Keywords:
torsades de pointes
arrhythmias
congenital LQTS
genetic mutations
ECG monitoring
drug-induced LQTS

  • Abstract

    Long QT syndrome (LQTS) poses significant challenges in anesthetic management due to its potential to provoke life-threatening arrhythmias such as Torsades de Pointes, which can lead to sudden cardiac death if not properly managed. This review examines the pathophysiology of LQTS, its classification into congenital and acquired forms, and the associated anesthetic risks, while providing evidence-based strategies for its safe and effective management. Congenital LQTS is subdivided into LQT1, LQT2, and LQT3, each associated with distinct genetic mutations, ion channel dysfunctions, and specific triggers, whereas acquired LQTS arises from factors such as drug-induced effects, electrolyte imbalances, and underlying medical conditions. Accurate diagnosis hinges on a thorough clinical evaluation, electrocardiogram findings, and, where applicable, genetic testing to guide individualized risk stratification and tailored management plans. Anesthetic management in LQTS demands meticulous planning, vigilance, and a comprehensive understanding of the syndrome’s complexities. Preoperative strategies focus on optimizing electrolyte levels, discontinuing QT-prolonging medications, and assessing genetic predispositions that may exacerbate risks. The intraoperative phase requires continuous ECG monitoring to detect QT prolongation, the judicious selection of anesthetic drugs to minimize arrhythmogenic potential, and readiness to address arrhythmic events with therapies such as intravenous magnesium sulfate and immediate defibrillation. Postoperative care emphasizes extended monitoring, strict maintenance of electrolyte balance, and the avoidance of QT-prolonging agents to reduce the risk of delayed complications. This review underscores the importance of a multidisciplinary approach, involving anesthesiologists, cardiologists, and geneticists, in delivering optimal care to patients with LQTS. By focusing on detailed preoperative assessment, careful drug selection, and proactive intra- and postoperative management, clinicians can effectively minimize risks and enhance patient safety. These recommendations provide a robust framework for navigating the challenges of anesthesia in individuals with LQTS.

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Dhanure, V., Bhalerao, N., & Paul, A. (2025). Anesthesia in Long QT syndrome: A review of pathophysiology, risk factors, and management strategies. Multidisciplinary Reviews, 8(10), 2025277. https://doi.org/10.31893/multirev.2025277
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