Dental management of the patient with cardiac arrhythmias: an update.

Cardiac arrhythmias are present in a significant percentage of the population seeking dental treatment. Cardiac arrhythmias may be disturbances of rhythm, rate, or conduction of the heart. They may be found in healthy individuals and in those with various forms of cardiovascular disease. Some of these arrhythmias are of little concern to the patient or dentist; however, some can produce symptoms, and some can be lifethreatening, including arrhythmias that occur secondary to anxiety (eg, those associated with dental care). Therefore, patients with significant arrhythmias must be identified before undergoing dental treatment. Cardiac arrhythmias may be found in healthy individuals, in patients taking various medications, and in patients with certain cardiovascular conditions or with other systemic diseases. The most common causes are (1) primary cardiovascular disorders, (2) pulmonary disorders (eg, embolism or hypoxia), (3) autonomic disorders, (4) systemic disorders (eg, thyroid disease), (5) drug-related side effects, and (6) electrolyte imbalances. The purpose of this article was to review the types of cardiac arrhythmias and their treatment, the importance and identification of the more significant arrhythmias in the dental patient, and the dental management considerations for patients with a cardiac arrhythmia. TYPES AND SIGNIFICANCE OF ARRHYTHMIAS Arrhythmias are classified on the basis of causing ectopic beats, slowing of the heart rate, speeding of the heart rate, and arresting the heart rate. They encompass a broad spectrum, ranging from incidental arrhythmias such as premature atrial beats to lethal ones including ventricular fibrillation. Some of the more common arrhythmias include premature atrial or ventricular beats, sinus bradycardia, and sinus tachycardia.