1
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Zhu W, Bian X, Lv J. From genes to clinical management: A comprehensive review of long QT syndrome pathogenesis and treatment. Heart Rhythm O2 2024; 5:573-586. [PMID: 39263612 PMCID: PMC11385408 DOI: 10.1016/j.hroo.2024.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2024] Open
Abstract
Background Long QT syndrome (LQTS) is a rare cardiac disorder characterized by prolonged ventricular repolarization and increased risk of ventricular arrhythmias. This review summarizes current knowledge of LQTS pathogenesis and treatment strategies. Objectives The purpose of this study was to provide an in-depth understanding of LQTS genetic and molecular mechanisms, discuss clinical presentation and diagnosis, evaluate treatment options, and highlight future research directions. Methods A systematic search of PubMed, Embase, and Cochrane Library databases was conducted to identify relevant studies published up to April 2024. Results LQTS involves mutations in ion channel-related genes encoding cardiac ion channels, regulatory proteins, and other associated factors, leading to altered cellular electrophysiology. Acquired causes can also contribute. Diagnosis relies on clinical history, electrocardiographic findings, and genetic testing. Treatment strategies include lifestyle modifications, β-blockers, potassium channel openers, device therapy, and surgical interventions. Conclusion Advances in understanding LQTS have improved diagnosis and personalized treatment approaches. Challenges remain in risk stratification and management of certain patient subgroups. Future research should focus on developing novel pharmacological agents, refining device technologies, and conducting large-scale clinical trials. Increased awareness and education are crucial for early detection and appropriate management of LQTS.
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Affiliation(s)
- Wenjing Zhu
- Department of Pulmonary and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Xueyan Bian
- Department of Pediatrics, Lixia District People's Hospital, Jinan, Shandong, China
| | - Jianli Lv
- Department of Pediatric Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
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2
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Balestra E, Bobbo M, Cittar M, Chicco D, D’Agata Mottolese B, Barbi E, Caiffa T. Congenital Long QT Syndrome in Children and Adolescents: A General Overview. CHILDREN (BASEL, SWITZERLAND) 2024; 11:582. [PMID: 38790576 PMCID: PMC11119491 DOI: 10.3390/children11050582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 04/24/2024] [Accepted: 05/06/2024] [Indexed: 05/26/2024]
Abstract
Congenital long QT syndrome (LQTS) represents a disorder of myocardial repolarization characterized by a prolongation of QTc interval on ECG, which can degenerate into fast polymorphic ventricular arrhythmias. The typical symptoms of LQTS are syncope and palpitations, mainly triggered by adrenergic stimuli, but it can also manifest with cardiac arrest. At least 17 genotypes have been associated with LQTS, with a specific genotype-phenotype relationship described for the three most common subtypes (LQTS1, -2, and -3). β-Blockers are the first-line therapy for LQTS, even if the choice of the appropriate patients needing to be treated may be challenging. In specific cases, interventional measures, such as an implantable cardioverter-defibrillator (ICD) or left cardiac sympathetic denervation (LCSD), are useful. The aim of this review is to highlight the current state-of-the-art knowledge on LQTS, providing an updated picture of possible diagnostic algorithms and therapeutic management.
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Affiliation(s)
- Elia Balestra
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34127 Trieste, Italy;
| | - Marco Bobbo
- Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, 34127 Trieste, Italy; (M.B.); (D.C.); (B.D.M.); (T.C.)
| | - Marco Cittar
- Cardiovascular Department, Centre for Diagnosis and Management of Cardiomyopathies, Azienda Sanitaria Universitaria Integrata di Trieste, University of Trieste, 34127 Trieste, Italy;
| | - Daniela Chicco
- Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, 34127 Trieste, Italy; (M.B.); (D.C.); (B.D.M.); (T.C.)
| | - Biancamaria D’Agata Mottolese
- Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, 34127 Trieste, Italy; (M.B.); (D.C.); (B.D.M.); (T.C.)
| | - Egidio Barbi
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34127 Trieste, Italy;
- Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, 34127 Trieste, Italy; (M.B.); (D.C.); (B.D.M.); (T.C.)
| | - Thomas Caiffa
- Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, 34127 Trieste, Italy; (M.B.); (D.C.); (B.D.M.); (T.C.)
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3
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Badura K, Buławska D, Dąbek B, Witkowska A, Lisińska W, Radzioch E, Skwira S, Młynarska E, Rysz J, Franczyk B. Primary Electrical Heart Disease-Principles of Pathophysiology and Genetics. Int J Mol Sci 2024; 25:1826. [PMID: 38339103 PMCID: PMC10855675 DOI: 10.3390/ijms25031826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/27/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024] Open
Abstract
Primary electrical heart diseases, often considered channelopathies, are inherited genetic abnormalities of cardiomyocyte electrical behavior carrying the risk of malignant arrhythmias leading to sudden cardiac death (SCD). Approximately 54% of sudden, unexpected deaths in individuals under the age of 35 do not exhibit signs of structural heart disease during autopsy, suggesting the potential significance of channelopathies in this group of age. Channelopathies constitute a highly heterogenous group comprising various diseases such as long QT syndrome (LQTS), short QT syndrome (SQTS), idiopathic ventricular fibrillation (IVF), Brugada syndrome (BrS), catecholaminergic polymorphic ventricular tachycardia (CPVT), and early repolarization syndromes (ERS). Although new advances in the diagnostic process of channelopathies have been made, the link between a disease and sudden cardiac death remains not fully explained. Evolving data in electrophysiology and genetic testing suggest previously described diseases as complex with multiple underlying genes and a high variety of factors associated with SCD in channelopathies. This review summarizes available, well-established information about channelopathy pathogenesis, genetic basics, and molecular aspects relative to principles of the pathophysiology of arrhythmia. In addition, general information about diagnostic approaches and management is presented. Analyzing principles of channelopathies and their underlying causes improves the understanding of genetic and molecular basics that may assist general research and improve SCD prevention.
