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Paavola J, Väänänen H, Larsson K, Penttinen K, Toivonen L, Kontula K, Laine M, Aalto-Setälä K, Swan H, Viitasalo M. Slowed depolarization and irregular repolarization in catecholaminergic polymorphic ventricular tachycardia: a study from cellular Ca2+ transients and action potentials to clinical monophasic action potentials and electrocardiography. Europace 2015; 18:1599-1607. [PMID: 26705554 DOI: 10.1093/europace/euv380] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 10/17/2015] [Indexed: 01/08/2023] Open
Abstract
AIMS Spontaneous Ca2+ release leads to afterdepolarizations and triggered arrhythmia in catecholaminergic polymorphic ventricular tachycardia (CPVT). Irregular Ca2+ release is hypothesized to manifest as slowed depolarization and irregular repolarization. Our goal was to study depolarization and repolarization abnormalities in CPVT, as they remain largely uninvestigated. METHODS AND RESULTS We studied intracellular Ca2+ handling and action potentials (APs) in an induced pluripotent stem cell (iPSC) model of CPVT. Induced pluripotent stem cell cardiomyocytes from a RyR2-P2328S patient showed increased non-alternating variability of Ca2+ transients in response to isoproterenol. β-Agonists decreased AP upslope velocity in CPVT cells and in monophasic AP recordings of CPVT patients. We compared 24 h electrocardiograms (ECGs) of 19 CPVT patients carrying RyR2 mutations and 19 healthy controls. Short-term variability (STV) of the QT interval was 6.9 ± 0.5 ms in CPVT patients vs. 5.5 ± 0.4 ms in controls (P < 0.05) and associated with a history of arrhythmic events. Mean T-wave alternans (TWA) was 25 ± 1.4 µV in CPVT patients vs. 31 ± 2.0 µV in controls (P < 0.05). Older CPVT patients showed lower maximal upslope velocity of the ECG R-spike than control patients. CONCLUSION Catecholaminergic polymorphic ventricular tachycardia patients show higher STV of repolarization but lower TWA on the 24 h ECG than control patients, which is likely to reflect increased non-alternating variability of Ca2+ release by mutant RyR2s as observed in vitro. β-Agonists slow depolarization in RyR2-mutant cells and in CPVT patients. These findings may constitute a marker of arrhythmogenicity.
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Affiliation(s)
- Jere Paavola
- Minerva Foundation Institute for Medical Research, Helsinki, Finland .,Division of Cardiology, Heart and Lung Center HUS, Helsinki University Central Hospital, Helsinki, Finland
| | - Heikki Väänänen
- Department of Biomedical Engineering and Computational Science, Aalto University, Espoo, Finland
| | - Kim Larsson
- School of Medicine, University of Tampere, Tampere, Finland.,Biomeditech, University of Tampere, Tampere, Finland
| | - Kirsi Penttinen
- School of Medicine, University of Tampere, Tampere, Finland.,Biomeditech, University of Tampere, Tampere, Finland
| | - Lauri Toivonen
- Division of Cardiology, Heart and Lung Center HUS, Helsinki University Central Hospital, Helsinki, Finland
| | - Kimmo Kontula
- Department of Medicine, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
| | - Mika Laine
- Minerva Foundation Institute for Medical Research, Helsinki, Finland.,Division of Cardiology, Heart and Lung Center HUS, Helsinki University Central Hospital, Helsinki, Finland
| | - Katriina Aalto-Setälä
- School of Medicine, University of Tampere, Tampere, Finland.,Biomeditech, University of Tampere, Tampere, Finland.,Heart Center, Tampere University Hospital, Tampere, Finland
| | - Heikki Swan
- Division of Cardiology, Heart and Lung Center HUS, Helsinki University Central Hospital, Helsinki, Finland
| | - Matti Viitasalo
- Division of Cardiology, Heart and Lung Center HUS, Helsinki University Central Hospital, Helsinki, Finland
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53
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Ning F, Luo L, Ahmad S, Valli H, Jeevaratnam K, Wang T, Guzadhur L, Yang D, Fraser JA, Huang CLH, Ma A, Salvage SC. The RyR2-P2328S mutation downregulates Nav1.5 producing arrhythmic substrate in murine ventricles. Pflugers Arch 2015; 468:655-65. [PMID: 26545784 PMCID: PMC4792352 DOI: 10.1007/s00424-015-1750-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 09/25/2015] [Accepted: 10/19/2015] [Indexed: 01/05/2023]
Abstract
Catecholaminergic polymorphic ventricular tachycardia (CPVT) predisposes to ventricular arrhythmia due to altered Ca2+ homeostasis and can arise from ryanodine receptor (RyR2) mutations including RyR2-P2328S. Previous reports established that homozygotic murine RyR2-P2328S (RyR2S/S) hearts show an atrial arrhythmic phenotype associated with reduced action potential (AP) conduction velocity and sodium channel (Nav1.5) expression. We now relate ventricular arrhythmogenicity and slowed AP conduction in RyR2S/S hearts to connexin-43 (Cx43) and Nav1.5 expression and Na+ current (INa). Stimulation protocols applying extrasystolic S2 stimulation following 8 Hz S1 pacing at progressively decremented S1S2 intervals confirmed an arrhythmic tendency despite unchanged ventricular effective refractory periods (VERPs) in Langendorff-perfused RyR2S/S hearts. Dynamic pacing imposing S1 stimuli then demonstrated that progressive reductions of basic cycle lengths (BCLs) produced greater reductions in conduction velocity at equivalent BCLs and diastolic intervals in RyR2S/S than WT, but comparable changes in AP durations (APD90) and their alternans. Western blot analyses demonstrated that Cx43 protein expression in whole ventricles was similar, but Nav1.5 expression in both whole tissue and membrane fractions were significantly reduced in RyR2S/S compared to wild-type (WT). Loose patch-clamp studies similarly demonstrated reduced INa in RyR2S/S ventricles. We thus attribute arrhythmogenesis in RyR2S/S ventricles resulting from arrhythmic substrate produced by reduced conduction velocity to downregulated Nav1.5 reducing INa, despite normal determinants of repolarization and passive conduction. The measured changes were quantitatively compatible with earlier predictions of linear relationships between conduction velocity and the peak INa of the AP but nonlinear relationships between peak INa and maximum Na+ permeability.
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Affiliation(s)
- Feifei Ning
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yanta Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Ling Luo
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yanta Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - Shiraz Ahmad
- Physiological Laboratory, University of Cambridge, Cambridge, CB2 3EG, UK
| | - Haseeb Valli
- Physiological Laboratory, University of Cambridge, Cambridge, CB2 3EG, UK
| | - Kamalan Jeevaratnam
- Faculty of Health and Medical Science, Duke of Kent Building, University of Surrey, Guildford, GU2 7TE, UK
- Perdana University-Royal College of Surgeons Ireland, 43400 Serdang, Selangor, Darul Ehsan, Malaysia
| | - Tingzhong Wang
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yanta Road, Xi'an, Shaanxi, 710061, People's Republic of China
- Key Laboratory of Molecular Cardiology, Shaanxi Province, People's Republic of China
- Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Xi'an, People's Republic of China
| | - Laila Guzadhur
- Department of Biochemistry, University of Cambridge, Cambridge, CB2 1QW, UK
- Niche Science and Technology, Falstaff House, Bardolph Road, Richmond, UK
| | - Dandan Yang
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yanta Road, Xi'an, Shaanxi, 710061, People's Republic of China
| | - James A Fraser
- Physiological Laboratory, University of Cambridge, Cambridge, CB2 3EG, UK
| | - Christopher L-H Huang
- Physiological Laboratory, University of Cambridge, Cambridge, CB2 3EG, UK
- Department of Biochemistry, University of Cambridge, Cambridge, CB2 1QW, UK
| | - Aiqun Ma
- Department of Cardiovascular Medicine, First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yanta Road, Xi'an, Shaanxi, 710061, People's Republic of China.
- Key Laboratory of Molecular Cardiology, Shaanxi Province, People's Republic of China.
- Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Xi'an, People's Republic of China.
| | - Samantha C Salvage
- Physiological Laboratory, University of Cambridge, Cambridge, CB2 3EG, UK.
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Abstract
Sudden cardiac death (SCD) from cardiac arrest is a major international public health problem accounting for an estimated 15%-20% of all deaths. Although resuscitation rates are generally improving throughout the world, the majority of individuals who experience a sudden cardiac arrest will not survive. SCD most often develops in older adults with acquired structural heart disease, but it also rarely occurs in the young, where it is more commonly because of inherited disorders. Coronary heart disease is known to be the most common pathology underlying SCD, followed by cardiomyopathies, inherited arrhythmia syndromes, and valvular heart disease. During the past 3 decades, declines in SCD rates have not been as steep as for other causes of coronary heart disease deaths, and there is a growing fraction of SCDs not due to coronary heart disease and ventricular arrhythmias, particularly among certain subsets of the population. The growing heterogeneity of the pathologies and mechanisms underlying SCD present major challenges for SCD prevention, which are magnified further by a frequent lack of recognition of the underlying cardiac condition before death. Multifaceted preventative approaches, which address risk factors in seemingly low-risk and known high-risk populations, will be required to decrease the burden of SCD. In this Compendium, we review the wide-ranging spectrum of epidemiology underlying SCD within both the general population and in high-risk subsets with established cardiac disease placing an emphasis on recent global trends, remaining uncertainties, and potential targeted preventive strategies.
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Affiliation(s)
- Meiso Hayashi
- From the Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (M.H., W.S.); and Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (C.M.A.)
| | - Wataru Shimizu
- From the Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (M.H., W.S.); and Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (C.M.A.).
| | - Christine M Albert
- From the Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (M.H., W.S.); and Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (C.M.A.).
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Clinical and molecular characterization of a cardiac ryanodine receptor founder mutation causing catecholaminergic polymorphic ventricular tachycardia. Heart Rhythm 2015; 12:1636-43. [PMID: 25814417 DOI: 10.1016/j.hrthm.2015.03.033] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Indexed: 11/18/2022]
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Salvage SC, King JH, Chandrasekharan KH, Jafferji DIG, Guzadhur L, Matthews HR, Huang CL, Fraser JA. Flecainide exerts paradoxical effects on sodium currents and atrial arrhythmia in murine RyR2-P2328S hearts. Acta Physiol (Oxf) 2015; 214:361-75. [PMID: 25850710 PMCID: PMC4510817 DOI: 10.1111/apha.12505] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 11/03/2014] [Accepted: 04/01/2015] [Indexed: 12/30/2022]
Abstract
Aims Cardiac ryanodine receptor mutations are associated with catecholaminergic polymorphic ventricular tachycardia (CPVT), and some, including RyR2-P2328S, also predispose to atrial fibrillation. Recent work associates reduced atrial Nav1.5 currents in homozygous RyR2-P2328S (RyR2S/S) mice with slowed conduction and increased arrhythmogenicity. Yet clinically, and in murine models, the Nav1.5 blocker flecainide reduces ventricular arrhythmogenicity in CPVT. We aimed to determine whether, and how, flecainide influences atrial arrhythmogenicity in RyR2S/S mice and their wild-type (WT) littermates. Methods We explored effects of 1 μm flecainide on WT and RyR2S/S atria. Arrhythmic incidence, action potential (AP) conduction velocity (CV), atrial effective refractory period (AERP) and AP wavelength (λ = CV × AERP) were measured using multi-electrode array recordings in Langendorff-perfused hearts; Na+ currents (INa) were recorded using loose patch clamping of superfused atria. Results RyR2S/S showed more frequent atrial arrhythmias, slower CV, reduced INa and unchanged AERP compared to WT. Flecainide was anti-arrhythmic in RyR2S/S but pro-arrhythmic in WT. It increased INa in RyR2S/S atria, whereas it reduced INa as expected in WT. It increased AERP while sparing CV in RyR2S/S, but reduced CV while sparing AERP in WT. Thus, RyR2S/S hearts have low λ relative to WT; flecainide then increases λ in RyR2S/S but decreases λ in WT. Conclusions Flecainide (1 μm) rescues the RyR2-P2328S atrial arrhythmogenic phenotype by restoring compromised INa and λ, changes recently attributed to increased sarcoplasmic reticular Ca2+ release. This contrasts with the increased arrhythmic incidence and reduced INa and λ with flecainide in WT.
