1
|
Takase B, Ikeda T, Shimizu W, Abe H, Aiba T, Chinushi M, Koba S, Kusano K, Niwano S, Takahashi N, Takatsuki S, Tanno K, Watanabe E, Yoshioka K, Amino M, Fujino T, Iwasaki YK, Kohno R, Kinoshita T, Kurita Y, Masaki N, Murata H, Shinohara T, Yada H, Yodogawa K, Kimura T, Kurita T, Nogami A, Sumitomo N. JCS/JHRS 2022 Guideline on Diagnosis and Risk Assessment of Arrhythmia. Circ J 2024; 88:1509-1595. [PMID: 37690816 DOI: 10.1253/circj.cj-22-0827] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Affiliation(s)
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Haruhiko Abe
- Department of Heart Rhythm Management, University of Occupational and Environmental Health, Japan
| | - Takeshi Aiba
- Department of Clinical Laboratory Medicine and Genetics, National Cerebral and Cardiovascular Center
| | - Masaomi Chinushi
- School of Health Sciences, Niigata University School of Medicine
| | - Shinji Koba
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | - Naohiko Takahashi
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | - Seiji Takatsuki
- Department of Cardiology, Keio University School of Medicine
| | - Kaoru Tanno
- Cardiology Division, Cardiovascular Center, Showa University Koto-Toyosu Hospital
| | - Eiichi Watanabe
- Division of Cardiology, Department of Internal Medicine, Fujita Health University Bantane Hospital
| | | | - Mari Amino
- Department of Cardiology, Tokai University School of Medicine
| | - Tadashi Fujino
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine
| | - Yu-Ki Iwasaki
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Ritsuko Kohno
- Department of Heart Rhythm Management, University of Occupational and Environmental Health, Japan
| | - Toshio Kinoshita
- Department of Cardiovascular Medicine, Toho University Faculty of Medicine
| | - Yasuo Kurita
- Cardiovascular Center, International University of Health and Welfare, Mita Hospital
| | - Nobuyuki Masaki
- Department of Intensive Care Medicine, National Defense Medical College
| | | | - Tetsuji Shinohara
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University
| | - Hirotaka Yada
- Department of Cardiology, International University of Health and Welfare, Mita Hospital
| | - Kenji Yodogawa
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Takeshi Kimura
- Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | | | - Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| |
Collapse
|
2
|
Takase B, Ikeda T, Shimizu W, Abe H, Aiba T, Chinushi M, Koba S, Kusano K, Niwano S, Takahashi N, Takatsuki S, Tanno K, Watanabe E, Yoshioka K, Amino M, Fujino T, Iwasaki Y, Kohno R, Kinoshita T, Kurita Y, Masaki N, Murata H, Shinohara T, Yada H, Yodogawa K, Kimura T, Kurita T, Nogami A, Sumitomo N. JCS/JHRS 2022 Guideline on Diagnosis and Risk Assessment of Arrhythmia. J Arrhythm 2024; 40:655-752. [PMID: 39139890 PMCID: PMC11317726 DOI: 10.1002/joa3.13052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 04/22/2024] [Indexed: 08/15/2024] Open
Affiliation(s)
| | - Takanori Ikeda
- Department of Cardiovascular MedicineToho University Faculty of Medicine
| | - Wataru Shimizu
- Department of Cardiovascular MedicineNippon Medical School
| | - Haruhiko Abe
- Department of Heart Rhythm ManagementUniversity of Occupational and Environmental HealthJapan
| | - Takeshi Aiba
- Department of Clinical Laboratory Medicine and GeneticsNational Cerebral and Cardiovascular Center
| | | | - Shinji Koba
- Division of Cardiology, Department of MedicineShowa University School of Medicine
| | - Kengo Kusano
- Department of Cardiovascular MedicineNational Cerebral and Cardiovascular Center
| | - Shinichi Niwano
- Department of Cardiovascular MedicineKitasato University School of Medicine
| | - Naohiko Takahashi
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita University
| | | | - Kaoru Tanno
- Cardiovascular Center, Cardiology DivisionShowa University Koto‐Toyosu Hospital
| | - Eiichi Watanabe
- Division of Cardiology, Department of Internal MedicineFujita Health University Bantane Hospital
| | | | - Mari Amino
- Department of CardiologyTokai University School of Medicine
| | - Tadashi Fujino
- Department of Cardiovascular MedicineToho University Faculty of Medicine
| | - Yu‐ki Iwasaki
- Department of Cardiovascular MedicineNippon Medical School
| | - Ritsuko Kohno
- Department of Heart Rhythm ManagementUniversity of Occupational and Environmental HealthJapan
| | - Toshio Kinoshita
- Department of Cardiovascular MedicineToho University Faculty of Medicine
| | - Yasuo Kurita
- Cardiovascular Center, Mita HospitalInternational University of Health and Welfare
| | - Nobuyuki Masaki
- Department of Intensive Care MedicineNational Defense Medical College
| | | | - Tetsuji Shinohara
- Department of Cardiology and Clinical Examination, Faculty of MedicineOita University
| | - Hirotaka Yada
- Department of CardiologyInternational University of Health and Welfare Mita Hospital
| | - Kenji Yodogawa
- Department of Cardiovascular MedicineNippon Medical School
| | - Takeshi Kimura
- Cardiovascular MedicineKyoto University Graduate School of Medicine
| | | | - Akihiko Nogami
- Department of Cardiology, Faculty of MedicineUniversity of Tsukuba
| | - Naokata Sumitomo
- Department of Pediatric CardiologySaitama Medical University International Medical Center
| | | |
Collapse
|
3
|
Pinsky AM, Kulkarni VK, Bos JM, Neves R, Allison TG, Ackerman MJ. Proceed with caution: Standard protocol exercise stress tests fail to replicate the diagnostic utility of supine-stand tests for long QT syndrome. Pacing Clin Electrophysiol 2024; 47:455-461. [PMID: 38348899 DOI: 10.1111/pace.14945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 01/14/2024] [Accepted: 01/25/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Long QT syndrome (LQTS) is a sudden death predisposing condition characterized by ECG-derived prolongation of the QT interval. Previous studies have demonstrated that the supine-stand test may aid in the diagnosis of LQTS as patients fail to shorten their QT interval in response to standing up. The aim of this study was to evaluate the diagnostic accuracy of ECG data derived from standard protocol, clinically performed treadmill exercise stress tests (TESTs) in their ability to mimic the formal supine-stand test. METHODS We performed a retrospective review of 478 TESTs from patients evaluated for LQTS. Patients referred for evaluation of LQTS but who were dismissed as normal served as controls. Heart rate & QT values were obtained from standard protocol TESTs. RESULTS Overall, 243 patients with LQTS (125 LQT1, 63 LQT2, 55 LQT3; 146 [60%] female, mean age at TEST 30 ± 17 years) and 235 controls (142 [60%] female, mean age 24 ± 15 years) were included. The paired ΔQTc (QTcStand -QTcSupine ) was similar between LQTS (-5 ± 26) and controls (-2 ± 25; p = .2). During position change, the QT interval shortened by ≥20 ms in 33% of LQTS patients, remained unchanged in 62%, and increased in 5% of LQTS patients which was similar to controls (shortened in 40%, unchanged in 54%, and increased in 6% of controls; p = .2). Receiver-operator curve analysis to test the diagnostic ability of supine-stand ΔQT performed poorly in differentiating LQTS from controls with an of AUC 0.52 (p = .4). CONCLUSION TESTs should be used with caution when trying to interpret supine-stand changes for diagnosis of LQTS.
Collapse
Affiliation(s)
- Alexa M Pinsky
- Department of Cardiovascular Medicine (Division of Heart Rhythm Services), Windland Smith Rice Genetic Heart Rhythm Clinic, Mayo Clinic, Rochester, Minnesota, USA
| | - Veda K Kulkarni
- Department of Cardiovascular Medicine (Division of Heart Rhythm Services), Windland Smith Rice Genetic Heart Rhythm Clinic, Mayo Clinic, Rochester, Minnesota, USA
| | - J Martijn Bos
- Department of Cardiovascular Medicine (Division of Heart Rhythm Services), Windland Smith Rice Genetic Heart Rhythm Clinic, Mayo Clinic, Rochester, Minnesota, USA
| | - Raquel Neves
- Department of Cardiovascular Medicine (Division of Heart Rhythm Services), Windland Smith Rice Genetic Heart Rhythm Clinic, Mayo Clinic, Rochester, Minnesota, USA
| | - Thomas G Allison
- Department of Cardiovascular Medicine (Division of Heart Rhythm Services), Windland Smith Rice Genetic Heart Rhythm Clinic, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael J Ackerman
- Department of Cardiovascular Medicine (Division of Heart Rhythm Services), Windland Smith Rice Genetic Heart Rhythm Clinic, Mayo Clinic, Rochester, Minnesota, USA
- Department of Pediatric and Adolescent Medicine (Division of Pediatric Cardiology), Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
4
|
Hasegawa H, Tamura S, Nakajima T, Kawabata-Iwakawa R, Kobari T, Matsumoto N, Sano Y, Nishiyama M, Kurabayashi M, Kaneko Y, Nakatani Y, Ishii H. Diverse Phenotypic Manifestations in a Family with a Novel RYR2 E4107A Variant. Int Heart J 2024; 65:580-585. [PMID: 38825499 DOI: 10.1536/ihj.23-652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
Cardiac ryanodine receptor (RyR2) gain-of-function mutations cause catecholaminergic polymorphic ventricular tachycardia (CPVT). Conversely, RyR2 loss-of-function mutations cause a new disease entity, termed calcium release deficiency syndrome (CRDS), which may include RYR2-related long QT syndrome (LQTS). Importantly, unlike CPVT, patients with CRDS do not always exhibit exercise- or epinephrine-induced ventricular arrhythmias, which precludes a diagnosis of CRDS. Here we report a boy and his father, who both experienced exercise-induced cardiac events and harbor the same RYR2 E4107A variant. In the boy, an exercise stress test (EST) and epinephrine provocation test (EPT) did not induce any ventricular arrhythmias. QTc was slightly prolonged (QTc: 474 ms), and an EPT induced QTc prolongation (QTc-baseline: 466 ms, peak: 532 ms, steady-state: 527 ms). In contrast, in his father, QTc was not prolonged (QTc: 417 ms), and neither an EST nor EPT induced QTc prolongation. However, an EST induced multifocal premature ventricular contraction (PVC) bigeminy and bidirectional PVC couplets. Thus, they exhibited distinct clinical phenotypes: the boy exhibited LQTS (or CRDS) phenotype, whereas his father exhibited CPVT phenotype. These findings suggest that, in addition to the altered RyR2 function, other unidentified factors, such as other genetic, epigenetic, and environmental factors, and aging, may be involved in the diverse phenotypic manifestations. Considering that a single RYR2 variant can cause both CPVT and LQTS (or CRDS) phenotypes, in cascade screening of patients with CPVT and CRDS, an EST and EPT are not sufficient and genetic analysis is required to identify individuals who are at increased risk for life-threatening arrhythmias.
Collapse
Affiliation(s)
- Hiroshi Hasegawa
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
| | - Shuntaro Tamura
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
| | - Tadashi Nakajima
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
| | - Reika Kawabata-Iwakawa
- Division of Integrated Oncology Research, Gunma University Initiative for Advanced Research
| | - Takashi Kobari
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
| | | | - Yukie Sano
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
| | | | - Masahiko Kurabayashi
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
| | - Yoshiaki Kaneko
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
| | - Yosuke Nakatani
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
| | - Hideki Ishii
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
| |
Collapse
|
5
|
Alsaeed AH, Alqarawi W. Investigation of Unexplained Cardiac Arrest: Phenotyping and Genetic Testing. Card Electrophysiol Clin 2023; 15:307-318. [PMID: 37558301 DOI: 10.1016/j.ccep.2023.04.003] [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] [Indexed: 08/11/2023]
Abstract
Unexplained cardiac arrest (UCA) is a working diagnosis that should be replaced by a final diagnosis once evaluation is completed. Complete evaluation of UCA should include high-yield tests like cardiac magnetic resonance imaging, exercise treadmill test, and sodium-channel blocker challenge to identify latent causes of UCA. If no clear etiology is revealed after complete evaluation, idiopathic ventricular fibrillation may be diagnosed, and the strength of its diagnosis can be divided into definitive, probable, and possible based on the number of high-yield tests performed. Care should be provided by a multidisciplinary team with expertise in this area.