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Affiliation(s)
- Krzysztof Badura
- Department of Nephrocardiology, Medical University of Lodz, Ul. Zeromskiego 113, 90-549 Lodz, Poland (S.S.)
| | - Dominika Buławska
- Department of Nephrocardiology, Medical University of Lodz, Ul. Zeromskiego 113, 90-549 Lodz, Poland (S.S.)
| | - Bartłomiej Dąbek
- Department of Nephrocardiology, Medical University of Lodz, Ul. Zeromskiego 113, 90-549 Lodz, Poland (S.S.)
| | - Alicja Witkowska
- Department of Nephrocardiology, Medical University of Lodz, Ul. Zeromskiego 113, 90-549 Lodz, Poland (S.S.)
| | - Wiktoria Lisińska
- Department of Nephrocardiology, Medical University of Lodz, Ul. Zeromskiego 113, 90-549 Lodz, Poland (S.S.)
| | - Ewa Radzioch
- Department of Nephrocardiology, Medical University of Lodz, Ul. Zeromskiego 113, 90-549 Lodz, Poland (S.S.)
| | - Sylwia Skwira
- Department of Nephrocardiology, Medical University of Lodz, Ul. Zeromskiego 113, 90-549 Lodz, Poland (S.S.)
| | - Ewelina Młynarska
- Department of Nephrocardiology, Medical University of Lodz, Ul. Zeromskiego 113, 90-549 Lodz, Poland (S.S.)
| | - Jacek Rysz
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, Ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Beata Franczyk
- Department of Nephrocardiology, Medical University of Lodz, Ul. Zeromskiego 113, 90-549 Lodz, Poland (S.S.)
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4
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Ataíde Silva R, R Sousa A, de Carvalho MSL, Anjos R. Congenital long QT syndrome presenting as unexplained bradycardia. BMJ Case Rep 2022; 15:e242362. [PMID: 35236671 PMCID: PMC8895896 DOI: 10.1136/bcr-2021-242362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2022] [Indexed: 11/03/2022] Open
Abstract
Congenital long QT syndrome (LQTS) is a genetically autosomal heterogeneous disorder of the ion channels and causes about 10% of sudden death infant syndrome in newborns. Its estimated prevalence is approximately 1 in 2500, probably underestimated because of its clinical heterogenicity. Few cases of neonatal LQTS have been reported. In 4% of them, life-threatening arrhythmic events can be the first manifestation of LQTS. The authors report two cases of neonatal LQTS with heterogeneous genetic mutations. Both manifested by bradycardia, one since fetal life. One case had serious arrhythmias during beta blocker therapeutic establishment needing a pacemaker implantation. Genetic mutations found were not the most frequently described in association with neonatal bradycardia, thus the importance of this report. Presentation with bradycardia is relatively frequent in neonatal period, thus LQTS should be actively investigated in neonates with unexplained bradycardia. Beta blocker therapy reduces QTc and avoids arrhythmic events and sudden death.
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Affiliation(s)
- Rita Ataíde Silva
- Department of Pediatric Cardiology, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Carnaxide, Portugal
| | - Ana R Sousa
- Department of Pediatric Cardiology, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Carnaxide, Portugal
| | | | - Rui Anjos
- Department of Pediatric Cardiology, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Carnaxide, Portugal
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5
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Excellent response to β-1 adrenergic receptor blockade (metoprolol) and exercise restriction in high-risk type 1 long QT syndrome. A 22-year follow-up. HeartRhythm Case Rep 2021; 8:191-194. [PMID: 35492848 PMCID: PMC9039562 DOI: 10.1016/j.hrcr.2021.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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6
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Went TR, Sultan W, Sapkota A, Khurshid H, Qureshi IA, Jahan N, Tara A, Win M, Wiltshire DA, Kannan A, Ruo SW, Alfonso M. A Systematic Review on the Role of Βeta-Blockers in Reducing Cardiac Arrhythmias in Long QT Syndrome Subtypes 1-3. Cureus 2021; 13:e17632. [PMID: 34646680 PMCID: PMC8485362 DOI: 10.7759/cureus.17632] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2021] [Indexed: 12/12/2022] Open
Abstract
Long QT syndrome (LQTS) is one of the most common inherited cardiac channelopathies with a prevalence of 1:2000. The condition can be congenital or acquired with 15 recognized genotypes; the most common subtypes are LQTS 1, 2, and 3 making up to 85%-90% of the cases. LQTS is characterized by delayed ventricular cardiomyocyte repolarization manifesting on the surface electrocardiogram (EKG) by a prolonged corrected QT (QTc) interval. The mainstay of treatment for this condition involves in part or combination medical therapy via β-blockers as first-line (or other anti-arrhythmic), left cardiac sympathectomy, or implantable cardiac defibrillator placement. Given the high rate of adverse cardiac events (ACE) or sudden cardiac death (SCD) in this population of patients with this disease, this review seeks to highlight the genotype-specific treatment consensus in β-blocker therapy of the most common subtypes. A database search of PubMed, PMC, and Medline was conducted to ascertain the most recent data in the last five years on the management of LQTS types 1-3 and the role of β-blockers in reducing ACE in these types. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were adhered to in the study selection, and selected studies focused on humans, written in the English Language, and within the last five years of LQTS subtypes 1, 2, and 3. Eleven relevant studies were selected after considering inclusion criteria, exclusion criteria, and quality appraisal within the last five years, focusing on β-blocker selection directed based on the subtypes of LQTS. Two meta-analyses, one cohort study, and eight reviews provided significant data that non-selective β-blockers unequivocally are of benefit in these LQTS types. Summary of findings suggested nadolol followed by propranolol yields the best results in LQTS 1, while nadolol would yield the best effect in LQTS 2 and 3.