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Affiliation(s)
- S. C. Salvage
- Physiological Laboratory University of Cambridge Cambridge UK
| | - J. H. King
- Physiological Laboratory University of Cambridge Cambridge UK
| | | | | | - L. Guzadhur
- Department of Biochemistry University of Cambridge Cambridge UK
| | - H. R. Matthews
- Physiological Laboratory University of Cambridge Cambridge UK
| | - C. L.‐H. Huang
- Physiological Laboratory University of Cambridge Cambridge UK
- Department of Biochemistry University of Cambridge Cambridge UK
| | - J. A. Fraser
- Physiological Laboratory University of Cambridge Cambridge UK
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Roston TM, Vinocur JM, Maginot KR, Mohammed S, Salerno JC, Etheridge SP, Cohen M, Hamilton RM, Pflaumer A, Kanter RJ, Potts JE, LaPage MJ, Collins KK, Gebauer RA, Temple JD, Batra AS, Erickson C, Miszczak-Knecht M, Kubuš P, Bar-Cohen Y, Kantoch M, Thomas VC, Hessling G, Anderson C, Young ML, Ortega MC, Lau YR, Johnsrude CL, Fournier A, Kannankeril PJ, Sanatani S. Catecholaminergic polymorphic ventricular tachycardia in children: analysis of therapeutic strategies and outcomes from an international multicenter registry. Circ Arrhythm Electrophysiol 2015; 8:633-42. [PMID: 25713214 PMCID: PMC4472494 DOI: 10.1161/circep.114.002217] [Citation(s) in RCA: 165] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 02/11/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Catecholaminergic polymorphic ventricular tachycardia is an uncommon, potentially lethal, ion channelopathy. Standard therapies have high failure rates and little is known about treatment in children. Newer options such as flecainide and left cardiac sympathetic denervation are not well validated. We sought to define treatment outcomes in children with catecholaminergic polymorphic ventricular tachycardia. METHODS AND RESULTS This is a Pediatric and Congenital Electrophysiology Society multicenter, retrospective cohort study of catecholaminergic polymorphic ventricular tachycardia patients diagnosed before 19 years of age. The cohort included 226 patients, including 170 probands and 56 relatives. Symptomatic presentation was reported in 176 (78%). Symptom onset occurred at 10.8 (interquartile range, 6.8-13.2) years with a delay to diagnosis of 0.5 (0-2.6) years. Syncope (P<0.001), cardiac arrest (P<0.001), and treatment failure (P=0.008) occurred more often in probands. β-Blockers were prescribed in 205 of 211 patients (97%) on medication, and 25% experienced at least 1 treatment failure event. Implantable cardioverter defibrillators were placed in 121 (54%) and was associated with electrical storm in 22 (18%). Flecainide was used in 24% and left cardiac sympathetic denervation in 8%. Six deaths (3%) occurred during a cumulative follow-up of 788 patient-years. CONCLUSIONS This study demonstrates a malignant phenotype and lengthy delay to diagnosis in catecholaminergic polymorphic ventricular tachycardia. Probands were typically severely affected. β-Blockers were almost universally initiated; however, treatment failure, noncompliance and subtherapeutic dosing were often reported. Implantable cardioverter defibrillators were common despite numerous device-related complications. Treatment failure was rare in the quarter of patients on flecainide. Left cardiac sympathetic denervation was not uncommon although the indication was variable.
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MESH Headings
- Adolescent
- Age Factors
- Anti-Arrhythmia Agents/adverse effects
- Anti-Arrhythmia Agents/therapeutic use
- Child
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Defibrillators, Implantable
- Electric Countershock/adverse effects
- Electric Countershock/instrumentation
- Electric Countershock/mortality
- Female
- Humans
- Male
- Patient Selection
- Phenotype
- Registries
- Retrospective Studies
- Risk Factors
- Severity of Illness Index
- Sympathectomy/adverse effects
- Sympathectomy/mortality
- Tachycardia, Ventricular/complications
- Tachycardia, Ventricular/diagnosis
- Tachycardia, Ventricular/mortality
- Tachycardia, Ventricular/physiopathology
- Tachycardia, Ventricular/therapy
- Time Factors
- Treatment Outcome
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Affiliation(s)
- Thomas M. Roston
- Department of Pediatrics, Divisions of Cardiology, University of British Columbia, Vancouver, BC, Canada
| | | | | | - Saira Mohammed
- Department of Pediatrics, Divisions of Cardiology, University of British Columbia, Vancouver, BC, Canada
| | - Jack C. Salerno
- Department of Pediatrics, University of Washington, Seattle, WA
| | | | | | | | - Andreas Pflaumer
- Royal Children’s Hospital MCRI & University of Melbourne, Australia
| | | | - James E. Potts
- Department of Pediatrics, Divisions of Cardiology, University of British Columbia, Vancouver, BC, Canada
| | | | | | | | | | - Anjan S. Batra
- University of California at Irvine Medical Center, Orange, CA
| | | | | | - Peter Kubuš
- Children’s Heart Center, Prague, Czech Republic
| | | | - Michal Kantoch
- Stollery Children’s Hospital, University of Alberta, Edmonton, AB, Canada
| | | | | | - Chris Anderson
- Providence Sacred Heart Children’s Hospital, Spokane, WA
| | | | | | - Yung R. Lau
- University of Alabama at Birmingham, Birmingham, AL
| | | | | | | | - Shubhayan Sanatani
- Department of Pediatrics, Divisions of Cardiology, University of British Columbia, Vancouver, BC, Canada
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58
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Penttinen K, Swan H, Vanninen S, Paavola J, Lahtinen AM, Kontula K, Aalto-Setälä K. Antiarrhythmic Effects of Dantrolene in Patients with Catecholaminergic Polymorphic Ventricular Tachycardia and Replication of the Responses Using iPSC Models. PLoS One 2015; 10:e0125366. [PMID: 25955245 PMCID: PMC4425399 DOI: 10.1371/journal.pone.0125366] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 02/13/2015] [Indexed: 01/07/2023] Open
Abstract
Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a highly malignant inherited arrhythmogenic disorder. Type 1 CPVT (CPVT1) is caused by cardiac ryanodine receptor (RyR2) gene mutations resulting in abnormal calcium release from sarcoplasmic reticulum. Dantrolene, an inhibitor of sarcoplasmic Ca2+ release, has been shown to rescue this abnormal Ca2+ release in vitro. We assessed the antiarrhythmic efficacy of dantrolene in six patients carrying various RyR2 mutations causing CPVT. The patients underwent exercise stress test before and after dantrolene infusion. Dantrolene reduced the number of premature ventricular complexes (PVCs) on average by 74% (range 33-97) in four patients with N-terminal or central mutations in the cytosolic region of the RyR2 protein, while dantrolene had no effect in two patients with mutations in or near the transmembrane domain. Induced pluripotent stem cells (iPSCs) were generated from all the patients and differentiated into spontaneously beating cardiomyocytes (CMs). The antiarrhythmic effect of dantrolene was studied in CMs after adrenaline stimulation by Ca2+ imaging. In iPSC derived CMs with RyR2 mutations in the N-terminal or central region, dantrolene suppressed the Ca2+ cycling abnormalities in 80% (range 65-97) of cells while with mutations in or near the transmembrane domain only in 23 or 32% of cells. In conclusion, we demonstrate that dantrolene given intravenously shows antiarrhythmic effects in a portion of CPVT1 patients and that iPSC derived CM models replicate these individual drug responses. These findings illustrate the potential of iPSC models to individualize drug therapy of inherited diseases.
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Affiliation(s)
- Kirsi Penttinen
- BioMediTech, University of Tampere, Tampere, Finland; School of Medicine, University of Tampere, Tampere, Finland
| | - Heikki Swan
- Heart and Lung Center, Helsinki University Hospital, Helsinki, Finland
| | - Sari Vanninen
- Heart Hospital, Tampere University Hospital, Tampere, Finland
| | - Jere Paavola
- Minerva Foundation Institute for Medical Research, Helsinki, Finland
| | - Annukka M Lahtinen
- Department of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kimmo Kontula
- Department of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Katriina Aalto-Setälä
- BioMediTech, University of Tampere, Tampere, Finland; School of Medicine, University of Tampere, Tampere, Finland; Heart Hospital, Tampere University Hospital, Tampere, Finland
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59
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Martin CA, Huang CLH, Matthews GDK. Recent Developments in the Management of Patients at Risk for Sudden Cardiac Death. Postgrad Med 2015; 123:84-94. [DOI: 10.3810/pgm.2011.03.2266] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Leong IUS, Sucich J, Prosser DO, Skinner JR, Crawford JR, Higgins C, Love DR. Array comparative genomic hybridization identifies a heterozygous deletion of exon 3 of the RYR2 gene. Ups J Med Sci 2015; 120:190-7. [PMID: 25835811 PMCID: PMC4526874 DOI: 10.3109/03009734.2015.1029101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a heritable cardiac disorder characterized by life-threatening ventricular tachycardia caused by exercise or acute emotional stress. The standard diagnostic screening involves Sanger-based sequencing of 45 of the 105 translated exons of the RYR2 gene, and copy number changes of a limited number of exons that are detected using multiplex ligation-dependent probe amplification (MLPA). METHODS In the current study, a previously validated bespoke array comparative genomic hybridization (aCGH) technique was used to detect copy number changes in the RYR2 gene in a 43-year-old woman clinically diagnosed with CPVT. RESULTS The CGH array detected a 1.1 kb deletion encompassing exon 3 of the RYR2 gene. This is the first report using the aCGH technique to screen for mutations causing CPVT. CONCLUSIONS The aCGH method offers significant advantages over MLPA in genetic screening for heritable cardiac disorders.