Collapse
Affiliation(s)
- Abdulelah H Alsaeed
- Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Wael Alqarawi
- Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia; University of Ottawa Heart Institute, University of Ottawa, Ottawa, Canada.
| |
Collapse
|
6
|
Vink AS, Hermans BJM, Hooglugt JLQ, Peltenburg PJ, Meijborg VMF, Hofman N, Clur SAB, Blom NA, Delhaas T, Wilde AAM, Postema PG. Diagnostic Accuracy of the Standing Test in Adults Suspected for Congenital Long-QT Syndrome. J Am Heart Assoc 2023:e026419. [PMID: 37421262 PMCID: PMC10382089 DOI: 10.1161/jaha.122.026419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 02/08/2023] [Indexed: 07/10/2023]
Abstract
Background An elegant bedside provocation test has been shown to aid the diagnosis of long-QT syndrome (LQTS) in a retrospective cohort by evaluation of QT intervals and T-wave morphology changes resulting from the brief tachycardia provoked by standing. We aimed to prospectively determine the potential diagnostic value of the standing test for LQTS. Methods and Results In adults suspected for LQTS who had a standing test, the QT interval was assessed manually and automated. In addition, T-wave morphology changes were determined. A total of 167 controls and 131 genetically confirmed patients with LQTS were included. A prolonged heart rate-corrected QT interval (QTc) (men ≥430 ms, women ≥450 ms) at baseline before standing yielded a sensitivity of 61% (95% CI, 47-74) in men and 54% (95% CI, 42-66) in women, with a specificity of 90% (95% CI, 80-96) and 89% (95% CI, 81-95), respectively. In both men and women, QTc≥460 ms after standing increased sensitivity (89% [95% CI, 83-94]) but decreased specificity (49% [95% CI, 41-57]). Sensitivity further increased (P<0.01) when a prolonged baseline QTc was accompanied by a QTc≥460 ms after standing in both men (93% [95% CI, 84-98]) and women (90% [95% CI, 81-96]). However, the area under the curve did not improve. T-wave abnormalities after standing did not further increase the sensitivity or the area under the curve significantly. Conclusions Despite earlier retrospective studies, a baseline ECG and the standing test in a prospective evaluation displayed a different diagnostic profile for congenital LQTS but no unequivocal synergism or advantage. This suggests that there is markedly reduced penetrance and incomplete expression in genetically confirmed LQTS with retention of repolarization reserve in response to the brief tachycardia provoked by standing.
Collapse
Affiliation(s)
- Arja S Vink
- Department of Clinical and Experimental Cardiology Amsterdam UMC, University of Amsterdam Amsterdam The Netherlands
- Department of Pediatric Cardiology Amsterdam UMC, University of Amsterdam, Emma Children's Hospital Amsterdam The Netherlands
| | - Ben J M Hermans
- Department of Biomedical Engineering Maastricht University Maastricht The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Maastricht The Netherlands
| | - Jean-Luc Q Hooglugt
- Department of Clinical and Experimental Cardiology Amsterdam UMC, University of Amsterdam Amsterdam The Netherlands
- Department of Pediatric Cardiology Amsterdam UMC, University of Amsterdam, Emma Children's Hospital Amsterdam The Netherlands
| | - Puck J Peltenburg
- Department of Clinical and Experimental Cardiology Amsterdam UMC, University of Amsterdam Amsterdam The Netherlands
- Department of Pediatric Cardiology Amsterdam UMC, University of Amsterdam, Emma Children's Hospital Amsterdam The Netherlands
| | - Veronique M F Meijborg
- Department of Clinical and Experimental Cardiology Amsterdam UMC, University of Amsterdam Amsterdam The Netherlands
| | - Nynke Hofman
- Department of Clinical and Experimental Cardiology Amsterdam UMC, University of Amsterdam Amsterdam The Netherlands
| | - Sally-Ann B Clur
- Department of Pediatric Cardiology Amsterdam UMC, University of Amsterdam, Emma Children's Hospital Amsterdam The Netherlands
| | - Nico A Blom
- Department of Pediatric Cardiology Amsterdam UMC, University of Amsterdam, Emma Children's Hospital Amsterdam The Netherlands
- Department of Pediatric Cardiology Leiden University Medical Center Leiden The Netherlands
| | - Tammo Delhaas
- Department of Biomedical Engineering Maastricht University Maastricht The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Maastricht The Netherlands
| | - Arthur A M Wilde
- Department of Clinical and Experimental Cardiology Amsterdam UMC, University of Amsterdam Amsterdam The Netherlands
| | - Pieter G Postema
- Department of Clinical and Experimental Cardiology Amsterdam UMC, University of Amsterdam Amsterdam The Netherlands
| |
Collapse
|
7
|
Cui S, Hayashi K, Kobayashi I, Hosomichi K, Nomura A, Teramoto R, Usuda K, Okada H, Deng Y, Kobayashi-Sun J, Nishikawa T, Furusho H, Saito T, Hirase H, Ohta K, Fujimoto M, Horita Y, Kusayama T, Tsuda T, Tada H, Kato T, Usui S, Sakata K, Fujino N, Tajima A, Yamagishi M, Takamura M. The utility of zebrafish cardiac arrhythmia model to predict the pathogenicity of KCNQ1 variants. J Mol Cell Cardiol 2023; 177:50-61. [PMID: 36898499 DOI: 10.1016/j.yjmcc.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 03/11/2023]
Abstract
Genetic testing for inherited arrhythmias and discriminating pathogenic or benign variants from variants of unknown significance (VUS) is essential for gene-based medicine. KCNQ1 is a causative gene of type 1 long QT syndrome (LQTS), and approximately 30% of the variants found in type 1 LQTS are classified as VUS. We studied the role of zebrafish cardiac arrhythmia model in determining the clinical significance of KCNQ1 variants. We generated homozygous kcnq1 deletion zebrafish (kcnq1del/del) using the CRISPR/Cas9 and expressed human Kv7.1/MinK channels in kcnq1del/del embryos. We dissected the hearts from the thorax at 48 h post-fertilization and measured the transmembrane potential of the ventricle in the zebrafish heart. Action potential duration was calculated as the time interval between peak maximum upstroke velocity and 90% repolarization (APD90). The APD90 of kcnq1del/del embryos was 280 ± 47 ms, which was significantly shortened by injecting KCNQ1 wild-type (WT) cRNA and KCNE1 cRNA (168 ± 26 ms, P < 0.01 vs. kcnq1del/del). A study of two pathogenic variants (S277L and T587M) and one VUS (R451Q) associated with clinically definite LQTS showed that the APD90 of kcnq1del/del embryos with these mutant Kv7.1/MinK channels was significantly longer than that of Kv7.1 WT/MinK channels. Given the functional results of the zebrafish model, R451Q could be reevaluated physiologically from VUS to likely pathogenic. In conclusion, functional analysis using in vivo zebrafish cardiac arrhythmia model can be useful for determining the pathogenicity of loss-of-function variants in patients with LQTS.
Collapse
Affiliation(s)
- Shihe Cui
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Kenshi Hayashi
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan; School of Health Sciences, College of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan.
| | - Isao Kobayashi
- Faculty of Biological Science and Technology, Institute of Science and Engineering, Kanazawa University, Kanazawa, Japan
| | - Kazuyoshi Hosomichi
- Laboratory of Computational Genomics, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Akihiro Nomura
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Ryota Teramoto
- Laboratory for Comprehensive Genomic Analysis, RIKEN Center for Integrative Medical Sciences, Yokohama, Japan
| | - Keisuke Usuda
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Hirofumi Okada
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Yaowen Deng
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Jingjing Kobayashi-Sun
- Faculty of Biological Science and Technology, Institute of Science and Engineering, Kanazawa University, Kanazawa, Japan; Department of Clinical Engineering, Faculty of Health Sciences, Komatsu University, Komatsu, Japan
| | - Tetsuo Nishikawa
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Hiroshi Furusho
- Department of Cardiology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Takekatsu Saito
- Department of Pediatrics, Minamigaoka Hospital, Kanazawa, Japan
| | - Hiroaki Hirase
- Department of Cardiology, Takaoka Minami Heart Center, Takaoka, Japan
| | - Kunio Ohta
- Department of Pediatrics, School of Medicine, Institute of Medical, Pharmaceutical, and Health Sciences, Kanazawa University, Kanazawa, Japan; Medical Education Research Center, Graduate School of Medical Sciences, Kanazawa University, Japan
| | - Manabu Fujimoto
- Department of Cardiology, Kouseiren Takaoka Hospital, Takaoka, Japan
| | - Yuki Horita
- Department of Cardiology, Kanazawa Cardiovascular Hospital, Kanazawa, Japan
| | - Takashi Kusayama
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Toyonobu Tsuda
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Hayato Tada
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Takeshi Kato
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Soichiro Usui
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Kenji Sakata
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Noboru Fujino
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan; School of Health Sciences, College of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kanazawa, Japan
| | - Atsushi Tajima
- Department of Bioinformatics and Genomics, Graduate School of Advanced Preventive Medical Sciences, Kanazawa University, Kanazawa, Japan
| | | | - Masayuki Takamura
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| |
Collapse
|
8
|
Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA, Charron P, Corrado D, Dagres N, de Chillou C, Eckardt L, Friede T, Haugaa KH, Hocini M, Lambiase PD, Marijon E, Merino JL, Peichl P, Priori SG, Reichlin T, Schulz-Menger J, Sticherling C, Tzeis S, Verstrael A, Volterrani M. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J 2022; 43:3997-4126. [PMID: 36017572 DOI: 10.1093/eurheartj/ehac262] [Citation(s) in RCA: 874] [Impact Index Per Article: 437.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
|
9
|
Yang Y, Lv T, Li S, Liu P, Gao Q, Zhang P. Utility of Provocative Testing in the Diagnosis and Genotyping of Congenital Long QT Syndrome: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2022; 11:e025246. [PMID: 35861842 PMCID: PMC9707831 DOI: 10.1161/jaha.122.025246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 04/27/2022] [Indexed: 11/16/2022]
Abstract
Background Diagnosis is particularly challenging in concealed or asymptomatic long QT syndrome (LQTS). Provocative testing, unmasking the characterization of LQTS, is a promising alternative method for the diagnosis of LQTS, but without uniform standards. Methods and Results A comprehensive search was conducted in PubMed, Embase, and the Cochrane Library through October 14, 2021. The fixed effects model was used to assess the effect of the provocative testing on QTc interval. A total of 22 studies with 1137 patients with LQTS were included. At baseline, QTc interval was 40 ms longer in patients with LQTS than in controls (mean difference [MD], 40.54 [95% CI, 37.43-43.65]; P<0.001). Compared with the control group, patients with LQTS had 28 ms longer ΔQTc upon standing (MD, 28.82 [95% CI, 23.05-34.58]; P<0.001), nearly 30 ms longer both at peak exercise (MD, 27.31 [95% CI, 21.51-33.11]; P<0.001) and recovery 4 to 5 minutes (MD, 29.85 [95% CI, 24.36-35.35]; P<0.001). With epinephrine infusion, QTc interval was prolonged both in controls and patients with QTS, most obviously in LQT1 (MD, 68.26 [95% CI, 58.91-77.60]; P<0.001) and LQT2 (MD, 60.17 [95% CI, 50.18-70.16]; P<0.001). Subgroup analysis showed QTc interval response to abrupt stand testing and exercise testing varied between LQT1, LQT2, and LQT3, named Type Ⅰ, Type Ⅱ, and Type Ⅲ. Conclusions QTc trend Type Ⅰ and Type Ⅲ during abrupt stand testing and exercise testing can be used to propose a prospective evaluation of LQT1 and LQT3, respectively. Type Ⅱ QTc trend combined epinephrine infusion testing could distinguish LQT2 from control. A preliminary diagnostic workflow was proposed but deserves further evaluation.