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Affiliation(s)
- Terry R Went
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Waleed Sultan
- Medicine, Beni Suef University Faculty of Medicine, Beni Suef, EGY
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Surgery, Halifax Health Medical Center, Daytona Beach, USA
| | - Alisha Sapkota
- Psychiatry, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Hajra Khurshid
- Medicine and Psychiatry, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Israa A Qureshi
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Nasrin Jahan
- Psychiatry, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Anjli Tara
- General Medicine, General Surgery, and Emergency Department, Jinnah Postgraduate Medical Centre, Karachi, PAK
- Neurosurgery and General Surgery, Liaquat University of Medical and Health Sciences, Karachi, PAK
- Neurosurgery and General Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Myat Win
- General Surgery, Nottingham University Hospitals NHS Trust, Nottingham, GBR
- General Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Dwayne A Wiltshire
- Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Amudhan Kannan
- Neurological Surgery Research, Surgical Oncology Research, and General Surgery Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Surgical Pharmacology, General Surgery, and Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Sheila W Ruo
- General Surgery Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Michael Alfonso
- Medicine, Universidad del Rosario, Bogota, COL
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
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7
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Baracaldo-Santamaría D, Llinás-Caballero K, Corso-Ramirez JM, Restrepo CM, Dominguez-Dominguez CA, Fonseca-Mendoza DJ, Calderon-Ospina CA. Genetic and Molecular Aspects of Drug-Induced QT Interval Prolongation. Int J Mol Sci 2021; 22:8090. [PMID: 34360853 PMCID: PMC8347245 DOI: 10.3390/ijms22158090] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/04/2021] [Accepted: 07/06/2021] [Indexed: 12/22/2022] Open
Abstract
Long QT syndromes can be either acquired or congenital. Drugs are one of the many etiologies that may induce acquired long QT syndrome. In fact, many drugs frequently used in the clinical setting are a known risk factor for a prolonged QT interval, thus increasing the chances of developing torsade de pointes. The molecular mechanisms involved in the prolongation of the QT interval are common to most medications. However, there is considerable inter-individual variability in drug response, thus making the application of personalized medicine a relevant aspect in long QT syndrome, in order to evaluate the risk of every individual from a pharmacogenetic standpoint.
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Affiliation(s)
- Daniela Baracaldo-Santamaría
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia; (D.B.-S.); (J.M.C.-R.); (C.A.D.-D.)
| | - Kevin Llinás-Caballero
- GENIUROS Research Group, Center for Research in Genetics and Genomics (CIGGUR), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia; (K.L.-C.); (C.M.R.); (D.J.F.-M.)
- Institute for Immunological Research, University of Cartagena, Cartagena 130014, Colombia
| | - Julián Miguel Corso-Ramirez
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia; (D.B.-S.); (J.M.C.-R.); (C.A.D.-D.)
| | - Carlos Martín Restrepo
- GENIUROS Research Group, Center for Research in Genetics and Genomics (CIGGUR), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia; (K.L.-C.); (C.M.R.); (D.J.F.-M.)
| | | | - Dora Janeth Fonseca-Mendoza
- GENIUROS Research Group, Center for Research in Genetics and Genomics (CIGGUR), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia; (K.L.-C.); (C.M.R.); (D.J.F.-M.)
| | - Carlos Alberto Calderon-Ospina
- GENIUROS Research Group, Center for Research in Genetics and Genomics (CIGGUR), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia; (K.L.-C.); (C.M.R.); (D.J.F.-M.)
