolyte abnormalities, and avoidance of medications known to prolong the QT interval. Intraoperative anesthetic technique, monitoring strategies, and postoperative disposition were reviewed.
Results: Preoperative electrocardiogram demonstrated a markedly prolonged QTc interval (>500 ms). The patient remained on her home beta-blocker therapy and had normal serum electrolytes prior to induction. Anesthetic management prioritized minimizing sympathetic stimulation during induction and emergence and avoiding QT-prolonging agents when alternatives were available. Continuous ECG monitoring was maintained throughout the case. The surgical procedure was completed without hemodynamic instability or ventricular arrhythmia. Postoperatively, the patient was monitored on telemetry and had an uncomplicated recovery without QT-related events.
Discussion: This case illustrates key anesthetic considerations in patients with LQTS presenting for non-cardiac surgery. Maintenance of beta-blockade, electrolyte optimization, careful medication selection, and close perioperative monitoring are central to reducing arrhythmic risk. Given the frequency with which commonly used perioperative drugs may affect ventricular repolarization, anesthesiologists must remain vigilant when caring for this population. While no single anesthetic technique is universally recommended, thoughtful planning and anticipation of triggers for sympathetic activation can allow for safe anesthetic care in patients with LQTS.