Collapse
Affiliation(s)
- Ying Yang
- School of Clinical MedicineTsinghua UniversityBeijingChina
| | - Ting‐ting Lv
- Department of CardiologySchool of Clinical MedicineBeijing Tsinghua Changgung HospitalTsinghua UniversityBeijingChina
| | - Si‐yuan Li
- Department of CardiologySchool of Clinical MedicineBeijing Tsinghua Changgung HospitalTsinghua UniversityBeijingChina
| | - Peng Liu
- School of Clinical MedicineTsinghua UniversityBeijingChina
| | - Qing‐gele Gao
- School of Clinical MedicineTsinghua UniversityBeijingChina
| | - Ping Zhang
- School of Clinical MedicineTsinghua UniversityBeijingChina
- Department of CardiologySchool of Clinical MedicineBeijing Tsinghua Changgung HospitalTsinghua UniversityBeijingChina
| |
Collapse
|
10
|
Kekenes-Huskey PM, Burgess DE, Sun B, Bartos DC, Rozmus ER, Anderson CL, January CT, Eckhardt LL, Delisle BP. Mutation-Specific Differences in Kv7.1 ( KCNQ1) and Kv11.1 ( KCNH2) Channel Dysfunction and Long QT Syndrome Phenotypes. Int J Mol Sci 2022; 23:7389. [PMID: 35806392 PMCID: PMC9266926 DOI: 10.3390/ijms23137389] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 11/16/2022] Open
Abstract
The electrocardiogram (ECG) empowered clinician scientists to measure the electrical activity of the heart noninvasively to identify arrhythmias and heart disease. Shortly after the standardization of the 12-lead ECG for the diagnosis of heart disease, several families with autosomal recessive (Jervell and Lange-Nielsen Syndrome) and dominant (Romano-Ward Syndrome) forms of long QT syndrome (LQTS) were identified. An abnormally long heart rate-corrected QT-interval was established as a biomarker for the risk of sudden cardiac death. Since then, the International LQTS Registry was established; a phenotypic scoring system to identify LQTS patients was developed; the major genes that associate with typical forms of LQTS were identified; and guidelines for the successful management of patients advanced. In this review, we discuss the molecular and cellular mechanisms for LQTS associated with missense variants in KCNQ1 (LQT1) and KCNH2 (LQT2). We move beyond the "benign" to a "pathogenic" binary classification scheme for different KCNQ1 and KCNH2 missense variants and discuss gene- and mutation-specific differences in K+ channel dysfunction, which can predispose people to distinct clinical phenotypes (e.g., concealed, pleiotropic, severe, etc.). We conclude by discussing the emerging computational structural modeling strategies that will distinguish between dysfunctional subtypes of KCNQ1 and KCNH2 variants, with the goal of realizing a layered precision medicine approach focused on individuals.
Collapse
Affiliation(s)
- Peter M. Kekenes-Huskey
- Department of Cell and Molecular Physiology, Stritch School of Medicine, Loyola University Chicago, Maywood, IL 60153, USA
| | - Don E. Burgess
- Department of Physiology, College of Medicine, University of Kentucky, Lexington, KY 40536, USA; (D.E.B.); (E.R.R.)
| | - Bin Sun
- Department of Pharmacology, Harbin Medical University, Harbin 150081, China;
| | | | - Ezekiel R. Rozmus
- Department of Physiology, College of Medicine, University of Kentucky, Lexington, KY 40536, USA; (D.E.B.); (E.R.R.)
| | - Corey L. Anderson
- Cellular and Molecular Arrythmias Program, Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin-Madison, Madison, WI 53705, USA; (C.L.A.); (C.T.J.); (L.L.E.)
| | - Craig T. January
- Cellular and Molecular Arrythmias Program, Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin-Madison, Madison, WI 53705, USA; (C.L.A.); (C.T.J.); (L.L.E.)
| | - Lee L. Eckhardt
- Cellular and Molecular Arrythmias Program, Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin-Madison, Madison, WI 53705, USA; (C.L.A.); (C.T.J.); (L.L.E.)
| | - Brian P. Delisle
- Department of Physiology, College of Medicine, University of Kentucky, Lexington, KY 40536, USA; (D.E.B.); (E.R.R.)
| |
Collapse
|
11
|
Yodogawa K, Aiba T, Sumitomo N, Yamamoto T, Murata H, Iwasaki YK, Kokubo Y, Shimizu W. Differential diagnosis between LQT1 and LQT2 by QT/RR relationships using 24-hour Holter monitoring: A multicenter cross-sectional study. Ann Noninvasive Electrocardiol 2021; 26:e12878. [PMID: 34245193 PMCID: PMC8411756 DOI: 10.1111/anec.12878] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/16/2021] [Accepted: 06/29/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The clinical course and therapeutic strategies in the congenital long QT syndrome (LQTS) are genotype-specific. However, accurate estimation of LQTS genotype is often difficult from the standard 12-lead ECG. OBJECTIVES This study aims to evaluate the utility of QT/RR slope analysis by the 24-hour Holter monitoring for differential diagnosis of LQTS genotype between LQT1 and LQT2. METHODS This cross-sectional study enrolled 54 genetically identified LQTS patients (29 LQT1 and 25 LQT2) recruited from three medical institutions. The QT-apex (QTa) interval and the QT-end (QTe) interval at each 15-second were plotted against the RR intervals, and the linear regression (QTa/RR and QTe/RR slopes, respectively) was calculated from the entire 24-hour and separately during the day or night-time periods of the Holter recordings. RESULTS The QTe/RR and QTa/RR slopes at the entire 24-hour were significantly steeper in LQT2 compared to those in LQT1 patients (0.262 ± 0.063 vs. 0.204 ± 0.055, p = .0007; 0.233 ± 0.052 vs. 0.181 ± 0.040, p = .0002, respectively). The QTe interval was significantly longer, and QTe/RR and QTa/RR slopes at daytime were significantly steeper in LQT2 than in LQT1 patients. The receiver operating curve analysis revealed that the QTa/RR slope of 0.211 at the entire 24-hour Holter was the best cutoff value for differential diagnosis between LQT1 and LQT2 (sensitivity: 80.0%, specificity: 75.0%, and area under curve: 0.804 [95%CI = 0.68-0.93]). CONCLUSION The continuous 24-hour QT/RR analysis using the Holter monitoring may be useful to predict the genotype of congenital LQTS, particularly for LQT1 and LQT2.
Collapse
Affiliation(s)
- Kenji Yodogawa
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Takeshi Aiba
- Department of Advanced Arrhythmia and Translational Medical Science, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Naotaka Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Teppei Yamamoto
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Hiroshige Murata
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Yu-Ki Iwasaki
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Yoshihiro Kokubo
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| |
Collapse
|
12
|
Sekine T, Kamioka M, Hijioka N, Yamada S, Kaneshiro T, Takeishi Y. Symptomatic Long QT Syndrome Coexisting with Asymptomatic Acetylcholine-induced Vasospasm. Intern Med 2021; 60:2085-2088. [PMID: 33518575 PMCID: PMC8313919 DOI: 10.2169/internalmedicine.6475-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
We herein report a rare case of long QT syndrome (LQTS) coexisting with acetylcholine (Ach)-induced vasospasm. A 31-year-old woman experienced cardiopulmonary arrest during running. LQTS was diagnosed by an electrocardiogram, and the coexistence of Ach-induced vasospam was determined by an Ach provocation test on coronary angiography. Although an implantable cardioverter defibrillator was placed, a beta-blocker was not prescribed for two reasons: first, the patient showed Ach-induced vasospasm alone with no symptoms and no ST change by Ach injection, and second, the use of beta-blockers alone in such patients carries a risk of vasospasm-induced ventricular fibrillation.
Collapse
Affiliation(s)
- Toranosuke Sekine
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
| | - Masashi Kamioka
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
| | - Naoko Hijioka
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
| | - Shinya Yamada
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
| | - Takashi Kaneshiro
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
- Department of Arrhythmia and Cardiac Pacing, Fukushima Medical University, Japan
| | - Yasuchika Takeishi
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan
| |
Collapse
|
13
|
Vink AS, Hermans BJM, Pimenta J, Peltenburg PJ, Filippini LHPM, Hofman N, Clur SAB, Blom NA, Wilde AAM, Delhaas T, Postema PG. Diagnostic accuracy of the response to the brief tachycardia provoked by standing in children suspected for long QT syndrome. Heart Rhythm O2 2021; 2:149-159. [PMID: 34113917 PMCID: PMC8183857 DOI: 10.1016/j.hroo.2021.03.005] [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] [Indexed: 01/08/2023] Open
Abstract
Background Adult long QT syndrome (LQTS) patients have inadequate corrected QT interval (QTc) shortening and an abnormal T-wave response to the sudden heart rate acceleration provoked by standing. In adults, this knowledge can be used to aid an LQTS diagnosis and, possibly, for risk stratification. However, data on the diagnostic value of the standing test in children are currently limited. Objective To determine the potential value of the standing test to aid LQTS diagnostics in children. Methods In a prospective cohort including children (≤18 years) who had a standing test, comprehensive analyses were performed including manual and automated QT interval assessments and determination of T-wave morphology changes. Results We included 47 LQTS children and 86 control children. At baseline, the QTc that identified LQTS children with a 90% sensitivity was 435 ms, which yielded a 65% specificity. A QTc ≥ 490 ms after standing only slightly increased sensitivity (91%, 95% confidence interval [CI]: 80%–98%) and slightly decreased specificity (58%, 95% CI: 47%–70%). Sensitivity increased slightly more when T-wave abnormalities were present (94%, 95% CI: 82%–99%; specificity 53%, 95% CI: 42%–65%). When a baseline QTc ≥ 440 ms was accompanied by a QTc ≥ 490 ms and T-wave abnormalities after standing, sensitivity further increased (96%, 95% CI: 85%–99%) at the expense of a further specificity decrease (41%, 95% CI: 30%–52%). Beat-to-beat analysis showed that 30 seconds after standing, LQTS children had a greater increase in heart rate compared to controls, which was more evidently present in LQTS boys and LQTS type 1 children. Conclusion In children, the standing test has limited additive diagnostic value for LQTS over a baseline electrocardiogram, while T-wave abnormalities after standing also have limited additional value. The standing test for LQTS should only be used with caution in children.
Collapse
Affiliation(s)
- Arja S Vink
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, The Netherlands.,Department of Pediatric Cardiology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ben J M Hermans
- Department of Biomedical Engineering, Maastricht University, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Joana Pimenta
- Department of Pediatric Cardiology, Centro Hospitalar de São João, Porto, Portugal
| | - Puck J Peltenburg
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, The Netherlands.,Department of Pediatric Cardiology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Luc H P M Filippini
- Department of Pediatric Cardiology, Juliana Children's Hospital, The Hague, The Netherlands
| | - Nynke Hofman
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, The Netherlands
| | - Sally-Ann B Clur
- Department of Pediatric Cardiology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Nico A Blom
- Department of Pediatric Cardiology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Arthur A M Wilde
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, The Netherlands
| | - Tammo Delhaas
- Department of Biomedical Engineering, Maastricht University, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Pieter G Postema
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, The Netherlands
| |
Collapse
|
14
|
Stiles MK, Wilde AAM, Abrams DJ, Ackerman MJ, Albert CM, Behr ER, Chugh SS, Cornel MC, Gardner K, Ingles J, James CA, Juang JMJ, Kääb S, Kaufman ES, Krahn AD, Lubitz SA, MacLeod H, Morillo CA, Nademanee K, Probst V, Saarel EV, Sacilotto L, Semsarian C, Sheppard MN, Shimizu W, Skinner JR, Tfelt-Hansen J, Wang DW. 2020 APHRS/HRS expert consensus statement on the investigation of decedents with sudden unexplained death and patients with sudden cardiac arrest, and of their families. J Arrhythm 2021; 37:481-534. [PMID: 34141003 PMCID: PMC8207384 DOI: 10.1002/joa3.12449] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 10/14/2020] [Indexed: 12/26/2022] Open
Abstract
This international multidisciplinary document intends to provide clinicians with evidence-based practical patient-centered recommendations for evaluating patients and decedents with (aborted) sudden cardiac arrest and their families. The document includes a framework for the investigation of the family allowing steps to be taken, should an inherited condition be found, to minimize further events in affected relatives. Integral to the process is counseling of the patients and families, not only because of the emotionally charged subject, but because finding (or not finding) the cause of the arrest may influence management of family members. The formation of multidisciplinary teams is essential to provide a complete service to the patients and their families, and the varied expertise of the writing committee was formulated to reflect this need. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by Class of Recommendation and Level of Evidence. The recommendations were opened for public comment and reviewed by the relevant scientific and clinical document committees of the Asia Pacific Heart Rhythm Society (APHRS) and the Heart Rhythm Society (HRS); the document underwent external review and endorsement by the partner and collaborating societies. While the recommendations are for optimal care, it is recognized that not all resources will be available to all clinicians. Nevertheless, this document articulates the evaluation that the clinician should aspire to provide for patients with sudden cardiac arrest, decedents with sudden unexplained death, and their families.
