Safety of Local Dental Anesthesia in Patients With Cardiac Channelopathies

Study Overview
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Brief Summary
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Patients with cardiac channelopathies needing restorative dental treatment will be included in two sessions of the study, using local dental anesthetic: lidocaine 2% with epinephrine and lidocaine 2% without vasoconstrictor. The safety of the use of two cartridges (3.6 mL) will be evaluated. The patients will be their own control and will be assessed by Holter monitoring for 28 hours, blood pressure measurement and anxiety measuring.

Detailed Description
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Patients of Heart Institute of the University of São Paulo with inherited cardiac channelopathies will be included, considering the criteria for inclusion and non-inclusion, after reading and signing the informed consent. They will undergo dental restorative treatment in two sessions, in the morning period, with an interval of at least seven days (wash-out) between them, and the patients will be their own control. In the first session, after randomization, patients will receive lidocaine 2% without vasoconstrictor (LSA) or lidocaine 2% with 1: 100,000 epinephrine (LCA) (cross-over), resulting in two conditions: with adrenaline and without adrenaline. The randomization of the anesthetic solution will be performed by the main researcher, being blind to the performer researcher and to the patient. The injected volume will be 3.6 mL (2 cartridges) of the anesthetic solution, using blocking technique of the inferior alveolar nerve. The patients will be monitored by Holter for 28 hours starting one hour before the procedure, for registration and analysis of cardiac electrical activity during the two sessions. Blood pressure will be monitored with digital sphygmomanometer and anxiety will be measured with Facial Image Scale, both on three occasions: at the beginning of the baseline periods, before starting application of anesthesia and at the end of the proceedings. The results will be analyzed statistically.

Official Title
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Safety of Local Dental Anesthesia in Patients With Cardiac Channelopathies

Conditions
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Channelopathies, Brugada Syndrome, Long QT Syndrome, Ventricular, Tachycardia

Intervention / Treatment
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* Procedure: Dental restorative procedure


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients with any channelopathies below, kept on optimal drug therapy, with or without ICD: Brugada Syndrome, Long QT Syndrome and Catecholaminergic Polymorphic Ventricular Tachycardia Dental caries or unsatisfactory restorations in the mandible, indicating restorative dental treatment Exclusion Criteria: Patients allergic to lidocaine Patients undergoing ICD therapy for less than three months Patients with recurrent syncope in the last three months Patients with sustained arrhythmias documented for less than 3 months Have received epinephrine in the last 24 hours

Ages Eligible for Study
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Minimum Age: 6 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Lidocaine with epinephrine<br>Application of local dental anesthesia with two cartridges (3,6 mL) of lidocaine 2% with epinephrine 1:100.000 for dental restorative procedures in patients with cardiac channelopathies. | Procedure: Dental restorative procedure<br>* Infiltration of two cartridges (3.6 mL) of local anesthetics with 2% lidocaine with or without epinephrine 1:100,000, in two sessions with an interval of seven days between them, in oral mucosa in patients with cardiac channelopathies.<br>|
| Active Comparator: Lidocaine<br>Application of local dental anesthesia with two cartridges (3,6 mL) of lidocaine 2% without vasoconstrictor for dental restorative procedures in patients with cardiac channelopathies. | Procedure: Dental restorative procedure<br>* Infiltration of two cartridges (3.6 mL) of local anesthetics with 2% lidocaine with or without epinephrine 1:100,000, in two sessions with an interval of seven days between them, in oral mucosa in patients with cardiac channelopathies.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| No sustained ventricular tachycardia | No life-threatening arrhythmias and clinical signs and symptoms | during dental procedures | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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arrhythmias, cardiac, channelopathies, death, sudden, genetic testing, electrocardiography, ambulatory, anesthesia, local, dentistry