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Affiliation(s)
- Ivone U. S. Leong
- Diagnostic Genetics, LabPLUS, Auckland City Hospital, PO Box 110031, Auckland 1142, New Zealand
| | - Jennifer Sucich
- Diagnostic Genetics, LabPLUS, Auckland City Hospital, PO Box 110031, Auckland 1142, New Zealand
| | - Debra O. Prosser
- Diagnostic Genetics, LabPLUS, Auckland City Hospital, PO Box 110031, Auckland 1142, New Zealand
| | - Jonathan R. Skinner
- Greenlane Paediatric and Congenital Cardiac Service, Starship Children’s Hospital, Grafton Auckland, Private Bag 92024, New Zealand
- Cardiac Inherited Disease Group, Auckland City Hospital, Auckland, New Zealand
- Department of Child Health, The University of Auckland, Private Bag 92019, Auckland 1142, New Zealand
| | - Jackie R. Crawford
- Greenlane Paediatric and Congenital Cardiac Service, Starship Children’s Hospital, Grafton Auckland, Private Bag 92024, New Zealand
- Cardiac Inherited Disease Group, Auckland City Hospital, Auckland, New Zealand
| | - Colleen Higgins
- School of Applied Sciences, Auckland University of Technology, Private Bag 92006, Auckland, New Zealand
| | - Donald R. Love
- Diagnostic Genetics, LabPLUS, Auckland City Hospital, PO Box 110031, Auckland 1142, New Zealand
- Cardiac Inherited Disease Group, Auckland City Hospital, Auckland, New Zealand
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Swan H, Amarouch MY, Leinonen J, Marjamaa A, Kucera JP, Laitinen-Forsblom PJ, Lahtinen AM, Palotie A, Kontula K, Toivonen L, Abriel H, Widen E. Gain-of-Function Mutation of the
SCN5A
Gene Causes Exercise-Induced Polymorphic Ventricular Arrhythmias. ACTA ACUST UNITED AC 2014; 7:771-81. [DOI: 10.1161/circgenetics.114.000703] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background—
Over the past 15 years, a myriad of mutations in genes encoding cardiac ion channels and ion channel interacting proteins have been linked to a long list of inherited atrial and ventricular arrhythmias. The purpose of this study was to identify the genetic and functional determinants underlying exercise-induced polymorphic ventricular arrhythmia present in a large multigenerational family.
Methods and Results—
A large 4-generation family presenting with exercise-induced polymorphic ventricular arrhythmia, which was followed for 10 years, was clinically characterized. A novel
SCN5A
mutation was identified via whole exome sequencing and further functionally evaluated by patch-clamp studies using human embryonic kidney 293 cells. Of 37 living family members, a total of 13 individuals demonstrated ≥50 multiformic premature ventricular complexes or ventricular tachycardia upon exercise stress tests when sinus rate exceeded 99±17 beats per minute. Sudden cardiac arrest occurred in 1 individual during follow-up. Exome sequencing identified a novel missense mutation (p.I141V) in a highly conserved region of the
SCN5A
gene, encoding the Na
v
1.5 sodium channel protein that cosegregated with the arrhythmia phenotype. The mutation p.I141V shifted the activation curve toward more negative potentials and increased the window current, whereas action potential simulations suggested that it lowered the excitability threshold of cardiac cells.
Conclusions—
Gain-of-function of Na
v
1.5 may cause familial forms of exercise-induced polymorphic ventricular arrhythmias.
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Affiliation(s)
- Heikki Swan
- From the Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland (H.S., A.M., L.T.); Department of Clinical Research (M.Y.A., H.A), and Department of Physiology (J.P.K), University of Bern, Bern, Switzerland. and Institute for Molecular Medicine Finland (FIMM), University of Helsinki (J.L., A.P., E.W.), and Department of Medicine, University of Helsinki and Helsinki University Central Hospital (P.J.L.-F., A.M.L., K.K.), Helsinki, Finland
| | - Mohamed Yassine Amarouch
- From the Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland (H.S., A.M., L.T.); Department of Clinical Research (M.Y.A., H.A), and Department of Physiology (J.P.K), University of Bern, Bern, Switzerland. and Institute for Molecular Medicine Finland (FIMM), University of Helsinki (J.L., A.P., E.W.), and Department of Medicine, University of Helsinki and Helsinki University Central Hospital (P.J.L.-F., A.M.L., K.K.), Helsinki, Finland
| | - Jaakko Leinonen
- From the Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland (H.S., A.M., L.T.); Department of Clinical Research (M.Y.A., H.A), and Department of Physiology (J.P.K), University of Bern, Bern, Switzerland. and Institute for Molecular Medicine Finland (FIMM), University of Helsinki (J.L., A.P., E.W.), and Department of Medicine, University of Helsinki and Helsinki University Central Hospital (P.J.L.-F., A.M.L., K.K.), Helsinki, Finland
| | - Annukka Marjamaa
- From the Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland (H.S., A.M., L.T.); Department of Clinical Research (M.Y.A., H.A), and Department of Physiology (J.P.K), University of Bern, Bern, Switzerland. and Institute for Molecular Medicine Finland (FIMM), University of Helsinki (J.L., A.P., E.W.), and Department of Medicine, University of Helsinki and Helsinki University Central Hospital (P.J.L.-F., A.M.L., K.K.), Helsinki, Finland
| | - Jan P. Kucera
- From the Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland (H.S., A.M., L.T.); Department of Clinical Research (M.Y.A., H.A), and Department of Physiology (J.P.K), University of Bern, Bern, Switzerland. and Institute for Molecular Medicine Finland (FIMM), University of Helsinki (J.L., A.P., E.W.), and Department of Medicine, University of Helsinki and Helsinki University Central Hospital (P.J.L.-F., A.M.L., K.K.), Helsinki, Finland
| | - Päivi J. Laitinen-Forsblom
- From the Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland (H.S., A.M., L.T.); Department of Clinical Research (M.Y.A., H.A), and Department of Physiology (J.P.K), University of Bern, Bern, Switzerland. and Institute for Molecular Medicine Finland (FIMM), University of Helsinki (J.L., A.P., E.W.), and Department of Medicine, University of Helsinki and Helsinki University Central Hospital (P.J.L.-F., A.M.L., K.K.), Helsinki, Finland
| | - Annukka M. Lahtinen
- From the Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland (H.S., A.M., L.T.); Department of Clinical Research (M.Y.A., H.A), and Department of Physiology (J.P.K), University of Bern, Bern, Switzerland. and Institute for Molecular Medicine Finland (FIMM), University of Helsinki (J.L., A.P., E.W.), and Department of Medicine, University of Helsinki and Helsinki University Central Hospital (P.J.L.-F., A.M.L., K.K.), Helsinki, Finland
| | - Aarno Palotie
- From the Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland (H.S., A.M., L.T.); Department of Clinical Research (M.Y.A., H.A), and Department of Physiology (J.P.K), University of Bern, Bern, Switzerland. and Institute for Molecular Medicine Finland (FIMM), University of Helsinki (J.L., A.P., E.W.), and Department of Medicine, University of Helsinki and Helsinki University Central Hospital (P.J.L.-F., A.M.L., K.K.), Helsinki, Finland
| | - Kimmo Kontula
- From the Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland (H.S., A.M., L.T.); Department of Clinical Research (M.Y.A., H.A), and Department of Physiology (J.P.K), University of Bern, Bern, Switzerland. and Institute for Molecular Medicine Finland (FIMM), University of Helsinki (J.L., A.P., E.W.), and Department of Medicine, University of Helsinki and Helsinki University Central Hospital (P.J.L.-F., A.M.L., K.K.), Helsinki, Finland
| | - Lauri Toivonen
- From the Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland (H.S., A.M., L.T.); Department of Clinical Research (M.Y.A., H.A), and Department of Physiology (J.P.K), University of Bern, Bern, Switzerland. and Institute for Molecular Medicine Finland (FIMM), University of Helsinki (J.L., A.P., E.W.), and Department of Medicine, University of Helsinki and Helsinki University Central Hospital (P.J.L.-F., A.M.L., K.K.), Helsinki, Finland
| | - Hugues Abriel
- From the Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland (H.S., A.M., L.T.); Department of Clinical Research (M.Y.A., H.A), and Department of Physiology (J.P.K), University of Bern, Bern, Switzerland. and Institute for Molecular Medicine Finland (FIMM), University of Helsinki (J.L., A.P., E.W.), and Department of Medicine, University of Helsinki and Helsinki University Central Hospital (P.J.L.-F., A.M.L., K.K.), Helsinki, Finland
| | - Elisabeth Widen
- From the Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland (H.S., A.M., L.T.); Department of Clinical Research (M.Y.A., H.A), and Department of Physiology (J.P.K), University of Bern, Bern, Switzerland. and Institute for Molecular Medicine Finland (FIMM), University of Helsinki (J.L., A.P., E.W.), and Department of Medicine, University of Helsinki and Helsinki University Central Hospital (P.J.L.-F., A.M.L., K.K.), Helsinki, Finland
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Kozlovski J, Ingles J, Connell V, Hunt L, McGaughran J, Turner C, Davis A, Sy R, Semsarian C. Delay to diagnosis amongst patients with catecholaminergic polymorphic ventricular tachycardia. Int J Cardiol 2014; 176:1402-4. [DOI: 10.1016/j.ijcard.2014.08.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 08/02/2014] [Indexed: 10/24/2022]
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Arakawa J, Hamabe A, Aiba T, Nagai T, Yoshida M, Touya T, Ishigami N, Hisadome H, Katsushika S, Tabata H, Miyamoto Y, Shimizu W. A novel cardiac ryanodine receptor gene (RyR2) mutation in an athlete with aborted sudden cardiac death: a case of adult-onset catecholaminergic polymorphic ventricular tachycardia. Heart Vessels 2014; 30:835-40. [PMID: 25092222 DOI: 10.1007/s00380-014-0555-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 07/11/2014] [Indexed: 12/26/2022]
Abstract
Sudden cardiac death (SCD) in athletes <35 years of age are mostly due to congenital or acquired cardiac malformations or hypertrophic cardiomyopathy. However, ion channelopathies such as catecholaminergic polymorphic ventricular tachycardia (CPVT) or long-QT syndromes, which are less frequently observed, are also potential pathogenesis of SCD in young athletes. CPVT is an inherited arrhythmia that is induced by physical or emotional stress and may lead to ventricular fibrillation syncope or SCD. Here, we report a case of athlete woman with adult-onset CPVT and aborted SCD who has a novel missense mutation (K4392R) in the cardiac RyR2 gene.
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Affiliation(s)
- Junko Arakawa
- Department of Cardiology, Japan Self-Defense Forces Central Hospital, Ikejiri 1-2-24, Setagaya-ku, Tokyo, 154-8532, Japan.
- Department of Cardiology, KKR Mishuku Hospital, Tokyo, Japan.
| | - Akira Hamabe
- Department of Cardiology, Japan Self-Defense Forces Central Hospital, Ikejiri 1-2-24, Setagaya-ku, Tokyo, 154-8532, Japan
- Department of Cardiology, KKR Mishuku Hospital, Tokyo, Japan
| | - Takeshi Aiba
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Tomoo Nagai
- Department of Cardiology, Japan Self-Defense Forces Central Hospital, Ikejiri 1-2-24, Setagaya-ku, Tokyo, 154-8532, Japan
- Department of Cardiology, KKR Mishuku Hospital, Tokyo, Japan
| | - Mikoto Yoshida
- Department of Cardiology, Japan Self-Defense Forces Central Hospital, Ikejiri 1-2-24, Setagaya-ku, Tokyo, 154-8532, Japan
- Department of Cardiology, KKR Mishuku Hospital, Tokyo, Japan
| | - Takumi Touya
- Department of Cardiology, Japan Self-Defense Forces Central Hospital, Ikejiri 1-2-24, Setagaya-ku, Tokyo, 154-8532, Japan
- Department of Cardiology, KKR Mishuku Hospital, Tokyo, Japan
| | - Norio Ishigami
- Department of Cardiology, Japan Self-Defense Forces Central Hospital, Ikejiri 1-2-24, Setagaya-ku, Tokyo, 154-8532, Japan
- Department of Cardiology, KKR Mishuku Hospital, Tokyo, Japan
| | - Hideki Hisadome
- Department of Cardiology, KKR Mishuku Hospital, Tokyo, Japan
| | - Shuichi Katsushika
- Department of Cardiology, Japan Self-Defense Forces Central Hospital, Ikejiri 1-2-24, Setagaya-ku, Tokyo, 154-8532, Japan
- Department of Cardiology, KKR Mishuku Hospital, Tokyo, Japan
| | - Hirotsugu Tabata
- Department of Cardiology, Japan Self-Defense Forces Central Hospital, Ikejiri 1-2-24, Setagaya-ku, Tokyo, 154-8532, Japan
- Department of Cardiology, KKR Mishuku Hospital, Tokyo, Japan
| | - Yoshihiro Miyamoto
- Laboratory of Molecular Genetics, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
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Affiliation(s)
- Enid Gilbert-Barness
- Laboratory Medicine, Pediatric, Obstetrics and Gynecology, Department of Pathology, College of Medicine, Tampa General Hospital, University of South Florida Morsani, 1 Tampa General Circle, Tampa, FL 33606, USA.