Collapse
Affiliation(s)
- Martin K Stiles
- Waikato Clinical School Faculty of Medicine and Health Science The University of Auckland Hamilton New Zealand
| | - Arthur A M Wilde
- Heart Center Department of Clinical and Experimental Cardiology Amsterdam University Medical Center University of Amsterdam Amsterdam the Netherlands
| | | | | | | | - Elijah R Behr
- Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Institute St George's University of London, and St George's University Hospitals NHS Foundation Trust London UK
| | | | - Martina C Cornel
- Amsterdam University Medical Center Vrije Universiteit Amsterdam Clinical Genetics Amsterdam Public Health Research Institute Amsterdam the Netherlands
| | | | - Jodie Ingles
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute The University of Sydney Sydney Australia
| | | | - Jyh-Ming Jimmy Juang
- Cardiovascular Center and Division of Cardiology Department of Internal Medicine National Taiwan University Hospital and National Taiwan University College of Medicine Taipei Taiwan
| | - Stefan Kääb
- Department of Medicine I University Hospital LMU Munich Munich Germany
| | | | | | | | - Heather MacLeod
- Data Coordinating Center for the Sudden Death in the Young Case Registry Okemos MI USA
| | | | - Koonlawee Nademanee
- Chulalongkorn University Faculty of Medicine, and Pacific Rim Electrophysiology Research Institute at Bumrungrad Hospital Bangkok Thailand
| | | | - Elizabeth V Saarel
- Cleveland Clinic Lerner College of Cardiology at Case Western Reserve University Cleveland OH USA
- St Luke's Medical Center Boise ID USA
| | - Luciana Sacilotto
- Heart Institute University of São Paulo Medical School São Paulo Brazil
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute The University of Sydney Sydney Australia
| | - Mary N Sheppard
- Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Institute St George's University of London, and St George's University Hospitals NHS Foundation Trust London UK
| | - Wataru Shimizu
- Department of Cardiovascular Medicine Nippon Medical School Tokyo Japan
| | | | - Jacob Tfelt-Hansen
- Department of Forensic Medicine Faculty of Medical Sciences Rigshospitalet Copenhagen Denmark
| | - Dao Wu Wang
- The First Affiliated Hospital of Nanjing Medical University Nanjing China
| |
Collapse
|
15
|
Zhang M, Zhang Y, Yang C, Ma C, Tang J. A smartphone-assisted portable biosensor using laccase-mineral hybrid microflowers for colorimetric determination of epinephrine. Talanta 2021; 224:121840. [DOI: 10.1016/j.talanta.2020.121840] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/25/2020] [Accepted: 10/28/2020] [Indexed: 12/17/2022]
|
16
|
Sasaki T, Ikeda K, Nakajima T, Kawabata-Iwakawa R, Iizuka T, Dharmawan T, Tamura S, Niwamae N, Tange S, Nishiyama M, Kaneko Y, Kurabayashi M. Multiple arrhythmic and cardiomyopathic phenotypes associated with an SCN5A A735E mutation. J Electrocardiol 2021; 65:122-127. [PMID: 33610078 DOI: 10.1016/j.jelectrocard.2021.01.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 01/29/2021] [Accepted: 01/29/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND SCN5A mutations are associated with multiple arrhythmic and cardiomyopathic phenotypes including Brugada syndrome (BrS), sinus node dysfunction (SND), atrioventricular block, supraventricular tachyarrhythmias (SVTs), long QT syndrome (LQTS), dilated cardiomyopathy and left ventricular noncompaction. Several single SCN5A mutations have been associated with overlap of some of these phenotypes, but never with overlap of all the phenotypes. OBJECTIVE We encountered two pedigrees with multiple arrhythmic phenotypes with or without cardiomyopathic phenotypes, and sought to identify a responsible mutation and reveal its functional abnormalities. METHODS Target panel sequencing of 72 genes, including inherited arrhythmia syndromes- and cardiomyopathies-related genes, was employed in two probands. Cascade screening was performed by Saner sequencing. Wild-type or identified mutant SCN5A were expressed in tsA201 cells, and whole-cell sodium currents (INa) were recorded using patch-clamp techniques. RESULTS We identified an SCN5A A735E mutation in these probands, but did not identify any other mutations. All eight mutation carriers exhibited at least one of the arrhythmic phenotypes. Two patients exhibited multiple arrhythmic phenotypes: one (15-year-old girl) exhibited BrS, SND, and exercise and epinephrine-induced QT prolongation, the other (4-year-old boy) exhibited BrS, SND, and SVTs. Another one (30-year-old male) exhibited all arrhythmic and cardiomyopathic phenotypes, except for LQTS. One male suddenly died at age 22. Functional analysis revealed that the mutant did not produce functional INa. CONCLUSIONS A non-functional SCN5A A735E mutation could be associated with multiple arrhythmic and cardiomyopathic phenotypes, although there remains a possibility that other unidentified factors may be involved in the phenotypic variability of the mutation carriers.
Collapse
Affiliation(s)
- Takashi Sasaki
- Department of Cardiovascular Medicine, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Kentaro Ikeda
- Department of Cardiology, Gunma Children's Medical Center, Shibukawa, Gunma, Japan
| | - Tadashi Nakajima
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan.
| | - Reika Kawabata-Iwakawa
- Division of Integrated Oncology Research, Gunma University Initiative for Advanced Research, Maebashi, Gunma, Japan
| | - Takashi Iizuka
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Tommy Dharmawan
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Shuntaro Tamura
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Nogiku Niwamae
- Department of Cardiovascular Medicine, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | - Shoichi Tange
- Department of Cardiovascular Medicine, Japanese Red Cross Maebashi Hospital, Maebashi, Gunma, Japan
| | | | - Yoshiaki Kaneko
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Masahiko Kurabayashi
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| |
Collapse
|
17
|
Steinberg C, Pilote S, Philippon F, Laksman ZW, Champagne J, Simard C, Krahn AD, Drolet B. SCN5A-C683R exhibits combined gain-of-function and loss-of-function properties related to adrenaline-triggered ventricular arrhythmia. Exp Physiol 2021; 106:683-699. [PMID: 33480457 DOI: 10.1113/ep089088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 01/11/2021] [Indexed: 12/14/2022]
Abstract
NEW FINDINGS What is the role of SCN5A-C683R? SCN5A-C683R is a novel variant associated with an uncommon phenotype of adrenaline-triggered ventricular arrhythmia in the absence of a distinct ECG phenotype. What is the main finding and its importance? Functional studies demonstrated that NaV 1.5/C683R results in a mixed electrophysiological phenotype with gain-of-function (GOF) and loss-of-function (LOF) properties compared with NaV 1.5/wild type. Gain-of-function properties are characterized by a significant increase of the maximal current density and a hyperpolarizing shift of the steady-state activation. The LOF effect of NaV 1.5/C683R is characterized by increased closed-state inactivation. Electrophysiological properties and clinical manifestation of SCN5A-C683R are different from long-QT-3 or Brugada syndrome and might represent a distinct inherited arrhythmia syndrome. ABSTRACT Mutations of SCN5Ahave been identified as the genetic substrate of various inherited arrhythmia syndromes, including long-QT-3 and Brugada syndrome. We recently identified a novel SCN5A variant (C683R) in two genetically unrelated families. The index patients of both families experienced adrenaline-triggered ventricular arrhythmia with cardiac arrest but did not show a specific ECG phenotype, raising the hypothesis that SCN5A-C683R might be a susceptibility variant and the genetic substrate of distinct inherited arrhythmia. We conducted functional cellular studies to characterize the electrophysiological properties of NaV 1.5/C683R in order to explore the potential pathogenicity of this novel variant. The C683R variant was engineered by site-directed mutagenesis. NaV 1.5/wild type (WT) and NaV 1.5/C683R were expressed in tsA201 cells. Electrophysiological characterization of C683R was performed using the whole-cell patch-clamp technique. Adrenergic stimulation was mimicked by exposure to the protein kinase A activator 8-CPT-cAMP. The impact of β-blockers was tested by exposing NaV 1.5/WT and NaV 1.5/C683R currents to propranolol and nadolol. C683R resulted in a co-association of gain-of-function and loss-of-function properties of NaV 1.5. Gain-of-function properties were characterized by a significant increase of the maximal NaV 1.5 current density compared with NaV 1.5/WT (861 ± 309 vs. 627 ± 489 pA/pF; P < 0.05, n ≥ 9) that was potentiated in NaV 1.5/C683R with 8-CPT-cAMP stimulation (869 ± 287 vs. 607 ± 320 pA/pF; P < 0.05, n ≥ 12). C683R also resulted in a significant hyperpolarizing shift in the voltage of steady-state activation (-65.4 ± 3.0 vs. -57.2 ± 4.8 mV; P < 0.001), resulting in an increased window current compared with WT. The loss-of-function effect of NaV 1.5/C683R was characterized by significantly increased closed-state inactivation compared with NaV 1.5/WT (P < 0.05). C683R is a novel SCN5A variant resulting in a co-association of gain-of-function and loss-of-function properties of the cardiac sodium channel NaV 1.5. The phenotype is characterized by adrenaline-triggered ventricular arrhythmias. Electrophysiological properties and clinical manifestations are different from long-QT-3 or Brugada syndrome and might represent a distinct inherited arrhythmia syndrome.
