Safety of Local Dental Anesthesia in Patients With Cardiac Channelopathies

Overview

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.

Study Type

  • Study Type: Interventional
  • Study Design
    • Allocation: Randomized
    • Intervention Model: Crossover Assignment
    • Primary Purpose: Supportive Care
    • Masking: Double (Participant, Investigator)
  • Study Primary Completion Date: August 2018

Detailed Description

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.

Interventions

  • Procedure: Dental restorative procedure
    • 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.

Arms, Groups and Cohorts

  • Active Comparator: Lidocaine with epinephrine
    • 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.
  • Active Comparator: Lidocaine
    • 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.

Clinical Trial Outcome Measures

Primary Measures

  • No sustained ventricular tachycardia
    • Time Frame: during dental procedures
    • No life-threatening arrhythmias and clinical signs and symptoms

Participating in This Clinical Trial

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

Gender Eligibility: All

Minimum Age: 6 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • University of Sao Paulo General Hospital
  • Collaborator
    • Fundação de Amparo à Pesquisa do Estado de São Paulo
  • Provider of Information About this Clinical Study
    • Principal Investigator: Itamara Lucia Itagiba Neves, Principal Investigator – University of Sao Paulo General Hospital
  • Overall Official(s)
    • Itamara LI Neves, PhD, Principal Investigator, Instituto do Coração do HCFMUSP
    • Ana CG Oliveira, S, Study Chair, Instituto do Coração do HCFMUSP
    • Ricardo S Neves, PhD, Study Director, Instituto do Coração do HCFMUSP
    • Luciana Sacilotto, S, Study Chair, Instituto do Coração do HCFMUSP
    • Francisco CC Darrieux, PhD, Study Chair, Instituto do Coração do HCFMUSP
    • Maurício I Scanavacca, PhD, Study Director, Instituto do Coração do HCFMUSP
    • Denise Hachul, PhD, Study Chair, Instituto do Coração do HCFMUSP
    • Cesar J Gruppi, PhD, Study Director, Instituto do Coração do HCFMUSP

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