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Effects of individualized exercise training in patients with catecholaminergic polymorphic ventricular tachycardia type 1. Am J Cardiol 2014; 113:1829-33. [PMID: 24837260 DOI: 10.1016/j.amjcard.2014.03.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Revised: 03/05/2014] [Accepted: 03/05/2014] [Indexed: 11/23/2022]
Abstract
Ventricular arrhythmias (VAs) in patients with catecholaminergic polymorphic ventricular tachycardia type 1 (CPVT1) are triggered at an individual and reproducible heart rate (HR) during exercise. Long-term effects of exercise on arrhythmia threshold in CPVT1 are not known. To investigate whether exercise training (ET) is feasible in patients with CPVT1, 13 patients with CPVT1 and confirmed genetic mutations performed bicycle exercise testing with maximal oxygen uptake (VO2max) measurements at baseline and after 13 weeks. The threshold HR for VA was defined as the HR when bigeminal ventricular extrasystoles or more severe VAs occurred. Six patients were enrolled in a 12-week high-intensity ergometer bicycle ET program (ET patients) with 60 min exercise sessions 3 times per week. The remaining 7 patients with CPVT1 were included as "sedentary" control (SED) patients complying with current recommendations to restrain from high-intensity physical activity. ET patients completed 28 ± 3 exercise sessions (78 ± 8% program completion) with 13 ± 3% increase in VO2max versus baseline (20.2 ± 1.6 vs 17.9 ± 1.3 ml/kg/min, p <0.05). No adverse events occurred. Baseline threshold for VA was 100 ± 6 beats/min in ET patients and 135 ± 4 beats/min in SED patients. After the training period, threshold HR for VA was 111 ± 10 beats/min in ET patients and 123 ± 6 beats/min in SED patients. The threshold for VA increased in ET compared with SED patients (+11 vs -12 beats/min, p <0.05). In conclusion, patients with CPVT1 benefitted from individualized ET with improved aerobic capacity and increased threshold HR for VA compared with SED patients.
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Bouchard C, Rankinen T, Timmons JA. Genomics and genetics in the biology of adaptation to exercise. Compr Physiol 2013; 1:1603-48. [PMID: 23733655 DOI: 10.1002/cphy.c100059] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This article is devoted to the role of genetic variation and gene-exercise interactions in the biology of adaptation to exercise. There is evidence from genetic epidemiology research that DNA sequence differences contribute to human variation in physical activity level, cardiorespiratory fitness in the untrained state, cardiovascular and metabolic response to acute exercise, and responsiveness to regular exercise. Methodological and technological advances have made it possible to undertake the molecular dissection of the genetic component of complex, multifactorial traits, such as those of interest to exercise biology, in terms of tissue expression profile, genes, and allelic variants. The evidence from animal models and human studies is considered. Data on candidate genes, genome-wide linkage results, genome-wide association findings, expression arrays, and combinations of these approaches are reviewed. Combining transcriptomic and genomic technologies has been shown to be more powerful as evidenced by the development of a recent molecular predictor of the ability to increase VO2max with exercise training. For exercise as a behavior and physiological fitness as a state to be major players in public health policies will require that the role of human individuality and the influence of DNA sequence differences be understood. Likewise, progress in the use of exercise in therapeutic medicine will depend to a large extent on our ability to identify the favorable responders for given physiological properties to a given exercise regimen.
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Affiliation(s)
- Claude Bouchard
- Human Genomics Laboratory, Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA.
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Potential role of cardiac calsequestrin in the lethal arrhythmic effects of cocaine. Drug Alcohol Depend 2013; 133:344-51. [PMID: 23876860 PMCID: PMC4097383 DOI: 10.1016/j.drugalcdep.2013.06.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2013] [Revised: 06/11/2013] [Accepted: 06/14/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND Cocaine-related deaths are continuously rising and its overdose is often associated with lethal cardiotoxic effects. METHODS AND RESULTS Our approach, employing isothermal titration calorimetry (ITC) and light scattering in parallel, has confirmed the significant affinity of human cardiac calsequestrin (CASQ2) for cocaine. Calsequestrin (CASQ) is a major Ca(2+)-storage protein within the sarcoplasmic reticulum (SR) of both cardiac and skeletal muscles. CASQ acts as a Ca(2+) buffer and Ca(2+)-channel regulator through its unique Ca(2+)-dependent oligomerization. Equilibrium dialysis and atomic absorption spectroscopy experiments illustrated the perturbational effect of cocaine on CASQ2 polymerization, resulting in substantial reduction of its Ca(2+)-binding capacity. We also confirmed the accumulation of cocaine in rat heart tissue and the substantial effects cocaine has on cultured C2C12 cells. The same experiments were performed with methamphetamine as a control, which displayed neither affinity for CASQ2 nor any significant effects on its function. Since cocaine did not have any direct effect on the Ca(2+)-release channel judging from our single channel recordings, these studies provide new insights into how cocaine may interfere with the normal E-C coupling mechanism with lethal arrhythmogenic consequences. CONCLUSION We propose that cocaine accumulates in SR through its affinity for CASQ2 and affects both SR Ca(2+) storage and release by altering the normal CASQ2 Ca(2+)-dependent polymerization. By this mechanism, cocaine use could produce serious cardiac problems, especially in people who have genetically-impaired CASQ2, defects in other E-C coupling components, or compromised cocaine metabolism and clearance.
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Biermann J, Faber TS. [Ventricular tachycardia under stress : Characteristic symptom or prognostic relevance?]. Herzschrittmacherther Elektrophysiol 2013; 24:197-201. [PMID: 24100620 DOI: 10.1007/s00399-013-0293-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 09/16/2013] [Indexed: 10/26/2022]
Abstract
Exercise-induced ventricular tachycardia (EIVT) is typical and quite common in patients with long QT-Syndrome (LQTS) or catecholaminergic polymorphic ventricular tachycardia (CPVT). Although patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) or hypertrophic cardiomyopathy (HCM) experience EIVT infrequently, the occurrence of EIVT is of great prognostic value in these patients. The following overview will introduce these cardiomyopathies and highlight the importance of their EIVT.
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Affiliation(s)
- Jürgen Biermann
- Klinik für Kardiologie und Angiologie I, Universitäts-Herzzentrum Freiburg - Bad Krozingen, Hugstetter Straße 55, 79106, Freiburg i. Br., Deutschland,
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Dolmatova E, Mahida S, Ellinor PT, Lubitz SA. Genetic Etiology and Evaluation of Sudden Cardiac Death. Curr Cardiol Rep 2013; 15:389. [DOI: 10.1007/s11886-013-0389-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Zhang Y, Matthews GDK, Lei M, Huang CLH. Abnormal Ca(2+) homeostasis, atrial arrhythmogenesis, and sinus node dysfunction in murine hearts modeling RyR2 modification. Front Physiol 2013; 4:150. [PMID: 23805105 PMCID: PMC3691467 DOI: 10.3389/fphys.2013.00150] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Accepted: 06/05/2013] [Indexed: 12/19/2022] Open
Abstract
Ryanodine receptor type 2 (RyR2) mutations are implicated in catecholaminergic polymorphic ventricular tachycardia (CPVT) thought to result from altered myocyte Ca(2+) homeostasis reflecting inappropriate "leakiness" of RyR2-Ca(2+) release channels arising from increases in their basal activity, alterations in their phosphorylation, or defective interactions with other molecules or ions. The latter include calstabin, calsequestrin-2, Mg(2+), and extraluminal or intraluminal Ca(2+). Recent clinical studies additionally associate RyR2 abnormalities with atrial arrhythmias including atrial tachycardia (AT), fibrillation (AF), and standstill, and sinus node dysfunction (SND). Some RyR2 mutations associated with CPVT in mouse models also show such arrhythmias that similarly correlate with altered Ca(2+) homeostasis. Some examples show evidence for increased Ca(2+)/calmodulin-dependent protein kinase II (CaMKII) phosphorylation of RyR2. A homozygotic RyR2-P2328S variant demonstrates potential arrhythmic substrate resulting from reduced conduction velocity (CV) in addition to delayed afterdepolarizations (DADs) and ectopic action potential (AP) firing. Finally, one model with an increased RyR2 activity in the sino-atrial node (SAN) shows decreased automaticity in the presence of Ca(2+)-dependent decreases in I Ca, L and diastolic sarcoplasmic reticular (SR) Ca(2+) depletion.
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Affiliation(s)
- Yanmin Zhang
- Department of Paediatrics, Institute of Shaanxi Province Children's Cardiovascular Diseases, The Shaanxi Provincial People's Hospital of Xi'an Jiaotong UniversityXi'an, PR of China
- Faculty of Medicine and Human Sciences, Institute of Cardiovascular Sciences, University of ManchesterManchester, UK
| | | | - Ming Lei
- Faculty of Medicine and Human Sciences, Institute of Cardiovascular Sciences, University of ManchesterManchester, UK
| | - Christopher L.-H. Huang
- Physiological Laboratory, Faculty of Biology, University of CambridgeCambridge, UK
- Department of Biochemistry, University of CambridgeCambridge, UK
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Lahtinen AM, Havulinna AS, Noseworthy PA, Jula A, Karhunen PJ, Perola M, Newton-Cheh C, Salomaa V, Kontula K. Prevalence of arrhythmia-associated gene mutations and risk of sudden cardiac death in the Finnish population. Ann Med 2013; 45:328-35. [PMID: 23651034 PMCID: PMC3778376 DOI: 10.3109/07853890.2013.783995] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Sudden cardiac death (SCD) remains a major cause of death in Western countries. It has a heritable component, but previous molecular studies have mainly focused on common genetic variants. We studied the prevalence, clinical phenotypes, and risk of SCD presented by ten rare mutations previously associated with arrhythmogenic right ventricular cardiomyopathy, long QT syndrome, or catecholaminergic polymorphic ventricular tachycardia. METHODS The occurrence of ten arrhythmia-associated mutations was determined in four large prospective population cohorts (FINRISK 1992, 1997, 2002, and Health 2000, n = 28,465) and two series of forensic autopsies (The Helsinki Sudden Death Study and The Tampere Autopsy Study, n = 825). Follow-up data were collected from national registries. RESULTS The ten mutations showed a combined prevalence of 79 per 10,000 individuals in Finland, and six of them showed remarkable geographic clustering. Of a total of 715 SCD cases, seven (1.0%) carried one of the ten mutations assayed: three carried KCNH2 R176W, one KCNH2 L552S, two PKP2 Q59L, and one RYR2 R3570W. CONCLUSIONS Arrhythmia-associated mutations are prevalent in the general Finnish population but do not seem to present a major risk factor for SCD, at least during a mean of 10-year follow-up of a random adult population sample.