Collapse
Affiliation(s)
- Christian Steinberg
- Division of Cardiology, Electrophysiology Service, Institut universitaire de cardiologie et de pneumologie de Québec, IUCPQ-UL), Laval University, Québec, QC, Canada.,IUCPQ-UL Research Center, Laval University, Québec, QC, Canada
| | - Sylvie Pilote
- IUCPQ-UL Research Center, Laval University, Québec, QC, Canada.,Faculty of Pharmacy, Laval University, Québec, QC, Canada
| | - François Philippon
- Division of Cardiology, Electrophysiology Service, Institut universitaire de cardiologie et de pneumologie de Québec, IUCPQ-UL), Laval University, Québec, QC, Canada.,IUCPQ-UL Research Center, Laval University, Québec, QC, Canada
| | - Zachary W Laksman
- Heart Rhythm Services, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Jean Champagne
- Division of Cardiology, Electrophysiology Service, Institut universitaire de cardiologie et de pneumologie de Québec, IUCPQ-UL), Laval University, Québec, QC, Canada.,IUCPQ-UL Research Center, Laval University, Québec, QC, Canada
| | - Chantale Simard
- IUCPQ-UL Research Center, Laval University, Québec, QC, Canada.,Faculty of Pharmacy, Laval University, Québec, QC, Canada
| | - Andrew D Krahn
- Heart Rhythm Services, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Benoît Drolet
- IUCPQ-UL Research Center, Laval University, Québec, QC, Canada.,Faculty of Pharmacy, Laval University, Québec, QC, Canada
| |
Collapse
|
18
|
Stiles MK, Wilde AAM, Abrams DJ, Ackerman MJ, Albert CM, Behr ER, Chugh SS, Cornel MC, Gardner K, Ingles J, James CA, Jimmy Juang JM, Kääb S, Kaufman ES, Krahn AD, Lubitz SA, MacLeod H, Morillo CA, Nademanee K, Probst V, Saarel EV, Sacilotto L, Semsarian C, Sheppard MN, Shimizu W, Skinner JR, Tfelt-Hansen J, Wang DW. 2020 APHRS/HRS expert consensus statement on the investigation of decedents with sudden unexplained death and patients with sudden cardiac arrest, and of their families. Heart Rhythm 2021; 18:e1-e50. [PMID: 33091602 PMCID: PMC8194370 DOI: 10.1016/j.hrthm.2020.10.010] [Citation(s) in RCA: 147] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 10/09/2020] [Indexed: 12/13/2022]
Abstract
This international multidisciplinary document intends to provide clinicians with evidence-based practical patient-centered recommendations for evaluating patients and decedents with (aborted) sudden cardiac arrest and their families. The document includes a framework for the investigation of the family allowing steps to be taken, should an inherited condition be found, to minimize further events in affected relatives. Integral to the process is counseling of the patients and families, not only because of the emotionally charged subject, but because finding (or not finding) the cause of the arrest may influence management of family members. The formation of multidisciplinary teams is essential to provide a complete service to the patients and their families, and the varied expertise of the writing committee was formulated to reflect this need. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by Class of Recommendation and Level of Evidence. The recommendations were opened for public comment and reviewed by the relevant scientific and clinical document committees of the Asia Pacific Heart Rhythm Society (APHRS) and the Heart Rhythm Society (HRS); the document underwent external review and endorsement by the partner and collaborating societies. While the recommendations are for optimal care, it is recognized that not all resources will be available to all clinicians. Nevertheless, this document articulates the evaluation that the clinician should aspire to provide for patients with sudden cardiac arrest, decedents with sudden unexplained death, and their families.
Collapse
Affiliation(s)
- Martin K Stiles
- Waikato Clinical School, Faculty of Medicine and Health Science, The University of Auckland, Hamilton, New Zealand
| | - Arthur A M Wilde
- Amsterdam University Medical Center, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam, the Netherlands
| | | | | | | | - Elijah R Behr
- Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Institute, St George's, University of London, and St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Sumeet S Chugh
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Martina C Cornel
- Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Clinical Genetics, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | | | - Jodie Ingles
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, Australia
| | | | - Jyh-Ming Jimmy Juang
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Stefan Kääb
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany
| | | | - Andrew D Krahn
- The University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Heather MacLeod
- Data Coordinating Center for the Sudden Death in the Young Case Registry, Okemos, Michigan, USA
| | | | - Koonlawee Nademanee
- Chulalongkorn University, Faculty of Medicine, and Pacific Rim Electrophysiology Research Institute at Bumrungrad Hospital, Bangkok, Thailand
| | | | - Elizabeth V Saarel
- Cleveland Clinic Lerner College of Cardiology at Case Western Reserve University, Cleveland, Ohio, and St Luke's Medical Center, Boise, Idaho, USA
| | - Luciana Sacilotto
- Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, Australia
| | - Mary N Sheppard
- Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Institute, St George's, University of London, and St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Jonathan R Skinner
- Cardiac Inherited Disease Group, Starship Hospital, Auckland, New Zealand
| | - Jacob Tfelt-Hansen
- Department of Forensic Medicine, Faculty of Medical Sciences, Rigshospitalet, Copenhagen, Denmark
| | - Dao Wu Wang
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| |
Collapse
|
19
|
Takahashi K, Shimizu W, Makita N, Nakayashiro M. Dynamic QT response to cold-water face immersion in long-QT syndrome type 3. Pediatr Int 2020; 62:899-906. [PMID: 32449227 PMCID: PMC7496693 DOI: 10.1111/ped.14319] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 05/03/2020] [Accepted: 05/18/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Abnormal dynamics of QT intervals in response to sympathetic nervous system stimulation are used to diagnose long-QT syndrome (LQTS). We hypothesized that parasympathetic stimulation with cold-water face immersion following exercise would influence QT dynamics in patients with LQTS type 3 (LQT3). METHODS Study participants (n = 42; mean age = 11.2 years) comprised 20 genotyped LQTS children and 22 healthy children. The LQTS group was divided into LQT3 (n = 12) and non-LQT3 (n = 8) subgroups. Provocative testing for assessing QT dynamics comprised a treadmill exercise followed by cold-water face immersion. The QT intervals were automatically measured at rest and during exercise, recovery, and cold-water face immersion. The QT/heart rate (HR) relationship was visualized by plotting beat-to-beat confluence of the data. RESULTS The QT/HR slopes, determined by linear regression analysis, were steeper in the LQTS group than in the control group during exercise and immersion tests: -2.16 ± 0.63 versus -1.21 ± 0.28, P < 0.0001, and -2.02 ± 0.76 vs -0.75 ± 0.24, P < 0.0001, respectively. The LQT3 patients had steeper slopes in the immersion test than did non-LQT3 and control individuals: -2.42 ± 0.52 vs -1.40 ± 0.65, P < 0.0001, and vs -0.75 ± 0.24, P < 0.0001. CONCLUSIONS The QT dynamics of LQT3 patients differ from those of other LQTS subtypes during the post-exercise cold-water face immersion test in this study. Abnormal QT dynamics during the parasympathetic provocative test are concordant with the fact that cardiac events occur when HRs are lower or during sleep in LQT3 patients.
Collapse
Affiliation(s)
- Kazuhiro Takahashi
- Department of Pediatric CardiologyOkinawa Nanbu and Children’s Medical CenterOkinawaJapan
| | | | - Naomasa Makita
- National Cerebral and Cardiovascular CenterResearch InstituteOsakaJapan
| | - Mami Nakayashiro
- Department of Pediatric CardiologyOkinawa Nanbu and Children’s Medical CenterOkinawaJapan
| |
Collapse
|
20
|
Jeon S, Lee HJ, Jung YH, Do W, Cho AR, Baik J, Lee DW, Kim EJ, Kim E, Hong JM. Concealed congenital long QT syndrome during velopharyngeal dysfunction correction: a case report. J Dent Anesth Pain Med 2020; 20:165-171. [PMID: 32617412 PMCID: PMC7321742 DOI: 10.17245/jdapm.2020.20.3.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/07/2020] [Accepted: 05/12/2020] [Indexed: 12/02/2022] Open
Abstract
The congenital long QT syndrome (LQTS) is an inherited cardiac disorder characterized by increased QT intervals and a tendency to experience ventricular tachycardia, which can cause fainting, heart failure, or sudden death. A 4-year-old female patient undergoing velopharyngeal correction surgery under general anesthesia suddenly developed Torsades de pointes. Although the patient spontaneously resolved to sinus rhythm without treatment, subsequent QT prolongation persisted. Here, we report a case of concealed LQTS with a literature review.
Collapse
Affiliation(s)
- Soeun Jeon
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Busan, Korea.,Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Hyeon-Jeong Lee
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Busan, Korea.,Medical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Young-Hoon Jung
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Busan, Korea
| | - Wangseok Do
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Busan, Korea
| | - Ah-Reum Cho
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Busan, Korea
| | - Jiseok Baik
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Busan, Korea
| | - Do-Won Lee
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Busan, Korea
| | - Eun-Jung Kim
- Department of Dental Anesthesia and Pain Medicine, School of Dentistry, Pusan National University, Dental Research Institute, Yangsan, Korea
| | - Eunsoo Kim
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Busan, Korea
| | - Jeong-Min Hong
- Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University, Busan, Korea
| |
Collapse
|
21
|
Nakajima T, Dharmawan T, Kawabata-Iwakawa R, Tamura S, Hasegawa H, Kobari T, Kaneko Y, Nishiyama M, Kurabayashi M. Biophysical defects of an SCN5A V1667I mutation associated with epinephrine-induced marked QT prolongation. J Cardiovasc Electrophysiol 2020; 31:2107-2115. [PMID: 32437023 DOI: 10.1111/jce.14575] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 04/22/2020] [Accepted: 04/27/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The epinephrine infusion test (EIT) typically induces marked QT prolongation in LQT1, but not LQT3, while the efficacy of β-blocker therapy is established in LQT1, but not LQT3. We encountered an LQT3 family, with an SCN5A V1667I mutation, that exhibited epinephrine-induced marked QT prolongation. METHODS Wild-type (WT) or V1667I-SCN5A was transiently expressed into tsA-201 cells, and whole-cell sodium currents (INa ) were recorded using patch-clamp techniques. To mimic the effects of epinephrine, INa was recorded after the application of protein kinase A (PKA) activator, 8-CPT-cAMP (200 μM), for 10 minutes. RESULTS The peak density of V1667I-INa was significantly larger than WT-INa (WT: 469 ± 48 pA/pF, n = 20; V1667I: 690 ± 62 pA/pF, n = 19, P < .01). The steady-state activation (SSA) and fast inactivation rate of V1667I-INa were comparable to WT-INa . V1667I-INa displayed a significant depolarizing shift in steady-state inactivation (SSI) in comparison to WT-INa (V1/2 -WT: -88.1 ± 0.8 mV, n = 17; V1667I: -82.5 ± 1.1 mV, n = 17, P < .01), which increases window currents. Tetrodotoxin (30 μM)-sensitive persistent V1667I-INa was comparable to WT-INa . However, the ramp pulse protocol (RPP) displayed an increased hump in V1667I-INa in comparison to WT-INa . Although 8-CPT-cAMP shifted SSA to hyperpolarizing potentials in WT-INa and V1667I-INa to the same extent, it shifted SSI to hyperpolarizing potentials much less in V1667I-INa than in WT-INa (V1/2 -WT: -92.7 ± 1.3 mV, n = 6; V1667I: -85.3 ± 1.6 mV, n = 6, P < .01). Concordantly, the RPP displayed an increased hump in V1667I-INa , but not in WT-INa . CONCLUSIONS We demonstrated an increase of V1667I-INa by PKA activation, which may provide a rationale for the efficacy of β-blocker therapy in some cases of LQT3.