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8
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Lankaputhra M, Voskoboinik A. Congenital Long QT Syndrome: A Clinician's Guide. Intern Med J 2021; 51:1999-2011. [PMID: 34151491 DOI: 10.1111/imj.15437] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/31/2021] [Accepted: 06/15/2021] [Indexed: 11/29/2022]
Abstract
Congenital long QT syndrome (LQTS) is a familial cardiac ion channelopathy first described over sixty years ago. It is characterised by prolonged ventricular repolarization (long QT on ECG), ventricular arrhythmias and associated syncope or sudden cardiac death. As the most closely studied cardiac channelopathy, over the decades we have gained a deep appreciation of the complex genetic model of LQTS. Variability in genetic expression and incomplete penetrance leads to a heterogenous phenotype that can be challenging to clinically classify. In recent times, progress has been made in diagnostic method, risk stratification and treatment options. This review has been written as a guide for the general cardiologist to understand the basic pathophysiology, diagnosis, and management priorities for the most encountered LQTS subtypes: LQT1, LQT2 and LQT3. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Aleksandr Voskoboinik
- Division of Cardiology, Alfred Health, Melbourne, Australia.,Division of Cardiology Western Health, Monash University & Baker Heart & Diabetes Institute, Melbourne, Australia
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9
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London KS, Zegre-Hemsey J, Root M, Kleinmann A, White JL. Retrospective Diagnosis of Congenital Long QT Syndrome in a Patient With Febrile Syncope. J Emerg Nurs 2021; 46:214-219. [PMID: 32164933 DOI: 10.1016/j.jen.2020.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/09/2020] [Accepted: 01/11/2020] [Indexed: 12/29/2022]
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10
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Welzel T, Donner B, van den Anker JN. Intrauterine Growth Retardation in Pregnant Women with Long QT Syndrome Treated with Beta-Receptor Blockers. Neonatology 2021; 118:406-415. [PMID: 34186538 DOI: 10.1159/000516845] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/22/2021] [Indexed: 11/19/2022]
Abstract
Pregnant women with inherited long QT syndrome (iLQTS) are at an increased risk for preterm delivery and intrauterine growth retardation (IUGR) due to their underlying disease. Additionally, they are at a risk of arrhythmogenic events, particularly during the postpartum period because of physiological changes and increased emotional/physical stress. β-receptor blockers can effectively prevent life-threatening Torsades de Pointes ventricular tachycardia and they are the treatment of choice in iLQTS. Use of β-receptor blockers in pregnancy is recommended, although IUGR is commonly reported for prenatally exposed infants. IUGR, particularly in preterm infants, can result in adverse neonatal outcomes. This review was performed to support clinicians in their selection of β-receptor blocker treatment for their pregnant iLQTS women by (i) summarizing the available literature addressing the impact of different β-receptor blockers on IUGR and (ii) reporting additional aspects which might influence the β-receptor blocker selection. In general, experts recommend to use nonselective β-receptor blockers, such as nadolol and propranolol, for iLQTS management as these drugs seem to be superior in effectiveness. However, β-1-selective receptor blockers, such as bisoprolol or metoprolol, seem to affect less likely uterine contraction, peripheral vasodilation, and are associated with lower IUGR rates and fetal hypoglycemia. They are therefore recommended, except atenolol, as first-line therapy for pregnant women. Additionally, maternal factors such as iLQTS genotype, other underlying comorbidities (e.g., diabetes mellitus type 1, asthma bronchiale), and uteroplacental dysfunction or fetal factors have to be taken into account. Therefore, each woman with iLQTS who wants to become pregnant should be well-advised for a personalized β-receptor blocker therapy according to the individual risk-benefit evaluation by a multidisciplinary team of cardiologists, gynecologists, pediatric cardiologists, neonatologists, and clinical pharmacologists. During pregnancy, a close monitoring of IUGR and, after birth, monitoring of bradycardia, hypoglycemia, and respiratory depression in the neonate is mandatory. This review summarizes available data on β-receptor blocker-related risk for IUGR in prenatally exposed infants and illustrates which factors might influence β-receptor blocker selection with the aim to support clinicians in their pharmacological management of their pregnant iLQTS patients.
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Affiliation(s)
- Tatjana Welzel
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital of Basel, (UKBB), University of Basel, Basel, Switzerland
| | - Birgit Donner
- Pediatric Cardiology, University Children's Hospital of Basel (UKBB), University of Basel, Basel, Switzerland
| | - Johannes N van den Anker
- Pediatric Pharmacology and Pharmacometrics, University Children's Hospital of Basel, (UKBB), University of Basel, Basel, Switzerland.,Division of Clinical Pharmacology, Children's National Hospital, Washington, District of Columbia, USA
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11
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Functional evaluation of gene mutations in Long QT Syndrome: strength of evidence from in vitro assays for deciphering variants of uncertain significance. JOURNAL OF CONGENITAL CARDIOLOGY 2020. [DOI: 10.1186/s40949-020-00037-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Genetic screening is now commonplace for patients suspected of having inherited cardiac conditions. Variants of uncertain significance (VUS) in disease-associated genes pose problems for the diagnostician and reliable methods for evaluating VUS function are required. Although function is difficult to interrogate for some genes, heritable channelopathies have established mechanisms that should be amenable to well-validated evaluation techniques.