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Affiliation(s)
- Annukka M. Lahtinen
- Research Programs Unit, Molecular Medicine and Department of Medicine, University of Helsinki, Helsinki, Finland
| | | | - Peter A. Noseworthy
- Cardiovascular Research Center and Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
| | - Antti Jula
- National Institute for Health and Welfare, Turku, Finland
| | - Pekka J. Karhunen
- School of Medicine, University of Tampere and Centre for Laboratory Medicine, Tampere University Hospital, Tampere, Finland
| | - Markus Perola
- National Institute for Health and Welfare, Helsinki, Finland
- Institute of Molecular Medicine FIMM, University of Helsinki, Helsinki, Finland
| | - Christopher Newton-Cheh
- Cardiovascular Research Center and Center for Human Genetic Research, Massachusetts General Hospital, Boston, MA, USA
- Program in Medical and Population Genetics, Broad Institute, Cambridge, MA, USA
| | - Veikko Salomaa
- National Institute for Health and Welfare, Helsinki, Finland
| | - Kimmo Kontula
- Research Programs Unit, Molecular Medicine and Department of Medicine, University of Helsinki, Helsinki, Finland
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Miyake CY, Webster G, Czosek RJ, Kantoch MJ, Dubin AM, Avasarala K, Atallah J. Efficacy of Implantable Cardioverter Defibrillators in Young Patients With Catecholaminergic Polymorphic Ventricular Tachycardia. Circ Arrhythm Electrophysiol 2013; 6:579-87. [DOI: 10.1161/circep.113.000170] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Christina Y. Miyake
- From the Department of Pediatrics, Lucile Packard Children’s Hospital, Stanford University, Palo Alto, CA (C.Y.M., A.M.D.); Department of Pediatrics, Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL (G.W.); Department of Pediatrics, The Heart Center, Cincinnati Children’s Medical Center, Cincinnati, OH (R.J.C.); Department of Pediatrics, Children’s Hospital Oakland, Oakland, CA (K.A.); and Department of Pediatrics, Stollery Children’s Hospital, University
| | - Gregory Webster
- From the Department of Pediatrics, Lucile Packard Children’s Hospital, Stanford University, Palo Alto, CA (C.Y.M., A.M.D.); Department of Pediatrics, Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL (G.W.); Department of Pediatrics, The Heart Center, Cincinnati Children’s Medical Center, Cincinnati, OH (R.J.C.); Department of Pediatrics, Children’s Hospital Oakland, Oakland, CA (K.A.); and Department of Pediatrics, Stollery Children’s Hospital, University
| | - Richard J. Czosek
- From the Department of Pediatrics, Lucile Packard Children’s Hospital, Stanford University, Palo Alto, CA (C.Y.M., A.M.D.); Department of Pediatrics, Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL (G.W.); Department of Pediatrics, The Heart Center, Cincinnati Children’s Medical Center, Cincinnati, OH (R.J.C.); Department of Pediatrics, Children’s Hospital Oakland, Oakland, CA (K.A.); and Department of Pediatrics, Stollery Children’s Hospital, University
| | - Michal J. Kantoch
- From the Department of Pediatrics, Lucile Packard Children’s Hospital, Stanford University, Palo Alto, CA (C.Y.M., A.M.D.); Department of Pediatrics, Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL (G.W.); Department of Pediatrics, The Heart Center, Cincinnati Children’s Medical Center, Cincinnati, OH (R.J.C.); Department of Pediatrics, Children’s Hospital Oakland, Oakland, CA (K.A.); and Department of Pediatrics, Stollery Children’s Hospital, University
| | - Anne M. Dubin
- From the Department of Pediatrics, Lucile Packard Children’s Hospital, Stanford University, Palo Alto, CA (C.Y.M., A.M.D.); Department of Pediatrics, Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL (G.W.); Department of Pediatrics, The Heart Center, Cincinnati Children’s Medical Center, Cincinnati, OH (R.J.C.); Department of Pediatrics, Children’s Hospital Oakland, Oakland, CA (K.A.); and Department of Pediatrics, Stollery Children’s Hospital, University
| | - Kishor Avasarala
- From the Department of Pediatrics, Lucile Packard Children’s Hospital, Stanford University, Palo Alto, CA (C.Y.M., A.M.D.); Department of Pediatrics, Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL (G.W.); Department of Pediatrics, The Heart Center, Cincinnati Children’s Medical Center, Cincinnati, OH (R.J.C.); Department of Pediatrics, Children’s Hospital Oakland, Oakland, CA (K.A.); and Department of Pediatrics, Stollery Children’s Hospital, University
| | - Joseph Atallah
- From the Department of Pediatrics, Lucile Packard Children’s Hospital, Stanford University, Palo Alto, CA (C.Y.M., A.M.D.); Department of Pediatrics, Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL (G.W.); Department of Pediatrics, The Heart Center, Cincinnati Children’s Medical Center, Cincinnati, OH (R.J.C.); Department of Pediatrics, Children’s Hospital Oakland, Oakland, CA (K.A.); and Department of Pediatrics, Stollery Children’s Hospital, University
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Marx SO, Marks AR. Dysfunctional ryanodine receptors in the heart: new insights into complex cardiovascular diseases. J Mol Cell Cardiol 2013; 58:225-31. [PMID: 23507255 DOI: 10.1016/j.yjmcc.2013.03.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 02/26/2013] [Accepted: 03/02/2013] [Indexed: 01/07/2023]
Abstract
Calcium dependent signaling is highly regulated in cardiomyocytes and determines the force of cardiac muscle contraction. The cardiac ryanodine receptors (RyR2) play important roles in health and disease. Modulation of RyR2 by phosphorylation is required for sympathetic regulation of cardiac function. Abnormal regulation of RyR2 contributes to heart failure, and atrial and ventricular arrhythmias. RyR2 channels are oxidized, nitrosylated, and hyperphosphorylated by protein kinase A (PKA) in heart failure, resulting in "leaky" channels. These leaky RyR2 channels contribute to depletion of calcium from the sarcoplasmic reticulum, resulting in defective cardiac excitation-contraction coupling. In this review, we discuss both the importance of PKA and calcium/calmodulin-dependent kinase II (CaMKII) regulation of RyR2 in health, and how altered phosphorylation, nitrosylation and oxidation of RyR2 channels lead to cardiac disease. Correcting these defects using either genetic manipulation (knock-in) in mice, or specific and novel small molecules ameliorates the RyR2 dysfunction, reducing the progression to heart failure and the incidence of arrhythmias.
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Affiliation(s)
- Steven O Marx
- Division of Cardiology, College of Physicians and Surgeons of Columbia University, New York, NY 10032, USA
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King JH, Zhang Y, Lei M, Grace AA, Huang CLH, Fraser JA. Atrial arrhythmia, triggering events and conduction abnormalities in isolated murine RyR2-P2328S hearts. Acta Physiol (Oxf) 2013; 207:308-23. [PMID: 22958452 DOI: 10.1111/apha.12006] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 08/15/2012] [Accepted: 09/03/2012] [Indexed: 12/19/2022]
Abstract
AIM RyR2 mutations are associated with catecholaminergic polymorphic tachycardia, a condition characterized by ventricular and atrial arrhythmias. The present experiments investigate the atrial electrophysiology of homozygotic murine RyR2-P2328S (RyR2(S/S)) hearts for ectopic triggering events and for conduction abnormalities that might provide a re-entrant substrate. METHODS Electrocardiograph recordings were made from regularly stimulated RyR2(S/S) and wild type (WT) hearts, perfused using a novel modified Langendorff preparation. This permitted the simultaneous use of either floating intracellular microelectrodes to measure action potential (AP) parameters, or a multielectrode array to measure epicardial conduction velocity (CV). RESULTS RyR2(S/S) showed frequent sustained tachyarrhythmias, delayed afterdepolarizations and ectopic APs, increased interatrial conduction delays, reduced epicardial CVs and reduced maximum rates of AP depolarization ((dV/dt)(max)), despite similar effective refractory periods, AP durations and AP amplitudes. Effective interatrial CVs and (dV/dt)(max) values of APs following ectopic (S2) stimulation were lower than those of APs following regular stimulation and decreased with shortening S1S2 intervals. However, although RyR2(S/S) atria showed arrhythmias over a wider range of S1S2 intervals, the interatrial CV and (dV/dt)(max) of S2 APs provoking such arrhythmias were similar in RyR2(S/S) and WT. CONCLUSIONS These results suggest that abnormal intracellular Ca(2+) homoeostasis produces both arrhythmic triggers and a slow-conducting arrhythmic substrate in RyR2(S/S) atria. A similar mechanism might also contribute to arrhythmogenesis in other conditions, associated with diastolic Ca(2+) release, such as atrial fibrillation.
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Affiliation(s)
- J. H. King
- Physiological Laboratory; University of Cambridge; Cambridge; UK
| | - Y. Zhang
- Physiological Laboratory; University of Cambridge; Cambridge; UK
| | - M. Lei
- Institute of Cardiovascular Sciences; University of Manchester; Manchester; UK
| | - A. A. Grace
- Department of Biochemistry; University of Cambridge; Cambridge; UK
| | | | - J. A. Fraser
- Physiological Laboratory; University of Cambridge; Cambridge; UK
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75
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Faggioni M, Hwang HS, van der Werf C, Nederend I, Kannankeril PJ, Wilde AAM, Knollmann BC. Accelerated sinus rhythm prevents catecholaminergic polymorphic ventricular tachycardia in mice and in patients. Circ Res 2013; 112:689-97. [PMID: 23295832 DOI: 10.1161/circresaha.111.300076] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
RATIONALE Catecholaminergic polymorphic ventricular tachycardia (CPVT) is caused by mutations in cardiac ryanodine receptor (RyR2) or calsequestrin (Casq2) genes. Sinoatrial node dysfunction associated with CPVT may increase the risk for ventricular arrhythmia (VA). OBJECTIVE To test the hypothesis that CPVT is suppressed by supraventricular overdrive stimulation. METHODS AND RESULTS Using CPVT mouse models (Casq2(-/-) and RyR2(R4496C/+) mice), the effect of increasing sinus heart rate was tested by pretreatment with atropine and by atrial overdrive pacing. Increasing intrinsic sinus rate with atropine before catecholamine challenge suppressed ventricular tachycardia in 86% of Casq2(-/-) mice (6/7) and significantly reduced the VA score (atropine: 0.6±0.2 versus vehicle: 1.7±0.3; P<0.05). Atrial overdrive pacing completely prevented VA in 16 of 19 (84%) Casq2(-/-) and in 7 of 8 (88%) RyR2(R4496C/+) mice and significantly reduced ventricular premature beats in both CPVT models (P<0.05). Rapid pacing also prevented spontaneous calcium waves and triggered beats in isolated CPVT myocytes. In humans, heart rate dependence of CPVT was evaluated by screening a CPVT patient registry for antiarrhythmic drug-naïve individuals that reached >85% of their maximum-predicted heart rate during exercise testing. All 18 CPVT patients who fulfilled the inclusion criteria exhibited VA before reaching 87% of maximum heart rate. In 6 CPVT patients (33%), VA were paradoxically suppressed as sinus heart rates increased further with continued exercise. CONCLUSIONS Accelerated supraventricular rates suppress VAs in 2 CPVT mouse models and in a subset of CPVT patients. Hypothetically, atrial overdrive pacing may be a therapy for preventing exercise-induced ventricular tachycardia in treatment-refractory CPVT patients.