Collapse
Affiliation(s)
- Tadashi Nakajima
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Tommy Dharmawan
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Reika Kawabata-Iwakawa
- Division of Integrated Oncology Research, Gunma University Initiative for Advanced Research, Maebashi, Gunma, Japan
| | - Shuntaro Tamura
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Hiroshi Hasegawa
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Takashi Kobari
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Yoshiaki Kaneko
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Masahiko Nishiyama
- Division of Integrated Oncology Research, Gunma University Initiative for Advanced Research, Maebashi, Gunma, Japan.,Gunma University, Maebashi, Gunma, Japan
| | - Masahiko Kurabayashi
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| |
Collapse
|
22
|
Improving long QT syndrome diagnosis by a polynomial-based T-wave morphology characterization. Heart Rhythm 2020; 17:752-758. [DOI: 10.1016/j.hrthm.2019.12.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 12/29/2019] [Indexed: 11/20/2022]
|
23
|
Carll AP, Salatini R, Pirela SV, Wang Y, Xie Z, Lorkiewicz P, Naeem N, Qian Y, Castranova V, Godleski JJ, Demokritou P. Inhalation of printer-emitted particles impairs cardiac conduction, hemodynamics, and autonomic regulation and induces arrhythmia and electrical remodeling in rats. Part Fibre Toxicol 2020; 17:7. [PMID: 31996220 PMCID: PMC6990551 DOI: 10.1186/s12989-019-0335-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 12/29/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Using engineered nanomaterial-based toners, laser printers generate aerosols with alarming levels of nanoparticles that bear high bioactivity and potential health risks. Yet, the cardiac impacts of printer-emitted particles (PEPs) are unknown. Inhalation of particulate matter (PM) promotes cardiovascular morbidity and mortality, and ultra-fine particulates (< 0.1 μm aerodynamic diameter) may bear toxicity unique from larger particles. Toxicological studies suggest that PM impairs left ventricular (LV) performance; however, such investigations have heretofore required animal restraint, anesthesia, or ex vivo preparations that can confound physiologic endpoints and/or prohibit LV mechanical assessments during exposure. To assess the acute and chronic effects of PEPs on cardiac physiology, male Sprague Dawley rats were exposed to PEPs (21 days, 5 h/day) while monitoring LV pressure (LVP) and electrocardiogram (ECG) via conscious telemetry, analyzing LVP and heart rate variability (HRV) in four-day increments from exposure days 1 to 21, as well as ECG and baroreflex sensitivity. At 2, 35, and 70 days after PEPs exposure ceased, rats received stress tests. RESULTS On day 21 of exposure, PEPs significantly (P < 0.05 vs. Air) increased LV end systolic pressure (LVESP, + 18 mmHg) and rate-pressure-product (+ 19%), and decreased HRV indicating sympathetic dominance (root means squared of successive differences [RMSSD], - 21%). Overall, PEPs decreased LV ejection time (- 9%), relaxation time (- 3%), tau (- 5%), RMSSD (- 21%), and P-wave duration (- 9%). PEPs increased QTc interval (+ 5%) and low:high frequency HRV (+ 24%; all P < 0.05 vs. Air), while tending to decrease baroreflex sensitivity and contractility index (- 15% and - 3%, P < 0.10 vs. Air). Relative to Air, at both 2 and 35 days after PEPs, ventricular arrhythmias increased, and at 70 days post-exposure LVESP increased. PEPs impaired ventricular repolarization at 2 and 35 days post-exposure, but only during stress tests. At 72 days post-exposure, PEPs increased urinary dopamine 5-fold and protein expression of ventricular repolarizing channels, Kv1.5, Kv4.2, and Kv7.1, by 50%. CONCLUSIONS Our findings suggest exposure to PEPs increases cardiovascular risk by augmenting sympathetic influence, impairing ventricular performance and repolarization, and inducing hypertension and arrhythmia. PEPs may present significant health risks through adverse cardiovascular effects, especially in occupational settings, among susceptible individuals, and with long-term exposure.
Collapse
Affiliation(s)
- Alex P. Carll
- Department of Physiology, School of Medicine, University of Louisville, Louisville, KY USA
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY USA
- Center for Nanotechnology and Nanotoxicology. Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, 665 Huntington Avenue, Room 1310, Boston, MA 02115 USA
| | - Renata Salatini
- Department of Physiology, School of Medicine, University of Louisville, Louisville, KY USA
- Department of Surgery, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Sandra V. Pirela
- Center for Nanotechnology and Nanotoxicology. Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, 665 Huntington Avenue, Room 1310, Boston, MA 02115 USA
| | - Yun Wang
- Center for Nanotechnology and Nanotoxicology. Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, 665 Huntington Avenue, Room 1310, Boston, MA 02115 USA
- Department of Occupational and Environmental Health Sciences,School of Public Health, Peking University, Beijing, People’s Republic of China
| | - Zhengzhi Xie
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY USA
| | - Pawel Lorkiewicz
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY USA
| | - Nazratan Naeem
- Christina Lee Brown Envirome Institute, University of Louisville, Louisville, KY USA
| | - Yong Qian
- Pathology and Physiology Research Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Morgantown, WV USA
| | - Vincent Castranova
- Department of Pharmaceutical Sciences/Mary Babb Randolph Cancer Center, West Virginia University, Morgantown, WV USA
| | - John J. Godleski
- Center for Nanotechnology and Nanotoxicology. Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, 665 Huntington Avenue, Room 1310, Boston, MA 02115 USA
| | - Philip Demokritou
- Center for Nanotechnology and Nanotoxicology. Department of Environmental Health, T.H. Chan School of Public Health, Harvard University, 665 Huntington Avenue, Room 1310, Boston, MA 02115 USA
| |
Collapse
|
24
|
Deif B, Roberts JD. Diagnostic evaluation and arrhythmia mechanisms in survivors of unexplained cardiac arrest. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:1320-1330. [DOI: 10.1111/pace.13780] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/16/2019] [Accepted: 08/11/2019] [Indexed: 12/25/2022]
Affiliation(s)
- Bishoy Deif
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of MedicineWestern University London Ontario
| | - Jason D. Roberts
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of MedicineWestern University London Ontario
| |
Collapse
|
25
|
Churet M, Luttoo K, Hocini M, Haïssaguerre M, Sacher F, Duchateau J. Diagnostic reproducibility of epinephrine drug challenge interpretation in suspected long QT syndrome. J Cardiovasc Electrophysiol 2019; 30:896-901. [DOI: 10.1111/jce.13926] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/06/2019] [Accepted: 03/09/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Maxime Churet
- Department of Cardiology‐Cardiac Electrophysiology and PacingBordeaux University HospitalBordeaux France
| | - Khaled Luttoo
- Department of Cardiology‐Cardiac Electrophysiology and PacingBordeaux University HospitalBordeaux France
| | - Mélèze Hocini
- Department of Cardiology‐Cardiac Electrophysiology and PacingBordeaux University HospitalBordeaux France
| | - Michel Haïssaguerre
- Department of Cardiology‐Cardiac Electrophysiology and PacingBordeaux University HospitalBordeaux France
| | - Frédéric Sacher
- Department of Cardiology‐Cardiac Electrophysiology and PacingBordeaux University HospitalBordeaux France
| | - Josselin Duchateau
- Department of Cardiology‐Cardiac Electrophysiology and PacingBordeaux University HospitalBordeaux France
| |
Collapse
|
26
|
Arnar DO, Mairesse GH, Boriani G, Calkins H, Chin A, Coats A, Deharo JC, Svendsen JH, Heidbüchel H, Isa R, Kalman JM, Lane DA, Louw R, Lip GYH, Maury P, Potpara T, Sacher F, Sanders P, Varma N, Fauchier L, Haugaa K, Schwartz P, Sarkozy A, Sharma S, Kongsgård E, Svensson A, Lenarczyk R, Volterrani M, Turakhia M, Obel IWP, Abello M, Swampillai J, Kalarus Z, Kudaiberdieva G, Traykov VB, Dagres N, Boveda S, Vernooy K, Kalarus Z, Kudaiberdieva G, Mairesse GH, Kutyifa V, Deneke T, Hastrup Svendsen J, Traykov VB, Wilde A, Heinzel FR. Management of asymptomatic arrhythmias: a European Heart Rhythm Association (EHRA) consensus document, endorsed by the Heart Failure Association (HFA), Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), Cardiac Arrhythmia Society of Southern Africa (CASSA), and Latin America Heart Rhythm Society (LAHRS). Europace 2019; 21:844–845. [DOI: 10.1093/europace/euz046] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 02/24/2019] [Indexed: 12/22/2022] Open
Abstract
AbstractAsymptomatic arrhythmias are frequently encountered in clinical practice. Although studies specifically dedicated to these asymptomatic arrhythmias are lacking, many arrhythmias still require proper diagnostic and prognostic evaluation and treatment to avoid severe consequences, such as stroke or systemic emboli, heart failure, or sudden cardiac death. The present document reviews the evidence, where available, and attempts to reach a consensus, where evidence is insufficient or conflicting.
Collapse
Affiliation(s)
- David O Arnar
- Department of Medicine, Landspitali - The National University Hospital of Iceland and University of Iceland, Reykjavik, Iceland
| | | | - Giuseppe Boriani
- Division of Cardiology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Hugh Calkins
- Department of Arrhythmia Services, Johns Hopkins Medical Institutions Baltimore, MD, USA
| | - Ashley Chin
- Division of Cardiology, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Andrew Coats
- Department of Cardiology, University of Warwick, Warwickshire, UK
| | - Jean-Claude Deharo
- Department of Rhythmology, Hôpital Universitaire La Timone, Marseille, France
| | - Jesper Hastrup Svendsen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Hein Heidbüchel
- Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Rodrigo Isa
- Clínica RedSalud Vitacura and Hospital el Carmen de Maipú, Santiago, Chile
| | - Jonathan M Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
| | - Ruan Louw
- Department Cardiology (Electrophysiology), Mediclinic Midstream Hospital, Centurion, South Africa
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
| | - Philippe Maury
- Cardiology, University Hospital Rangueil, Toulouse, France
| | - Tatjana Potpara
- Cardiology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Serbia
| | - Frederic Sacher
- Service de Cardiologie, Institut Lyric, CHU de Bordeaux, Bordeaux, France
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Niraj Varma
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Laurent Fauchier
- Service de Cardiologie et Laboratoire d'Electrophysiologie Cardiaque, Centre Hospitalier Universitaire Trousseau et Université François Rabelais, Tours, France
| | - Kristina Haugaa
- Department of Cardiology, Center for Cardiological Innovation and Institute for Surgical Research, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Peter Schwartz
- Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin, Milan, Italy
| | - Andrea Sarkozy
- Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium
| | | | - Erik Kongsgård
- Department of Cardiology, OUS-Rikshospitalet, Oslo, Norway
| | - Anneli Svensson
- Department of Cardiology, University Hospital of Linkoping, Sweden
| | | | | | - Mintu Turakhia
- Stanford University, Cardiac Arrhythmia & Electrophysiology Service, Stanford, USA
| | | | | | - Janice Swampillai
- Electrophysiologist & Cardiologist, Waikato Hospital, University of Auckland, New Zealand
| | - Zbigniew Kalarus
- SMDZ in Zabrze, Medical University of Silesia, Katowice, Poland
- Department of Cardiology, Silesian Center for Heart Diseases, Zabrze
| | | | - Vassil B Traykov
- Department of Invasive Electrophysiology and Cardiac Pacing, Clinic of Cardiology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Abstract
The discovery of the human genome has ushered in a new era of molecular testing, advancing our knowledge and ability to identify cardiac channelopathies. Genetic variations can affect the opening and closing of the potassium, sodium, and calcium channels, resulting in arrhythmias and sudden death. Cardiac arrhythmias caused by disorders of ion channels are known as cardiac channelopathies. Nurses are important members of many interdisciplinary teams and must have a general understanding of the pathophysiology of the most commonly encountered cardiac channelopathies, electrocardiogram characteristics, approaches to treatment, and care for patients and their families. This article provides an overview of cardiac channelopathies that nurses might encounter in an array of clinical and research settings, focusing on the clinically relevant features of long QT syndrome, short QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia, and arrhythmogenic right ventricular dysplasia/cardiomyopathy.
Collapse
Affiliation(s)
- Kathleen T Hickey
- Kathleen T. Hickey is Professor of Nursing, Columbia University Medical Center, 622 W 168th St, New York, NY 10032 . Amir Elzomor is a premedical student at the Albert Dorman Honors College at the New Jersey Institute of Technology, Newark, New Jersey
| | - Amir Elzomor
- Kathleen T. Hickey is Professor of Nursing, Columbia University Medical Center, 622 W 168th St, New York, NY 10032 . Amir Elzomor is a premedical student at the Albert Dorman Honors College at the New Jersey Institute of Technology, Newark, New Jersey
| |
Collapse
|
28
|
Ahluwalia N, Raju H. Assessment of the QT Interval in Athletes: Red Flags and Pitfalls. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2018; 20:82. [PMID: 30146672 DOI: 10.1007/s11936-018-0678-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW Pre-participation athlete screening has led to the referral of asymptomatic athletes with a prolonged QT interval warranting their evaluation for long QT syndrome (LQTS). Establishing a diagnosis of LQTS can be difficult, particularly in asymptomatic athletes presenting with a prolonged QTc < 500 ms. This review examines the evaluatory pathway to ascertain the common pitfalls leading to mis- or overdiagnosis. We discuss the advanced ECG-based tools and consider their application in the diagnostic process. RECENT FINDINGS Critical analysis of the ECG, symptom, and pedigree analysis has established value but relies on experienced interpretation. Protocolisation of the former has effectively reduced error. Exercise recovery ECG testing has demonstrated diagnostic value and provocation testing, reliant on QT hysteresis in LQTS, have shown reasonable sensitivity. Although it is becoming more established in experienced centres, its diagnostic value relies on effective risk stratification and subject selection. LQTS is a rare condition and the precision of any available test is greatly diluted if pre-test probability is low. Clinical and familial evaluation and exercise ECG testing are the foundation of the evaluatory process following referral. Adjunctive tests may have high sensitivity for LQTS but rely on high pre-test probability. Several pitfalls have been identified that can lead to misdiagnosis and thus informed evaluation at an experienced specialist centre is appropriate.