The cellular electrophysiology techniques of ‘voltage-’ and ‘patch-’ clamp have a long history of successful use and have been central to identifying both the roles of genes involved in different forms of congenital Long QT Syndrome (LQTS) and the mechanisms by which mutations lead to aberrant ion channel function underlying clinical phenotypes. This is particularly evident for KCNQ1, KCNH2 and SCN5A, mutations in which underlie > 90% of genotyped LQTS cases (the LQT1-LQT3 subtypes). Recent studies utilizing high throughput (HT) planar patch-clamp recording have shown it to discriminate effectively between rare benign and pathological variants, studied through heterologous expression of recombinant channels. In combination with biochemical methods for evaluating channel trafficking and supported by biophysical modelling, patch clamp also provides detailed mechanistic insight into the functional consequences of identified mutations. Whilst potentially powerful, patient-specific stem-cell derived cardiomyocytes and genetically modified animal models are currently not well-suited to high throughput VUS study.
Conclusion
The widely adopted 2015 American College of Medical Genetics (ACMG) and Association for Molecular Pathology (AMP) guidelines for the interpretation of sequence variants include the PS3 criterion for consideration of evidence from well-established in vitro or in vivo assays. The wealth of information on underlying mechanisms of LQT1-LQT3 and recent HT patch clamp data support consideration of patch clamp data together (for LQT1 and LQT2) with information from biochemical trafficking assays as meeting the PS3 criterion of well established assays, able to provide ‘strong’ evidence for functional pathogenicity of identified VUS.
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Musunuru K, Hershberger RE, Day SM, Klinedinst NJ, Landstrom AP, Parikh VN, Prakash S, Semsarian C, Sturm AC. Genetic Testing for Inherited Cardiovascular Diseases: A Scientific Statement From the American Heart Association. CIRCULATION-GENOMIC AND PRECISION MEDICINE 2020; 13:e000067. [DOI: 10.1161/hcg.0000000000000067] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Advances in human genetics are improving the understanding of a variety of inherited cardiovascular diseases, including cardiomyopathies, arrhythmic disorders, vascular disorders, and lipid disorders such as familial hypercholesterolemia. However, not all cardiovascular practitioners are fully aware of the utility and potential pitfalls of incorporating genetic test results into the care of patients and their families. This statement summarizes current best practices with respect to genetic testing and its implications for the management of inherited cardiovascular diseases.
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13
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London KS, Hartwell C, Cesar S, Sarquella-Brugada G, White JL. Can Sudden Cardiac Death Risk in the Young be Identified in the Emergency Department? J Emerg Nurs 2020; 46:105-110. [DOI: 10.1016/j.jen.2019.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 09/20/2019] [Accepted: 09/23/2019] [Indexed: 11/16/2022]
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14
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Mesquita FCP, Arantes PC, Kasai-Brunswick TH, Araujo DS, Gubert F, Monnerat G, Silva Dos Santos D, Neiman G, Leitão IC, Barbosa RAQ, Coutinho JL, Vaz IM, Dos Santos MN, Borgonovo T, Cruz FES, Miriuka S, Medei EH, Campos de Carvalho AC, Carvalho AB. R534C mutation in hERG causes a trafficking defect in iPSC-derived cardiomyocytes from patients with type 2 long QT syndrome. Sci Rep 2019; 9:19203. [PMID: 31844156 PMCID: PMC6915575 DOI: 10.1038/s41598-019-55837-w] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 12/03/2019] [Indexed: 02/06/2023] Open
Abstract
Patient-specific cardiomyocytes obtained from induced pluripotent stem cells (CM-iPSC) offer unprecedented mechanistic insights in the study of inherited cardiac diseases. The objective of this work was to study a type 2 long QT syndrome (LQTS2)-associated mutation (c.1600C > T in KCNH2, p.R534C in hERG) in CM-iPSC. Peripheral blood mononuclear cells were isolated from two patients with the R534C mutation and iPSCs were generated. In addition, the same mutation was inserted in a control iPSC line by genome editing using CRISPR/Cas9. Cells expressed pluripotency markers and showed spontaneous differentiation into the three embryonic germ layers. Electrophysiology demonstrated that action potential duration (APD) of LQTS2 CM-iPSC was significantly longer than that of the control line, as well as the triangulation of the action potentials (AP), implying a longer duration of phase 3. Treatment with the IKr inhibitor E4031 only caused APD prolongation in the control line. Patch clamp showed a reduction of IKr on LQTS2 CM-iPSC compared to control, but channel activation was not significantly affected. Immunofluorescence for hERG demonstrated perinuclear staining in LQTS2 CM-iPSC. In conclusion, CM-iPSC recapitulated the LQTS2 phenotype and our findings suggest that the R534C mutation in KCNH2 leads to a channel trafficking defect to the plasma membrane.