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Affiliation(s)
- Michela Faggioni
- Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37232-0575, USA
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Kawamura M, Ohno S, Naiki N, Nagaoka I, Dochi K, Wang Q, Hasegawa K, Kimura H, Miyamoto A, Mizusawa Y, Itoh H, Makiyama T, Sumitomo N, Ushinohama H, Oyama K, Murakoshi N, Aonuma K, Horigome H, Honda T, Yoshinaga M, Ito M, Horie M. Genetic Background of Catecholaminergic Polymorphic Ventricular Tachycardia in Japan. Circ J 2013; 77:1705-13. [DOI: 10.1253/circj.cj-12-1460] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Mihoko Kawamura
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science
| | - Seiko Ohno
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science
| | - Nobu Naiki
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science
| | - Iori Nagaoka
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science
| | - Kenichi Dochi
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science
| | - Qi Wang
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science
| | - Kanae Hasegawa
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science
| | - Hiromi Kimura
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science
| | - Akashi Miyamoto
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science
| | - Yuka Mizusawa
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science
| | - Hideki Itoh
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science
| | - Takeru Makiyama
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Naokata Sumitomo
- Department of Pediatrics and Child Health, Nihon University School of Medicine
| | - Hiroya Ushinohama
- Department of Pediatric Cardiology, Fukuoka Children’s Hospital and Medical Center for Infectious Disease
| | - Kotaro Oyama
- Department of Pediatric Cardiology, Iwate Medical University Memorial Heart Center
| | - Nobuyuki Murakoshi
- Cardiovascular Division, Graduate School of Comprehensive Human Sciences, University of Tsukuba
| | - Kazutaka Aonuma
- Cardiovascular Division, Graduate School of Comprehensive Human Sciences, University of Tsukuba
| | | | - Takafumi Honda
- Department of Pediatrics, Tokyo Women’s Medical University Yachiyo Medical Center
| | - Masao Yoshinaga
- Department of Pediatrics, National Hospital Organization Kagoshima Medical Center
| | - Makoto Ito
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science
| | - Minoru Horie
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science
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Abriel H, Zaklyazminskaya EV. Cardiac channelopathies: genetic and molecular mechanisms. Gene 2012; 517:1-11. [PMID: 23266818 DOI: 10.1016/j.gene.2012.12.061] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 12/03/2012] [Indexed: 12/20/2022]
Abstract
Channelopathies are diseases caused by dysfunctional ion channels, due to either genetic or acquired pathological factors. Inherited cardiac arrhythmic syndromes are among the most studied human disorders involving ion channels. Since seminal observations made in 1995, thousands of mutations have been found in many of the different genes that code for cardiac ion channel subunits and proteins that regulate the cardiac ion channels. The main phenotypes observed in patients carrying these mutations are congenital long QT syndrome (LQTS), Brugada syndrome (BrS), catecholaminergic polymorphic ventricular tachycardia (CPVT), short QT syndrome (SQTS) and variable types of conduction defects (CD). The goal of this review is to present an update of the main genetic and molecular mechanisms, as well as the associated phenotypes of cardiac channelopathies as of 2012.
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Affiliation(s)
- Hugues Abriel
- Department of Clinical Research, University of Bern, Switzerland.
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78
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NAPOLITANO CARLO. Bridging the Dimensions of Research on Cardiac Ryanodine Receptor Mutations. J Cardiovasc Electrophysiol 2012; 24:219-20. [DOI: 10.1111/jce.12028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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79
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ZHANG YANMIN, WU JINGJING, JEEVARATNAM KAMALAN, KING JAMESH, GUZADHUR LAILA, REN XIAOLEI, GRACE ANDREWA, LEI MING, HUANG CHRISTOPHERLH, FRASER JAMESA. Conduction Slowing Contributes to Spontaneous Ventricular Arrhythmias in Intrinsically Active Murine RyR2-P2328S
Hearts. J Cardiovasc Electrophysiol 2012; 24:210-8. [DOI: 10.1111/jce.12015] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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80
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Leenhardt A, Denjoy I, Guicheney P. Catecholaminergic polymorphic ventricular tachycardia. Circ Arrhythm Electrophysiol 2012; 5:1044-52. [PMID: 23022705 DOI: 10.1161/circep.111.962027] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Antoine Leenhardt
- AP-HP, Hôpital Bichat, Service de Cardiologie et Centre de Référence des Maladies Cardiaques Héréditaires, Paris, France.
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van der Werf C, Nederend I, Hofman N, van Geloven N, Ebink C, Frohn-Mulder IM, Alings AMW, Bosker HA, Bracke FA, van den Heuvel F, Waalewijn RA, Bikker H, van Tintelen JP, Bhuiyan ZA, van den Berg MP, Wilde AA. Familial Evaluation in Catecholaminergic Polymorphic Ventricular Tachycardia. Circ Arrhythm Electrophysiol 2012; 5:748-56. [DOI: 10.1161/circep.112.970517] [Citation(s) in RCA: 121] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Christian van der Werf
- From the Department of Cardiology, Heart Failure Research Center (C.v.d.W., I.N., A.A.M.W.), Department of Clinical Genetics (N.H., H.B., Z.A.B.), and Clinical Research Unit (N.v.G.), Academic Medical Center, Amsterdam, The Netherlands; Department of Cardiology, Maasstad Hospital, Rotterdam, The Netherlands (C.E.); Department of Pediatrics, Division of Pediatric Cardiology, Erasmus MC-Sophia, Rotterdam, The Netherlands (I.M.E.F-M.); Department of Cardiology, Amphia Hospital, Breda, The Netherlands
| | - Ineke Nederend
- From the Department of Cardiology, Heart Failure Research Center (C.v.d.W., I.N., A.A.M.W.), Department of Clinical Genetics (N.H., H.B., Z.A.B.), and Clinical Research Unit (N.v.G.), Academic Medical Center, Amsterdam, The Netherlands; Department of Cardiology, Maasstad Hospital, Rotterdam, The Netherlands (C.E.); Department of Pediatrics, Division of Pediatric Cardiology, Erasmus MC-Sophia, Rotterdam, The Netherlands (I.M.E.F-M.); Department of Cardiology, Amphia Hospital, Breda, The Netherlands
| | - Nynke Hofman
- From the Department of Cardiology, Heart Failure Research Center (C.v.d.W., I.N., A.A.M.W.), Department of Clinical Genetics (N.H., H.B., Z.A.B.), and Clinical Research Unit (N.v.G.), Academic Medical Center, Amsterdam, The Netherlands; Department of Cardiology, Maasstad Hospital, Rotterdam, The Netherlands (C.E.); Department of Pediatrics, Division of Pediatric Cardiology, Erasmus MC-Sophia, Rotterdam, The Netherlands (I.M.E.F-M.); Department of Cardiology, Amphia Hospital, Breda, The Netherlands
| | - Nan van Geloven
- From the Department of Cardiology, Heart Failure Research Center (C.v.d.W., I.N., A.A.M.W.), Department of Clinical Genetics (N.H., H.B., Z.A.B.), and Clinical Research Unit (N.v.G.), Academic Medical Center, Amsterdam, The Netherlands; Department of Cardiology, Maasstad Hospital, Rotterdam, The Netherlands (C.E.); Department of Pediatrics, Division of Pediatric Cardiology, Erasmus MC-Sophia, Rotterdam, The Netherlands (I.M.E.F-M.); Department of Cardiology, Amphia Hospital, Breda, The Netherlands
| | - Corné Ebink
- From the Department of Cardiology, Heart Failure Research Center (C.v.d.W., I.N., A.A.M.W.), Department of Clinical Genetics (N.H., H.B., Z.A.B.), and Clinical Research Unit (N.v.G.), Academic Medical Center, Amsterdam, The Netherlands; Department of Cardiology, Maasstad Hospital, Rotterdam, The Netherlands (C.E.); Department of Pediatrics, Division of Pediatric Cardiology, Erasmus MC-Sophia, Rotterdam, The Netherlands (I.M.E.F-M.); Department of Cardiology, Amphia Hospital, Breda, The Netherlands
| | - Ingrid M.E. Frohn-Mulder
- From the Department of Cardiology, Heart Failure Research Center (C.v.d.W., I.N., A.A.M.W.), Department of Clinical Genetics (N.H., H.B., Z.A.B.), and Clinical Research Unit (N.v.G.), Academic Medical Center, Amsterdam, The Netherlands; Department of Cardiology, Maasstad Hospital, Rotterdam, The Netherlands (C.E.); Department of Pediatrics, Division of Pediatric Cardiology, Erasmus MC-Sophia, Rotterdam, The Netherlands (I.M.E.F-M.); Department of Cardiology, Amphia Hospital, Breda, The Netherlands
| | - A. Marco W. Alings
- From the Department of Cardiology, Heart Failure Research Center (C.v.d.W., I.N., A.A.M.W.), Department of Clinical Genetics (N.H., H.B., Z.A.B.), and Clinical Research Unit (N.v.G.), Academic Medical Center, Amsterdam, The Netherlands; Department of Cardiology, Maasstad Hospital, Rotterdam, The Netherlands (C.E.); Department of Pediatrics, Division of Pediatric Cardiology, Erasmus MC-Sophia, Rotterdam, The Netherlands (I.M.E.F-M.); Department of Cardiology, Amphia Hospital, Breda, The Netherlands
| | - Hans A. Bosker
- From the Department of Cardiology, Heart Failure Research Center (C.v.d.W., I.N., A.A.M.W.), Department of Clinical Genetics (N.H., H.B., Z.A.B.), and Clinical Research Unit (N.v.G.), Academic Medical Center, Amsterdam, The Netherlands; Department of Cardiology, Maasstad Hospital, Rotterdam, The Netherlands (C.E.); Department of Pediatrics, Division of Pediatric Cardiology, Erasmus MC-Sophia, Rotterdam, The Netherlands (I.M.E.F-M.); Department of Cardiology, Amphia Hospital, Breda, The Netherlands
| | - Frank A. Bracke
- From the Department of Cardiology, Heart Failure Research Center (C.v.d.W., I.N., A.A.M.W.), Department of Clinical Genetics (N.H., H.B., Z.A.B.), and Clinical Research Unit (N.v.G.), Academic Medical Center, Amsterdam, The Netherlands; Department of Cardiology, Maasstad Hospital, Rotterdam, The Netherlands (C.E.); Department of Pediatrics, Division of Pediatric Cardiology, Erasmus MC-Sophia, Rotterdam, The Netherlands (I.M.E.F-M.); Department of Cardiology, Amphia Hospital, Breda, The Netherlands
| | - Freek van den Heuvel
- From the Department of Cardiology, Heart Failure Research Center (C.v.d.W., I.N., A.A.M.W.), Department of Clinical Genetics (N.H., H.B., Z.A.B.), and Clinical Research Unit (N.v.G.), Academic Medical Center, Amsterdam, The Netherlands; Department of Cardiology, Maasstad Hospital, Rotterdam, The Netherlands (C.E.); Department of Pediatrics, Division of Pediatric Cardiology, Erasmus MC-Sophia, Rotterdam, The Netherlands (I.M.E.F-M.); Department of Cardiology, Amphia Hospital, Breda, The Netherlands
| | - Reinier A. Waalewijn