Collapse
Affiliation(s)
| | - Hariharan Raju
- MQ Health Cardiology, Macquarie University, 2 Technology Place, Sydney, NSW, 2109, Australia.
| |
Collapse
|
29
|
Schnell F, Behar N, Carré F. Long-QT Syndrome and Competitive Sports. Arrhythm Electrophysiol Rev 2018; 7:187-192. [PMID: 30416732 PMCID: PMC6141947 DOI: 10.15420/aer.2018.39.3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 07/17/2018] [Indexed: 01/02/2023] Open
Abstract
Long QT syndrome (LQTS) is an inherited channelopathy which exposes athletes to a risk of sudden cardiac death. Diagnosis is more difficult in this population because: the QT interval is prolonged by training; and the extreme bradycardia frequently observed in athletes makes the QT correction formula less accurate. Based on limited clinical data which tend to demonstrate that exercise, especially swimming, is a trigger for cardiac events, participation in any competitive sports practice is not supported by 2005 European guidelines. However, based on recent retrospective studies and adopting a different medical approach, involving the patient-athlete in shared decision making, the 2015 US guidelines are less restrictive, especially in asymptomatic genotype-positive/phenotype-negative athletes. These guidelines also consider giving medical clearance to competitive sport participation in asymptomatic athletes with appropriate medical therapy.
Collapse
Affiliation(s)
- Frédéric Schnell
- University of Rennes, Department of Sports MedicineUniversity Hospital of Rennes, Inserm, LTSI-UMR 1099 Rennes, France
| | - Nathalie Behar
- University of Rennes, Department of Cardiology UniversityHospital of Rennes, Inserm, LTSI-UMR 1099 Rennes, France
| | - François Carré
- University of Rennes, Department of Sports MedicineUniversity Hospital of Rennes, Inserm, LTSI-UMR 1099 Rennes, France
| |
Collapse
|
30
|
Waldmann V, Bougouin W, Karam N, Dumas F, Sharifzadehgan A, Gandjbakhch E, Algalarrondo V, Narayanan K, Zhao A, Amet D, Jost D, Geri G, Lamhaut L, Beganton F, Ludes B, Bruneval P, Plu I, Hidden-Lucet F, Albuisson J, Lavergne T, Piot O, Alonso C, Leenhardt A, Lellouche N, Extramiana F, Cariou A, Jouven X, Marijon E. Characteristics and clinical assessment of unexplained sudden cardiac arrest in the real-world setting: focus on idiopathic ventricular fibrillation. Eur Heart J 2018; 39:1981-1987. [PMID: 29566157 PMCID: PMC5982722 DOI: 10.1093/eurheartj/ehy098] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 11/30/2017] [Accepted: 02/13/2018] [Indexed: 12/22/2022] Open
Abstract
Aims Recent studies have shown that in more than half of apparently unexplained sudden cardiac arrests (SCA), a specific aetiology can be unmasked by a careful evaluation. The characteristics and the extent to which such cases undergo a systematic thorough investigation in real-life practice are unknown. Methods and results Data were analysed from an ongoing study, collecting all cases of out-of-hospital cardiac arrest in Paris area. Investigations performed during the index hospitalization or planned after discharge were gathered to evaluate the completeness of assessment of unexplained SCA. Between 2011 and 2016, among the 18 622 out-of-hospital cardiac arrests, 717 survivors (at hospital discharge) fulfilled the definition of cardiac SCA. Of those, 88 (12.3%) remained unexplained after electrocardiogram, echocardiography, and coronary angiography. Cardiac magnetic resonance imaging yielded the diagnosis in 25 (3.5%) cases, other investigations accounted for 14 (2.4%) additional diagnoses, and 49 (6.8%) patients were labelled as idiopathic ventricular fibrillation (IVF) (48.7 ± 15 years, 69.4% male). Among those labelled IVF, only 8 (16.3%) cases benefited from a complete workup (including pharmacological testing). Younger patients [odds ratio (OR) 6.00, 95% confidence interval (CI) 1.80-22.26] and those admitted to university centres (OR 3.60, 95% CI 1.12-12.45) were more thoroughly investigated. Genetic testing and family screening were initiated in only 9 (18.4%) and 12 (24.5%) cases, respectively. Conclusion Our findings suggest that complete investigations are carried out in a very low proportion of unexplained SCA. Standardized, systematic approaches need to be implemented to ensure that opportunities for specific therapies and preventive strategies (including relatives) are not missed.
Collapse
Affiliation(s)
- Victor Waldmann
- Cardiology Department, European Georges Pompidou Hospital, 20-40 Rue Leblanc, 75908 Paris Cedex 15, France
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 Rue Leblanc, 75798 Paris Cedex 15, France
- Faculty of Medicine, Paris Descartes University, 12 Rue de l'Ecole de Médecine, 75006 Paris, France
| | - Wulfran Bougouin
- Cardiology Department, European Georges Pompidou Hospital, 20-40 Rue Leblanc, 75908 Paris Cedex 15, France
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 Rue Leblanc, 75798 Paris Cedex 15, France
- Faculty of Medicine, Paris Descartes University, 12 Rue de l'Ecole de Médecine, 75006 Paris, France
| | - Nicole Karam
- Cardiology Department, European Georges Pompidou Hospital, 20-40 Rue Leblanc, 75908 Paris Cedex 15, France
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 Rue Leblanc, 75798 Paris Cedex 15, France
- Faculty of Medicine, Paris Descartes University, 12 Rue de l'Ecole de Médecine, 75006 Paris, France
| | - Florence Dumas
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 Rue Leblanc, 75798 Paris Cedex 15, France
- Faculty of Medicine, Paris Descartes University, 12 Rue de l'Ecole de Médecine, 75006 Paris, France
- Emergency Department, Cochin Hospital, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Ardalan Sharifzadehgan
- Cardiology Department, European Georges Pompidou Hospital, 20-40 Rue Leblanc, 75908 Paris Cedex 15, France
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 Rue Leblanc, 75798 Paris Cedex 15, France
| | - Estelle Gandjbakhch
- Cardiology Department, La Pitié Salpêtrière University Hospital, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
- Groupe Parisien Universitaire de Rythmologie (G.P.U.R.)
| | - Vincent Algalarrondo
- Groupe Parisien Universitaire de Rythmologie (G.P.U.R.)
- Cardiology Department, Antoine-Béclère Hospital, 157 Rue de la Porte de Trivaux, 92140 Clamart, France
| | - Kumar Narayanan
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 Rue Leblanc, 75798 Paris Cedex 15, France
- Cardiology Department, Maxcure Hospitals, Behind Cyber Towers, Hitec City, 500081 Hyderabad, India
| | - Alexandre Zhao
- Cardiology Department, European Georges Pompidou Hospital, 20-40 Rue Leblanc, 75908 Paris Cedex 15, France
| | - Denis Amet
- Cardiology Department, European Georges Pompidou Hospital, 20-40 Rue Leblanc, 75908 Paris Cedex 15, France
| | - Daniel Jost
- Paris Firefighters Brigade, 1 Place Jules Renard, 75017 Paris, France
| | - Guillaume Geri
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 Rue Leblanc, 75798 Paris Cedex 15, France
- Intensive Care Unit, Ambroise Paré Hospital, 9 Avenue Charles de Gaulle, 92100 Boulogne Billancourt, France
| | - Lionel Lamhaut
- SAMU de Paris, Necker Hospital, 149 rue Sèvres, 75015 Paris, France
| | - Frankie Beganton
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 Rue Leblanc, 75798 Paris Cedex 15, France
| | - Bertrand Ludes
- Forensic Medical Institute, 2 Voie Mazas, 75012 Paris, France
| | - Patrick Bruneval
- Pathology Department, European Georges Pompidou Hospital, 20-40 Rue Leblanc, 75908 Paris Cedex 15, France
| | - Isabelle Plu
- Pathology Department, La Pitié Salpêtrière University Hospital, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - Françoise Hidden-Lucet
- Cardiology Department, La Pitié Salpêtrière University Hospital, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - Juliette Albuisson
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 Rue Leblanc, 75798 Paris Cedex 15, France
- Faculty of Medicine, Paris Descartes University, 12 Rue de l'Ecole de Médecine, 75006 Paris, France
- Genetic Department, European Georges Pompidou Hospital, 20-40 Rue Leblanc, 75908 Paris Cedex 15, France
| | - Thomas Lavergne
- Cardiology Department, European Georges Pompidou Hospital, 20-40 Rue Leblanc, 75908 Paris Cedex 15, France
- Faculty of Medicine, Paris Descartes University, 12 Rue de l'Ecole de Médecine, 75006 Paris, France
| | - Olivier Piot
- Cardiology Department, Centre Cardiologique du Nord, 32-36 Rue des Moulins Gémeaux, 93200 Saint-Denis, France
| | - Christine Alonso
- Cardiology Department, Clinique Ambroise Paré, 25-27 Boulevard Victor Hugo, 92200 Neuilly-sur-Seine, France
| | - Antoine Leenhardt
- Cardiology Department, Bichat-Claude-Bernard Hospital, 46 Rue Henri Huchard, 75877 Paris, France
| | - Nicolas Lellouche
- Groupe Parisien Universitaire de Rythmologie (G.P.U.R.)
- Cardiology Department, University Hospital Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Fabrice Extramiana
- Groupe Parisien Universitaire de Rythmologie (G.P.U.R.)
- Cardiology Department, Bichat-Claude-Bernard Hospital, 46 Rue Henri Huchard, 75877 Paris, France
| | - Alain Cariou
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 Rue Leblanc, 75798 Paris Cedex 15, France
- Faculty of Medicine, Paris Descartes University, 12 Rue de l'Ecole de Médecine, 75006 Paris, France
- Intensive Care Unit, Cochin Hospital, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Xavier Jouven
- Cardiology Department, European Georges Pompidou Hospital, 20-40 Rue Leblanc, 75908 Paris Cedex 15, France
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 Rue Leblanc, 75798 Paris Cedex 15, France
- Faculty of Medicine, Paris Descartes University, 12 Rue de l'Ecole de Médecine, 75006 Paris, France
| | - Eloi Marijon
- Cardiology Department, European Georges Pompidou Hospital, 20-40 Rue Leblanc, 75908 Paris Cedex 15, France
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 Rue Leblanc, 75798 Paris Cedex 15, France
- Faculty of Medicine, Paris Descartes University, 12 Rue de l'Ecole de Médecine, 75006 Paris, France
- Groupe Parisien Universitaire de Rythmologie (G.P.U.R.)
| | | |
Collapse
|
31
|
|
32
|
Nakano Y, Wataru S. Syncope in patients with inherited arrhythmias. J Arrhythm 2017; 33:572-578. [PMID: 29255503 PMCID: PMC5728986 DOI: 10.1016/j.joa.2017.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Revised: 07/08/2017] [Accepted: 07/11/2017] [Indexed: 12/19/2022] Open
Abstract
Syncope, a common symptom of cerebral ischemia often shows a multifactorial etiopathogenesis. Although inherited arrhythmias causing syncope is uncommon, such an occurrence could be a warning sign preceding cardiac arrest. Long QT syndrome (LQTS) is a typical inherited arrhythmia causing syncope in children. Early diagnosis and treatment of LQTS using beta-blockers prevents recurrent syncope in LQTS. Brugada syndrome, another typical inherited arrhythmia causes syncope or sudden cardiac arrest in young individuals. Syncope as a symptom is useful for risk stratification of fatal arrhythmias and in selection of appropriate therapy. Catecholaminergic polymorphic ventricular tachycardia, another rare inherited arrhythmia causing recurrent syncope is associated with poor outcomes without medication. Early detection and therapeutic intervention improve prognosis; thus, correct diagnosis of syncope is imperative in cases of these inherited arrhythmias. We describe syncope associated with three typical inherited arrhythmias and discuss various diagnostic modalities.