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Affiliation(s)
- Fernanda C P Mesquita
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro. Avenida Carlos Chagas Filho 373, Bloco G, Rio de Janeiro, RJ, 21941-902, Brazil
| | - Paulo C Arantes
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro. Avenida Carlos Chagas Filho 373, Bloco G, Rio de Janeiro, RJ, 21941-902, Brazil
| | - Tais H Kasai-Brunswick
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro. Avenida Carlos Chagas Filho 373, Bloco G, Rio de Janeiro, RJ, 21941-902, Brazil
- National Center for Structural Biology and Bioimaging, Federal University of Rio de Janeiro. Avenida Carlos Chagas Filho 373, Bloco M, Rio de Janeiro, RJ, 21941-902, Brazil
| | - Dayana S Araujo
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro. Avenida Carlos Chagas Filho 373, Bloco G, Rio de Janeiro, RJ, 21941-902, Brazil
| | - Fernanda Gubert
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro. Avenida Carlos Chagas Filho 373, Bloco G, Rio de Janeiro, RJ, 21941-902, Brazil
- Institute of Biomedical Sciences, Federal University of Rio de Janeiro. Avenida Carlos Chagas Filho 373, Bloco F, Rio de Janeiro, RJ, 21941-902, Brazil
| | - Gustavo Monnerat
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro. Avenida Carlos Chagas Filho 373, Bloco G, Rio de Janeiro, RJ, 21941-902, Brazil
| | - Danúbia Silva Dos Santos
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro. Avenida Carlos Chagas Filho 373, Bloco G, Rio de Janeiro, RJ, 21941-902, Brazil
| | - Gabriel Neiman
- FLENI Foundation, Sede Escobar. Ruta 9, Km 53, Belen de Escobar, BA, B1625, Argentina
| | - Isabela C Leitão
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro. Avenida Carlos Chagas Filho 373, Bloco G, Rio de Janeiro, RJ, 21941-902, Brazil
| | - Raiana A Q Barbosa
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro. Avenida Carlos Chagas Filho 373, Bloco G, Rio de Janeiro, RJ, 21941-902, Brazil
| | - Jorge L Coutinho
- National Institute of Cardiology, Rua das Laranjeiras 374, Rio de Janeiro, RJ, 22240-006, Brazil
| | - Isadora M Vaz
- Pontifical Catholic University of Parana. Rua Imaculada Conceição 1155, Curitiba, PR, 80215-901, Brazil
| | - Marcus N Dos Santos
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro. Avenida Carlos Chagas Filho 373, Bloco G, Rio de Janeiro, RJ, 21941-902, Brazil
| | - Tamara Borgonovo
- Pontifical Catholic University of Parana. Rua Imaculada Conceição 1155, Curitiba, PR, 80215-901, Brazil
| | - Fernando E S Cruz
- National Institute of Cardiology, Rua das Laranjeiras 374, Rio de Janeiro, RJ, 22240-006, Brazil
| | - Santiago Miriuka
- FLENI Foundation, Sede Escobar. Ruta 9, Km 53, Belen de Escobar, BA, B1625, Argentina
| | - Emiliano H Medei
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro. Avenida Carlos Chagas Filho 373, Bloco G, Rio de Janeiro, RJ, 21941-902, Brazil
- National Center for Structural Biology and Bioimaging, Federal University of Rio de Janeiro. Avenida Carlos Chagas Filho 373, Bloco M, Rio de Janeiro, RJ, 21941-902, Brazil
| | - Antonio C Campos de Carvalho
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro. Avenida Carlos Chagas Filho 373, Bloco G, Rio de Janeiro, RJ, 21941-902, Brazil.
- National Center for Structural Biology and Bioimaging, Federal University of Rio de Janeiro. Avenida Carlos Chagas Filho 373, Bloco M, Rio de Janeiro, RJ, 21941-902, Brazil.
- National Institute of Cardiology, Rua das Laranjeiras 374, Rio de Janeiro, RJ, 22240-006, Brazil.
- National Institute for Science and Technology in Regenerative Medicine. Avenida Carlos Chagas Filho 373, Bloco M, Rio de Janeiro, RJ, 21941-902, Brazil.
| | - Adriana B Carvalho
- Carlos Chagas Filho Institute of Biophysics, Federal University of Rio de Janeiro. Avenida Carlos Chagas Filho 373, Bloco G, Rio de Janeiro, RJ, 21941-902, Brazil.
- National Center for Structural Biology and Bioimaging, Federal University of Rio de Janeiro. Avenida Carlos Chagas Filho 373, Bloco M, Rio de Janeiro, RJ, 21941-902, Brazil.
- National Institute for Science and Technology in Regenerative Medicine. Avenida Carlos Chagas Filho 373, Bloco M, Rio de Janeiro, RJ, 21941-902, Brazil.
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Harper AR, Parikh VN, Goldfeder RL, Caleshu C, Ashley EA. Delivering Clinical Grade Sequencing and Genetic Test Interpretation for Cardiovascular Medicine. ACTA ACUST UNITED AC 2019; 10:CIRCGENETICS.116.001221. [PMID: 28411191 DOI: 10.1161/circgenetics.116.001221] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Andrew R Harper
- From the Royal Brompton and Harefield NHS Foundation Trust, London (A.R.H.); Wellcome Trust Centre for Human Genetics, University of Oxford, United Kingdom (A.R.H.); Department of Genetics, Stanford University, Stanford, CA (E.A.A., R.L.G.); and Center for Inherited Cardiovascular Disease, Stanford University, Stanford, CA (V.N.P., R.L.G., C.C., E.A.A.)