- From the Department of Cardiology, Heart Failure Research Center (C.v.d.W., I.N., A.A.M.W.), Department of Clinical Genetics (N.H., H.B., Z.A.B.), and Clinical Research Unit (N.v.G.), Academic Medical Center, Amsterdam, The Netherlands; Department of Cardiology, Maasstad Hospital, Rotterdam, The Netherlands (C.E.); Department of Pediatrics, Division of Pediatric Cardiology, Erasmus MC-Sophia, Rotterdam, The Netherlands (I.M.E.F-M.); Department of Cardiology, Amphia Hospital, Breda, The Netherlands
| | - Hennie Bikker
- From the Department of Cardiology, Heart Failure Research Center (C.v.d.W., I.N., A.A.M.W.), Department of Clinical Genetics (N.H., H.B., Z.A.B.), and Clinical Research Unit (N.v.G.), Academic Medical Center, Amsterdam, The Netherlands; Department of Cardiology, Maasstad Hospital, Rotterdam, The Netherlands (C.E.); Department of Pediatrics, Division of Pediatric Cardiology, Erasmus MC-Sophia, Rotterdam, The Netherlands (I.M.E.F-M.); Department of Cardiology, Amphia Hospital, Breda, The Netherlands
| | - J. Peter van Tintelen
- From the Department of Cardiology, Heart Failure Research Center (C.v.d.W., I.N., A.A.M.W.), Department of Clinical Genetics (N.H., H.B., Z.A.B.), and Clinical Research Unit (N.v.G.), Academic Medical Center, Amsterdam, The Netherlands; Department of Cardiology, Maasstad Hospital, Rotterdam, The Netherlands (C.E.); Department of Pediatrics, Division of Pediatric Cardiology, Erasmus MC-Sophia, Rotterdam, The Netherlands (I.M.E.F-M.); Department of Cardiology, Amphia Hospital, Breda, The Netherlands
| | - Zahurul A. Bhuiyan
- From the Department of Cardiology, Heart Failure Research Center (C.v.d.W., I.N., A.A.M.W.), Department of Clinical Genetics (N.H., H.B., Z.A.B.), and Clinical Research Unit (N.v.G.), Academic Medical Center, Amsterdam, The Netherlands; Department of Cardiology, Maasstad Hospital, Rotterdam, The Netherlands (C.E.); Department of Pediatrics, Division of Pediatric Cardiology, Erasmus MC-Sophia, Rotterdam, The Netherlands (I.M.E.F-M.); Department of Cardiology, Amphia Hospital, Breda, The Netherlands
| | - Maarten P. van den Berg
- From the Department of Cardiology, Heart Failure Research Center (C.v.d.W., I.N., A.A.M.W.), Department of Clinical Genetics (N.H., H.B., Z.A.B.), and Clinical Research Unit (N.v.G.), Academic Medical Center, Amsterdam, The Netherlands; Department of Cardiology, Maasstad Hospital, Rotterdam, The Netherlands (C.E.); Department of Pediatrics, Division of Pediatric Cardiology, Erasmus MC-Sophia, Rotterdam, The Netherlands (I.M.E.F-M.); Department of Cardiology, Amphia Hospital, Breda, The Netherlands
| | - Arthur A.M. Wilde
- From the Department of Cardiology, Heart Failure Research Center (C.v.d.W., I.N., A.A.M.W.), Department of Clinical Genetics (N.H., H.B., Z.A.B.), and Clinical Research Unit (N.v.G.), Academic Medical Center, Amsterdam, The Netherlands; Department of Cardiology, Maasstad Hospital, Rotterdam, The Netherlands (C.E.); Department of Pediatrics, Division of Pediatric Cardiology, Erasmus MC-Sophia, Rotterdam, The Netherlands (I.M.E.F-M.); Department of Cardiology, Amphia Hospital, Breda, The Netherlands
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82
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Calsequestrin mutations and catecholaminergic polymorphic ventricular tachycardia. Pediatr Cardiol 2012; 33:959-67. [PMID: 22421959 PMCID: PMC3393815 DOI: 10.1007/s00246-012-0256-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 02/16/2012] [Indexed: 10/28/2022]
Abstract
Cardiac calsequestrin (Casq2) is the major Ca2+ binding protein in the sarcoplasmic reticulum, which is the principle Ca2+ storage organelle of cardiac muscle. During the last decade, experimental studies have provided new concepts on the role of Casq2 in the regulation of cardiac muscle Ca2+ handling. Furthermore, mutations in the gene encoding for cardiac calsequestrin, CASQ2, cause a rare but severe form of catecholaminergic polymorphic ventricular tachycardia (CPVT). Here, we review the physiology of Casq2 in cardiac Ca2+ handling and discuss pathophysiological mechanisms that lead to CPVT caused by CASQ2 mutations. We also describe the clinical aspects of CPVT and provide an update of its contemporary clinical management.
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83
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Marai I, Khoury A, Suleiman M, Gepstein L, Blich M, Lorber A, Boulos M. Importance of ventricular tachycardia storms not terminated by implantable cardioverter defibrillators shocks in patients with CASQ2 associated catecholaminergic polymorphic ventricular tachycardia. Am J Cardiol 2012; 110:72-6. [PMID: 22481011 DOI: 10.1016/j.amjcard.2012.02.049] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2011] [Revised: 02/21/2012] [Accepted: 02/21/2012] [Indexed: 11/27/2022]
Abstract
In this study, the clinical and implantable cardioverter-defibrillator (ICD)-related follow-up of patients with catecholaminergic polymorphic ventricular tachycardia (CPVT) with homogenous missense mutations in CASQ2 was summarized. Patients were followed in a pediatric cardiology clinic and an ICD clinic. All patients were treated with high-dose β blockers. ICDs were recommended for patients who remained symptomatic despite medical treatment. Twenty-seven patients were followed for 1 to 15 years (median 9). Twenty patients (74%) were symptomatic at diagnosis; 13 (65%) remained symptomatic after treatment with high-dose β blockers and thus were advised to receive ICDs. Eight of these patients refused ICDs, and eventually 6 (75%) died suddenly. Four of the 5 patients who received ICDs had ventricular tachycardia storms treated but not terminated by recurrent ICD shocks. These ventricular tachycardia storms (2 episodes in 2 patients and 1 episode in 2 patient) terminated spontaneously after finishing the programmed ICD shocks, without degeneration to ventricular fibrillation. None of the patients who received ICDs died. In conclusion, patients with CASQ2-associated CPVT should be recommended to receive ICDs to prevent sudden death when medical therapy is not effective. These patients may have recurrent ventricular tachycardia storms treated but not terminated by recurrent ICD shocks, without degeneration to ventricular fibrillation.
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84
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Obeyesekere MN, Sy RW, Leong-Sit P, Gula LJ, Yee R, Skanes AC, Klein GJ, Krahn AD. Treatment of asymptomatic catecholaminergic polymorphic ventricular tachycardia. Future Cardiol 2012; 8:439-50. [DOI: 10.2217/fca.12.12] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Catecholaminergic polymorphic ventricular tachycardia is a rare genetic disorder caused by mutations in genes involved in the intracellular calcium homeostasis of cardiac cells. Affected patients typically present with life-threatening ventricular arrhythmias precipitated by emotional/physical stress. The diagnosis is based on the demonstration of polymorphic or bidirectional ventricular tachycardia associated with adrenergic stress. Genetic testing can be confirmatory in some patients. Treatment for catecholaminergic polymorphic ventricular tachycardia includes medical and surgical efforts to suppress the effects of epinephrine at the myocardial level and/or modulation of calcium homeostasis. Mortality is high when untreated and sudden cardiac death may be the first manifestation of the disease. First-degree relatives of a proband should be offered genetic testing if the causal mutation is known. If the family mutation is not known, relatives should be clinically evaluated with provocative testing. In the absence of rigorous trials, prophylactic treatment of the asymptomatic catecholaminergic polymorphic ventricular tachycardia patient appears to reduce morbidity and mortality.
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Affiliation(s)
| | - Raymond W Sy
- The University of Western Ontario, Division of Cardiology, London, Ontario, Canada
| | - Peter Leong-Sit
- The University of Western Ontario, Division of Cardiology, London, Ontario, Canada
| | - Lorne J Gula
- The University of Western Ontario, Division of Cardiology, London, Ontario, Canada
| | - Raymond Yee
- The University of Western Ontario, Division of Cardiology, London, Ontario, Canada
| | - Allan C Skanes
- The University of Western Ontario, Division of Cardiology, London, Ontario, Canada
| | - George J Klein
- The University of Western Ontario, Division of Cardiology, London, Ontario, Canada
| | - Andrew D Krahn
- The University of Western Ontario, Division of Cardiology, London, Ontario, Canada
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ANDRSOVA IRENA, VALASKOVA IVETA, KUBUS PETER, VIT PAVEL, GAILLYOVA RENATA, KADLECOVA JITKA, MANOUSKOVA LENKA, NOVOTNY TOMAS. Clinical Characteristics and Mutational Analysis of the RyR2 Gene in Seven Czech Families with Catecholaminergic Polymorphic Ventricular Tachycardia. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 35:798-803. [DOI: 10.1111/j.1540-8159.2012.03399.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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86
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Nannenberg EA, Sijbrands EJ, Dijksman LM, Alders M, van Tintelen JP, Birnie M, van Langen IM, Wilde AA. Mortality of Inherited Arrhythmia Syndromes. ACTA ACUST UNITED AC 2012; 5:183-9. [DOI: 10.1161/circgenetics.111.961102] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
For most arrhythmia syndromes, the risk of sudden cardiac death for asymptomatic mutation carriers is ill defined. Data on the natural history of these diseases, therefore, are essential. The family tree mortality ratio method offers the unique possibility to study the natural history at a time when the disease was not known and patients received no treatment.
Methods and Results—
In 6 inherited arrhythmia syndromes caused by specific mutations, we analyzed all-cause mortality with the family tree mortality ratio method (main outcome measure, standardized mortality ratio [SMR]). In long-QT syndrome (LQTS) type 1, severely increased mortality risk during all years of childhood was observed (1–19 years), in particular during the first 10 years of life (SMR, 2.9; 95% CI, 1.5–5.1). In LQTS type 2, we observed increasing SMRs starting from age 15 years, which just reached significance between age 30 and 39 (SMR, 4.0; 95% CI, 1.1–10.0). In LQTS type 3, the SMR was increased between age 15 and 19 years (SMR, 5.8; 95% CI, 1.2–16.9). In the SCN5A overlap syndrome, excess mortality was observed between age 10 and 59 years, with a peak between 20 and 39 years (SMR, 3.8; 95% CI, 2.5–5.7). In catecholaminergic polymorphic ventricular tachycardia, excess mortality was restricted to ages 20 to 39 years (SMR, 3.0; 95% CI, 1.3–6.0). In Brugada syndrome, excess mortality was observed between age 40 and 59 (SMR, 1.79; 95% CI, 1.2–2.4), particularly in men.
Conclusions—
We identified age ranges during which the mortality risk manifests in an unselected and untreated population, which can guide screening in these families.