| | - Victoria N Parikh
- From the Royal Brompton and Harefield NHS Foundation Trust, London (A.R.H.); Wellcome Trust Centre for Human Genetics, University of Oxford, United Kingdom (A.R.H.); Department of Genetics, Stanford University, Stanford, CA (E.A.A., R.L.G.); and Center for Inherited Cardiovascular Disease, Stanford University, Stanford, CA (V.N.P., R.L.G., C.C., E.A.A.)
| | - Rachel L Goldfeder
- From the Royal Brompton and Harefield NHS Foundation Trust, London (A.R.H.); Wellcome Trust Centre for Human Genetics, University of Oxford, United Kingdom (A.R.H.); Department of Genetics, Stanford University, Stanford, CA (E.A.A., R.L.G.); and Center for Inherited Cardiovascular Disease, Stanford University, Stanford, CA (V.N.P., R.L.G., C.C., E.A.A.)
| | - Colleen Caleshu
- From the Royal Brompton and Harefield NHS Foundation Trust, London (A.R.H.); Wellcome Trust Centre for Human Genetics, University of Oxford, United Kingdom (A.R.H.); Department of Genetics, Stanford University, Stanford, CA (E.A.A., R.L.G.); and Center for Inherited Cardiovascular Disease, Stanford University, Stanford, CA (V.N.P., R.L.G., C.C., E.A.A.)
| | - Euan A Ashley
- From the Royal Brompton and Harefield NHS Foundation Trust, London (A.R.H.); Wellcome Trust Centre for Human Genetics, University of Oxford, United Kingdom (A.R.H.); Department of Genetics, Stanford University, Stanford, CA (E.A.A., R.L.G.); and Center for Inherited Cardiovascular Disease, Stanford University, Stanford, CA (V.N.P., R.L.G., C.C., E.A.A.).
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Gouda S, Saif MQ, Shabana M, Salama S, Eldamaty A. Electrocardiogram screening of deaf children for long QT syndrome: An Egyptian experience. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:1414-1419. [PMID: 30132927 DOI: 10.1111/pace.13484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 07/23/2018] [Accepted: 08/10/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Jervell and Lange-Nielsen syndrome is an autosomal recessive form of long QT syndrome (LQTS), clinically manifested by long QT interval and bilateral sensorineural hearing loss (SNHL) with the highest prevalence in Norway and Sweden. No data are available about the prevalence of such syndrome in Egypt. OBJECTIVES This study aimed to assess by electrocardiogram (ECG) the prevalence of LQTS among Egyptian children with SNHL. METHODS One thousand and twelve patients, aged ≤ 10 years (mean age 5.8 ± 2.6), were included in this study, 578 male patients (57%) and 434 female patients (43%). A 12-lead ECG was recorded for all patients and the corrected QT interval (QTc) was calculated by Bazett's formula. The probability of LQTS was evaluated by Schwartz criteria and laboratory investigations were done on all patients with long QT interval. RESULTS In the current study, the mean QTc interval was 411.7 ± 25.3 ms (range 343-675 ms). Twenty-one patients (2.1 %) had probable LQTS; of these, 11 patients had intermediate probability (Schwartz score 1.5-3 points) and 10 patients had high probability (Schwartz score ≥ 3.5 points). CONCLUSION This study shows that 2.1% of Egyptian children with SNHL in a tertiary care setting have LQTS.
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Affiliation(s)
- Sherif Gouda
- Department of Cardiology, Cairo University, Cairo, Egypt
| | | | | | - Sameh Salama
- Department of Cardiology, Cairo University, Cairo, Egypt
| | - Ahmed Eldamaty
- Department of Cardiology, Cairo University, Cairo, Egypt
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Management of anaphylaxis and allergies in patients with long QT syndrome: A review of the current evidence. Ann Allergy Asthma Immunol 2018; 121:545-551. [PMID: 30059791 DOI: 10.1016/j.anai.2018.07.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 07/16/2018] [Accepted: 07/23/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To develop a treatment algorithm for patients with long QT syndrome (LQTS) in case they need antiallergic medications for allergic reactions, including asthma and anaphylaxis. DATA SOURCES A literature review was performed to assess safety and to develop antiallergic treatment strategies for patients with LQTS. STUDY SELECTIONS LQTS is a heterogeneous group of myocardial repolarization disorders characterized by prolongation of the QT interval that potentially results in life-threatening torsades de pointes tachycardia. Data on pharmacologic treatment in case of anaphylaxis in LQTS are sparse. For this narrative review, all currently available articles on the use of antiallergic drugs for allergic reactions, anaphylaxis, and asthma in patients with LQTS were used. RESULTS Local allergic symptoms can be safely treated primarily with fexofenadine, levocetirizine, desloratadine, or cetirizine and, if needed, a short course of corticosteroids. In case of systemic symptoms, epinephrine should be administered. It may be less effective in patients with LQTS treated with β-blockers, necessitating the use of glucagon as add-on treatment. In case of lower airway obstruction, ipratropium bromide should be used, but if not effective, inhaled β2-adrenergic agents may be used. Continuous cardiac monitoring is indicated with the use of epinephrine and inhaled β2-adrenergic agents. The use of the latter also warrants intense monitoring of serum potassium levels. Clemastine and dimetindene should be avoided in patients with LQTS. CONCLUSION Patients with LQTS have a higher risk of life-threatening complications during the treatment of their allergic reactions because of the underlying disease and concomitant treatment with β-blockers. Treatment algorithms will certainly decrease these complications.
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Walsh R, Cook SA. Issues and Challenges in Diagnostic Sequencing for Inherited Cardiac Conditions. Clin Chem 2016; 63:116-128. [PMID: 27879323 DOI: 10.1373/clinchem.2016.254698] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 10/24/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Inherited cardiac conditions are a relatively common group of Mendelian diseases associated with ill health and death, often in the young. Research into the genetic causes of these conditions has enabled confirmatory and predictive diagnostic sequencing to become an integral part of the clinical management of inherited cardiomyopathies, arrhythmias, aortopathies, and dyslipidemias. CONTENT Currently, the principle benefit of clinical genetic testing is the cascade screening of family members of patients with a pathogenic variant, enabling targeted follow up of presymptomatic genotype-positive individuals and discharge of genotype-negative individuals to health. For the affected proband, diagnostic sequencing can also be useful in discriminating inherited disease from alternative diagnoses, directing treatment, and for molecular autopsy in cases of sudden unexplained death. Advances in sequencing technology have expanded testing panels for inherited cardiac conditions and driven down costs, further improving the cost-effectiveness of genetic testing. However, this expanded testing requires great rigor in the identification of pathogenic variants, with domain-specific knowledge required for variant interpretation. SUMMARY Diagnostic sequencing has the potential to become an integral part of the clinical management of patients with inherited cardiac conditions. However, to move beyond just confirmatory and predictive testing, a much greater understanding is needed of the genetic basis of these conditions, the role of the environment, and the underlying disease mechanisms. With this additional information it is likely that genetic testing will increasingly be used for stratified and preventative strategies in the era of genomic medicine.
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Affiliation(s)
- Roddy Walsh
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, London, UK.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Stuart A Cook
- National Heart and Lung Institute, Imperial College London, London, UK; .,National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore.,MRC Clinical Sciences Centre, Imperial College London, London, UK.,Division of Cardiovascular & Metabolic Disorders, Duke-National University of Singapore, Singapore
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Mital S, Musunuru K, Garg V, Russell MW, Lanfear DE, Gupta RM, Hickey KT, Ackerman MJ, Perez MV, Roden DM, Woo D, Fox CS, Ware S. Enhancing Literacy in Cardiovascular Genetics: A Scientific Statement From the American Heart Association. ACTA ACUST UNITED AC 2016; 9:448-467. [PMID: 27672144 DOI: 10.1161/hcg.0000000000000031] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Advances in genomics are enhancing our understanding of the genetic basis of cardiovascular diseases, both congenital and acquired, and stroke. These advances include finding genes that cause or increase the risk for childhood and adult-onset diseases, finding genes that influence how patients respond to medications, and the development of genetics-guided therapies for diseases. However, the ability of cardiovascular and stroke clinicians to fully understand and apply this knowledge to the care of their patients has lagged. This statement addresses what the specialist caring for patients with cardiovascular diseases and stroke should know about genetics; how they can gain this knowledge; how they can keep up-to-date with advances in genetics, genomics, and pharmacogenetics; and how they can apply this knowledge to improve the care of patients and families with cardiovascular diseases and stroke.
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Minton TB, Rosing J, Spar DS, Strawn JR, Garcia-Delgar B, Coffey BJ. Psychopharmacologic Management of Anxiety in an Adolescent with Congenital Long QT Syndrome. J Child Adolesc Psychopharmacol 2016; 26:485-9. [PMID: 27285068 PMCID: PMC6448365 DOI: 10.1089/cap.2016.29109.bjc] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
| | - Joanna Rosing
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - David S. Spar
- Division of Pediatric Cardiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jeffrey R. Strawn
- Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Blanca Garcia-Delgar
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Barbara J. Coffey
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York
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Gaba P, Bos JM, Cannon BC, Cha YM, Friedman PA, Asirvatham SJ, Ackerman MJ. Implantable cardioverter-defibrillator explantation for overdiagnosed or overtreated congenital long QT syndrome. Heart Rhythm 2016; 13:879-85. [DOI: 10.1016/j.hrthm.2015.12.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Indexed: 11/15/2022]
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Ramakrishna H, O’Hare M, Mookadam F, Gutsche JT, Shah R, Augoustides JG. Sudden Cardiac Death and Disorders of the QT Interval: Anesthetic Implications and Focus on Perioperative Management. J Cardiothorac Vasc Anesth 2015; 29:1723-33. [DOI: 10.1053/j.jvca.2015.07.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Indexed: 12/19/2022]
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Bossu A, van der Heyden MAG, de Boer TP, Vos MA. A 2015 focus on preventing drug-induced arrhythmias. Expert Rev Cardiovasc Ther 2015; 14:245-53. [DOI: 10.1586/14779072.2016.1116940] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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β-Blockers are vital in the current management of congenital long QT syndrome, but genotype-specific treatments may be options in the future. DRUGS & THERAPY PERSPECTIVES 2015. [DOI: 10.1007/s40267-015-0205-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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