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Affiliation(s)
- Eline A. Nannenberg
- From the Department of Clinical Genetics (E.A.N., M.A.) and Heart Failure Research Center (E.A.N., L.M.D., M.B., A.A.M.W.), Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands; Department of Internal Medicine, Division of Pharmacology, Vascular and Metabolic Diseases, Erasmus Medical Center, Rotterdam, The Netherlands (E.J.G.S.); and Department of Clinical Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (J.P.T., I.M.L.)
| | - Eric J.G. Sijbrands
- From the Department of Clinical Genetics (E.A.N., M.A.) and Heart Failure Research Center (E.A.N., L.M.D., M.B., A.A.M.W.), Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands; Department of Internal Medicine, Division of Pharmacology, Vascular and Metabolic Diseases, Erasmus Medical Center, Rotterdam, The Netherlands (E.J.G.S.); and Department of Clinical Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (J.P.T., I.M.L.)
| | - Lea M. Dijksman
- From the Department of Clinical Genetics (E.A.N., M.A.) and Heart Failure Research Center (E.A.N., L.M.D., M.B., A.A.M.W.), Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands; Department of Internal Medicine, Division of Pharmacology, Vascular and Metabolic Diseases, Erasmus Medical Center, Rotterdam, The Netherlands (E.J.G.S.); and Department of Clinical Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (J.P.T., I.M.L.)
| | - Marielle Alders
- From the Department of Clinical Genetics (E.A.N., M.A.) and Heart Failure Research Center (E.A.N., L.M.D., M.B., A.A.M.W.), Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands; Department of Internal Medicine, Division of Pharmacology, Vascular and Metabolic Diseases, Erasmus Medical Center, Rotterdam, The Netherlands (E.J.G.S.); and Department of Clinical Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (J.P.T., I.M.L.)
| | - J. Peter van Tintelen
- From the Department of Clinical Genetics (E.A.N., M.A.) and Heart Failure Research Center (E.A.N., L.M.D., M.B., A.A.M.W.), Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands; Department of Internal Medicine, Division of Pharmacology, Vascular and Metabolic Diseases, Erasmus Medical Center, Rotterdam, The Netherlands (E.J.G.S.); and Department of Clinical Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (J.P.T., I.M.L.)
| | - Martijn Birnie
- From the Department of Clinical Genetics (E.A.N., M.A.) and Heart Failure Research Center (E.A.N., L.M.D., M.B., A.A.M.W.), Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands; Department of Internal Medicine, Division of Pharmacology, Vascular and Metabolic Diseases, Erasmus Medical Center, Rotterdam, The Netherlands (E.J.G.S.); and Department of Clinical Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (J.P.T., I.M.L.)
| | - Irene M. van Langen
- From the Department of Clinical Genetics (E.A.N., M.A.) and Heart Failure Research Center (E.A.N., L.M.D., M.B., A.A.M.W.), Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands; Department of Internal Medicine, Division of Pharmacology, Vascular and Metabolic Diseases, Erasmus Medical Center, Rotterdam, The Netherlands (E.J.G.S.); and Department of Clinical Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (J.P.T., I.M.L.)
| | - Arthur A.M. Wilde
- From the Department of Clinical Genetics (E.A.N., M.A.) and Heart Failure Research Center (E.A.N., L.M.D., M.B., A.A.M.W.), Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands; Department of Internal Medicine, Division of Pharmacology, Vascular and Metabolic Diseases, Erasmus Medical Center, Rotterdam, The Netherlands (E.J.G.S.); and Department of Clinical Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands (J.P.T., I.M.L.)
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Hayashi M, Denjoy I, Hayashi M, Extramiana F, Maltret A, Roux-Buisson N, Lupoglazoff JM, Klug D, Maury P, Messali A, Guicheney P, Leenhardt A. The role of stress test for predicting genetic mutations and future cardiac events in asymptomatic relatives of catecholaminergic polymorphic ventricular tachycardia probands. ACTA ACUST UNITED AC 2012; 14:1344-51. [DOI: 10.1093/europace/eus031] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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89
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Postmortem genetic testing of the ryanodine receptor 2 (RYR2) gene in a cohort of sudden unexplained death cases. Int J Legal Med 2012; 127:139-44. [DOI: 10.1007/s00414-011-0658-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Accepted: 12/14/2011] [Indexed: 01/28/2023]
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Abstract
Calsequestrin is the most abundant Ca-binding protein of the specialized endoplasmic reticulum found in muscle, the sarcoplasmic reticulum (SR). Calsequestrin binds Ca with high capacity and low affinity and importantly contributes to the mobilization of Ca during each contraction both in skeletal and cardiac muscle. Surprisingly, mutations in the gene encoding the cardiac isoform of calsequestrin (Casq2) have been associated with an inherited form of ventricular arrhythmia triggered by emotional or physical stress termed catecholaminergic polymorphic ventricular tachycardia (CPVT). Despite normal cardiac contractility and normal resting ECG, CPVT patients present with a high risk of sudden death at a young age. Here, we review recent new insights regarding the role of calsequestrin in genetic and acquired arrhythmia disorders. Mouse models of CPVT have shed light on the pathophysiological mechanism underlying CPVT. Casq2 is not only a Ca-storing protein as initially hypothesized, but it has a far more complex function in Ca handling and regulating SR Ca release channels. The functional importance of Casq2 interactions with other SR proteins and the importance of alterations in Casq2 trafficking are also being investigated. Reports of altered Casq2 trafficking in animal models of acquired heart diseases such as heart failure suggest that Casq2 may contribute to arrhythmia risk beyond genetic forms of Casq2 dysfunction.
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Affiliation(s)
- Michela Faggioni
- Departments of Medicine and Pharmacology, Vanderbilt University School of Medicine, Nashville, Tennessee 37232-0575, USA
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91
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Abstract
In general, syncope in children and adolescents is a benign event. Syncope during exercise may identify patients with a potentially fatal condition. Catecholaminergic polymorphic ventricular tachycardia is characterized by life-threatening ventricular arrhythmias, usually polymorphic ventricular tachycardia or ventricular fibrillation, occurring under conditions of exercise or emotional stress. Catecholaminergic polymorphic ventricular tachycardia is a familial condition that presents with exercise-induced syncope or sudden death in children or young adults. Detailed evaluation should be considered for patients who have syncope during exercise, injure themselves during the fall (i.e., unprotected faint with no antecedent warning prodrome), or who have a family history of syncope, early sudden cardiac death, myocardial disease, or arrhythmias.
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MARJAMAA ANNUKKA, HIIPPALA ANITA, ARRHENIUS BIANCA, LAHTINEN ANNUKKAM, KONTULA KIMMO, TOIVONEN LAURI, HAPPONEN JUHAMATTI, SWAN HEIKKI. Intravenous Epinephrine Infusion Test in Diagnosis of Catecholaminergic Polymorphic Ventricular Tachycardia. J Cardiovasc Electrophysiol 2011; 23:194-9. [DOI: 10.1111/j.1540-8167.2011.02188.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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93
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van der Werf C, Zwinderman AH, Wilde AAM. Therapeutic approach for patients with catecholaminergic polymorphic ventricular tachycardia: state of the art and future developments. Europace 2011; 14:175-83. [PMID: 21893508 DOI: 10.1093/europace/eur277] [Citation(s) in RCA: 132] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Christian van der Werf
- Department of Cardiology, Heart Failure Research Center, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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94
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Affiliation(s)
- Simon Modi
- Arrhythmia Service, London Health Sciences Centre, 339 Windermere Road, London, Ontario, Canada
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95
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van der Werf C, Kannankeril PJ, Sacher F, Krahn AD, Viskin S, Leenhardt A, Shimizu W, Sumitomo N, Fish FA, Bhuiyan ZA, Willems AR, van der Veen MJ, Watanabe H, Laborderie J, Haïssaguerre M, Knollmann BC, Wilde AAM. Flecainide therapy reduces exercise-induced ventricular arrhythmias in patients with catecholaminergic polymorphic ventricular tachycardia. J Am Coll Cardiol 2011; 57:2244-54. [PMID: 21616285 DOI: 10.1016/j.jacc.2011.01.026] [Citation(s) in RCA: 278] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2010] [Revised: 12/17/2010] [Accepted: 01/03/2011] [Indexed: 01/11/2023]
Abstract
OBJECTIVES This study evaluated the efficacy and safety of flecainide in addition to conventional drug therapy in patients with catecholaminergic polymorphic ventricular tachycardia (CPVT). BACKGROUND CPVT is an inherited arrhythmia syndrome caused by gene mutations that destabilize cardiac ryanodine receptor Ca(2+) release channels. Sudden cardiac death is incompletely prevented by conventional drug therapy with β-blockers with or without Ca(2+) channel blockers. The antiarrhythmic agent flecainide directly targets the molecular defect in CPVT by inhibiting premature Ca(2+) release and triggered beats in vitro. METHODS We collected data from every consecutive genotype-positive CPVT patient started on flecainide at 8 international centers before December 2009. The primary outcome measure was the reduction of ventricular arrhythmias during exercise testing. RESULTS Thirty-three patients received flecainide because of exercise-induced ventricular arrhythmias despite conventional (for different reasons, not always optimal) therapy (median age 25 years; range 7 to 68 years; 73% female). Exercise tests comparing flecainide in addition to conventional therapy with conventional therapy alone were available for 29 patients. Twenty-two patients (76%) had either partial (n = 8) or complete (n = 14) suppression of exercise-induced ventricular arrhythmias with flecainide (p < 0.001). No patient experienced worsening of exercise-induced ventricular arrhythmias. The median daily flecainide dose in responders was 150 mg (range 100 to 300 mg). During a median follow-up of 20 months (range 12 to 40 months), 1 patient experienced implantable cardioverter-defibrillator shocks for polymorphic ventricular arrhythmias, which were associated with a low serum flecainide level. In 1 patient, flecainide successfully suppressed exercise-induced ventricular arrhythmias for 29 years. CONCLUSIONS Flecainide reduced exercise-induced ventricular arrhythmias in patients with CPVT not controlled by conventional drug therapy.
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Affiliation(s)
- Christian van der Werf
- Department of Cardiology, Heart Failure Research Center, Academic Medical Center, Amsterdam, the Netherlands
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96
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Sorgente A, de Asmundis C, Bayrak F, Chierchia GB, Sarkozy A, Noppen M, Brugada P. Inefficacious ICD shocks treated with left cardiac sympathetic denervation in a patient with catecholaminergic polymorphic ventricular tachycardia. J Cardiol Cases 2011; 4:e34-e37. [DOI: 10.1016/j.jccase.2011.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Revised: 03/30/2011] [Accepted: 05/16/2011] [Indexed: 11/15/2022] Open
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98
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Abstract
Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an inherited arrhythmogenic disease occurring in patients with a structurally normal heart: the disease is characterized by life-threatening arrhythmias elicited by stress and emotion. In 2001, the ryanodine receptor was identified as the gene that is linked to CPVT; shortly thereafter, cardiac calsequestrin was implicated in the recessive form of the same disease. It became clear that abnormalities in intracellular Ca(2+) regulation could profoundly disrupt the electrophysiological properties of the heart. In this article, we discuss the molecular basis of the disease and the pathophysiological mechanisms that are impacting clinical diagnosis and management of affected individuals. As of today, the interaction between basic scientists and clinicians to understand CPVT and identify new therapeutic strategies is one of the most compelling examples of the importance of translational research in cardiology.
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Affiliation(s)
- Silvia G Priori
- Molecular Cardiology Laboratories, IRCCS Fondazione Salvatore Maugeri, Via Maugeri 10/10A, Pavia, Italy.
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99
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MacLennan DH, Zvaritch E. Mechanistic models for muscle diseases and disorders originating in the sarcoplasmic reticulum. BIOCHIMICA ET BIOPHYSICA ACTA-MOLECULAR CELL RESEARCH 2011; 1813:948-64. [DOI: 10.1016/j.bbamcr.2010.11.009] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Revised: 11/11/2010] [Accepted: 11/18/2010] [Indexed: 11/29/2022]
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100
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Marjamaa A, Laitinen-Forsblom P, Wronska A, Toivonen L, Kontula K, Swan H. Ryanodine receptor (RyR2) mutations in sudden cardiac death: Studies in extended pedigrees and phenotypic characterization in vitro. Int J Cardiol 2011; 147:246-52. [DOI: 10.1016/j.ijcard.2009.08.041] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2009] [Revised: 07/09/2009] [Accepted: 08/21/2009] [Indexed: 11/28/2022]
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