Collapse
Affiliation(s)
- Yukiko Nakano
- Department of Cardiovascular Medicine, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical Science, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima734-8551, Japan
| | - Shimizu Wataru
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| |
Collapse
|
33
|
Muñoz-Esparza C, Zorio E, Domingo Valero D, Peñafiel-Verdú P, Sánchez-Muñoz JJ, García-Molina E, Sabater M, Navarro M, San-Román I, Pérez I, Santos JJ, Cabañas-Perianes V, Valdés M, Pascual D, García-Alberola A, Gimeno Blanes JR. Valor del «test de bipedestación» en el diagnóstico y la evaluación de la respuesta al tratamiento con bloqueadores beta en el síndrome de QT largo. Rev Esp Cardiol (Engl Ed) 2017. [DOI: 10.1016/j.recesp.2016.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
34
|
Miyazaki A, Sakaguchi H, Matsumura Y, Hayama Y, Noritake K, Negishi J, Tsuda E, Miyamoto Y, Aiba T, Shimizu W, Kusano K, Shiraishi I, Ohuchi H. Mid-Term Follow-up of School-Aged Children With Borderline Long QT Interval. Circ J 2017; 81:726-732. [PMID: 28216547 DOI: 10.1253/circj.cj-16-0991] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND There are no definitive diagnostic criteria or follow-up strategies for long QT syndrome (LQTS) in children with a borderline long QT interval (b-LQT).Methods and Results:We retrospectively evaluated the clinical course, genetic testing results, corrected QT interval (QTc), and LQTS score of 59 school-aged children (5-18 years old) with a b-LQT (400≤QTc<500 ms). Syncope, but neither aborted cardiac arrest nor sudden cardiac death, occurred in 2 patients during the follow-up (6±3.4 years) with LQTS scores ≥4.5 points. The genetic testing results were positive in 92%, 57%, and 67% of patients with high, intermediate, and low probabilities of LQTS, respectively. The maximum and mean QTc during the follow-up significantly differed among the categories with a probability of LQTS, but not the minimum QTc. However, the QTc at rest and at the recovery point after exercise stress testing dramatically changed at the last follow-up. Consequently, the probability of LQTS changed in half of the patients. CONCLUSIONS The LQTS score is a reasonable indicator for evaluating school-aged children with a b-LQT, and patients with a low LQTS score appear to be at low risk for cardiac events. However, the LQTS score can change during follow-up. Therefore, when there is doubt or concern for patients with a b-LQT, it is preferable to continue following them. Guidelines on follow-up strategies are desired for b-LQT.
Collapse
Affiliation(s)
- Aya Miyazaki
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Heima Sakaguchi
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Yu Matsumura
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Yosuke Hayama
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Kanae Noritake
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Jun Negishi
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Etsuko Tsuda
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Yoshihiro Miyamoto
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center.,Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center
| | - Takeshi Aiba
- Department of Cardiovascular Medicine, Division of Arrhythmias and Electrophysiology, National Cerebral and Cardiovascular Center
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Division of Arrhythmias and Electrophysiology, National Cerebral and Cardiovascular Center.,Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Kengo Kusano
- Department of Cardiovascular Medicine, Division of Arrhythmias and Electrophysiology, National Cerebral and Cardiovascular Center
| | - Isao Shiraishi
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| | - Hideo Ohuchi
- Department of Pediatric Cardiology, National Cerebral and Cardiovascular Center
| |
Collapse
|
35
|
Muñoz-Esparza C, Zorio E, Domingo Valero D, Peñafiel-Verdú P, Sánchez-Muñoz JJ, García-Molina E, Sabater M, Navarro M, San-Román I, Pérez I, Santos JJ, Cabañas-Perianes V, Valdés M, Pascual D, García-Alberola A, Gimeno Blanes JR. Value of the "Standing Test" in the Diagnosis and Evaluation of Beta-blocker Therapy Response in Long QT Syndrome. ACTA ACUST UNITED AC 2017; 70:907-914. [PMID: 28233664 DOI: 10.1016/j.rec.2017.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 12/20/2016] [Indexed: 11/19/2022]
Abstract
INTRODUCTION AND OBJECTIVES Patients with congenital long QT syndrome (LQTS) have an abnormal QT adaptation to sudden changes in heart rate provoked by standing. The present study sought to evaluate the standing test in a cohort of LQTS patients and to assess if this QT maladaptation phenomenon is ameliorated by beta-blocker therapy. METHODS Electrographic assessments were performed at baseline and immediately after standing in 36 LQTS patients (6 LQT1 [17%], 20 LQT2 [56%], 3 LQT7 [8%], 7 unidentified-genotype patients [19%]) and 41 controls. The corrected QT interval (QTc) was measured at baseline (QTcsupine) and immediately after standing (QTcstanding); the QTc change from baseline (ΔQTc) was calculated as QTcstanding - QTcsupine. The test was repeated in 26 patients receiving beta-blocker therapy. RESULTS Both QTcstanding and ΔQTc were significantly higher in the LQTS group than in controls (QTcstanding, 528 ± 46ms vs 420 ± 15ms, P < .0001; ΔQTc, 78 ± 40ms vs 8 ± 13ms, P < .0001). No significant differences were noted between LQT1 and LQT2 patients. Typical ST-T wave patterns appeared after standing in LQTS patients. Receiver operating characteristic curves of QTcstanding and ΔQTc showed a significant increase in diagnostic value compared with the QTcsupine (area under the curve for both, 0.99 vs 0.85; P < .001). Beta-blockers attenuated the response to standing in LQTS patients (QTcstanding, 440 ± 32ms, P < .0001; ΔQTc, 14 ± 16ms, P < .0001). CONCLUSIONS Evaluation of the QTc after the simple maneuver of standing shows a high diagnostic performance and could be important for monitoring the effects of beta-blocker therapy in LQTS patients.
Collapse
Affiliation(s)
- Carmen Muñoz-Esparza
- Unidad de Cardiopatías Familiares, Hospital Clínico Universitario Virgen de la Arrixaca, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria, Murcia, Spain.
| | - Esther Zorio
- Unidad de Valoración del Riesgo de Muerte Súbita Familiar, Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Diana Domingo Valero
- Unidad de Valoración del Riesgo de Muerte Súbita Familiar, Servicio de Cardiología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Pablo Peñafiel-Verdú
- Unidad de Cardiopatías Familiares, Hospital Clínico Universitario Virgen de la Arrixaca, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria, Murcia, Spain
| | - Juan J Sánchez-Muñoz
- Unidad de Cardiopatías Familiares, Hospital Clínico Universitario Virgen de la Arrixaca, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria, Murcia, Spain
| | - Esperanza García-Molina
- Unidad de Cardiopatías Familiares, Hospital Clínico Universitario Virgen de la Arrixaca, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria, Murcia, Spain
| | - María Sabater
- Unidad de Cardiopatías Familiares, Hospital Clínico Universitario Virgen de la Arrixaca, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria, Murcia, Spain
| | - Marina Navarro
- Unidad de Cardiopatías Familiares, Hospital Clínico Universitario Virgen de la Arrixaca, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria, Murcia, Spain
| | - Irene San-Román
- Unidad de Cardiopatías Familiares, Hospital Clínico Universitario Virgen de la Arrixaca, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria, Murcia, Spain
| | - Inmaculada Pérez
- Unidad de Cardiopatías Familiares, Hospital Clínico Universitario Virgen de la Arrixaca, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria, Murcia, Spain
| | - Juan J Santos
- Unidad de Cardiopatías Familiares, Hospital Clínico Universitario Virgen de la Arrixaca, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria, Murcia, Spain
| | - Valentín Cabañas-Perianes
- Departamento de Hematología y Análisis Clínico, Hospital Clínico Universitario Virgen de la Arrixaca, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria, Murcia, Spain
| | - Mariano Valdés
- Unidad de Cardiopatías Familiares, Hospital Clínico Universitario Virgen de la Arrixaca, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria, Murcia, Spain
| | - Domingo Pascual
- Unidad de Cardiopatías Familiares, Hospital Clínico Universitario Virgen de la Arrixaca, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria, Murcia, Spain
| | - Arcadio García-Alberola
- Unidad de Cardiopatías Familiares, Hospital Clínico Universitario Virgen de la Arrixaca, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria, Murcia, Spain
| | - Juan R Gimeno Blanes
- Unidad de Cardiopatías Familiares, Hospital Clínico Universitario Virgen de la Arrixaca, Universidad de Murcia, Instituto Murciano de Investigación Biosanitaria, Murcia, Spain
| |
Collapse
|
36
|
Jang SY, Cho Y, Kim NK, Kim CY, Sohn J, Roh JH, Bae MH, Lee JH, Yang DH, Park HS, Chae SC, Oh TH, Kim GJ. Video-Assisted Thoracoscopic Left Cardiac Sympathetic Denervation in Patients with Hereditary Ventricular Arrhythmias. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:232-241. [PMID: 28012188 DOI: 10.1111/pace.13008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 12/12/2016] [Accepted: 12/18/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Left cardiac sympathetic denervation (LCSD) has been underutilized in patients with hereditary ventricular arrhythmia syndromes such as congenital long QT syndrome (LQTS) and catecholaminergic polymorphic ventricular tachycardia (CPVT). The purpose of this study was to investigate the safety and efficacy of video-assisted thoracoscopic (VATS) LCSD in such patients. METHODS Fifteen patients (four men, 24.6 ± 10.5 years old) who underwent VATS-LCSD between November 2010 and January 2015 for hereditary ventricular arrhythmia syndromes at Kyungpook National University Hospital were enrolled in this study. The safety and efficacy of VATS-LCSD were evaluated by periprocedural epinephrine tests and assessing the development of complications and cardiac events during follow-up. RESULTS Fourteen patients with LQTS and one patient with CPVT underwent VATS-LCSD. Six and one patients developed ventricular tachyarrhythmia during preprocedural and postprocedural epinephrine test, respectively (P = 0.063). No serious complications such as Horner syndrome, pneumothorax, or bleeding developed after LCSD. Mean hospital stay after VATS-LCSD was 3.7 ± 1.5 days. During a mean follow-up of 927 ± 350 days, one LQTS patient and one CPVT patient, neither of whom manifested tachyarrhythmia during post-LCSD epinephrine test, developed torsades de pointes and syncope, respectively. The annual event rates of six patients who were symptomatic during the period preceding LCSD decreased from 0.97 to 0.19 events/year (P = 0.045). CONCLUSIONS VATS-LCSD was a safe, and effective procedure for patients with hereditary ventricular tachycardia syndrome, with no serious adverse events and with short hospital stay.
Collapse
Affiliation(s)
- Se Yong Jang
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea.,Cardiology Center, Kyungpook National University Medical Center, Daegu, Republic of Korea
| | - Yongkeun Cho
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Nam Kyun Kim
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Chang-Yeon Kim
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Jihyun Sohn
- Cardiology Center, Kyungpook National University Medical Center, Daegu, Republic of Korea
| | - Jae-Hyung Roh
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Myung Hwan Bae
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Jang Hoon Lee
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Dong Heon Yang
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea.,Cardiology Center, Kyungpook National University Medical Center, Daegu, Republic of Korea
| | - Hun Sik Park
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Shung Chull Chae
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Tak-Hyuk Oh
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Gun Jik Kim
- Department of Thoracic and Cardiovascular Surgery, Kyungpook National University Hospital, Daegu, Republic of Korea
| |
Collapse
|
37
|
Ichikawa M, Aiba T, Ohno S, Shigemizu D, Ozawa J, Sonoda K, Fukuyama M, Itoh H, Miyamoto Y, Tsunoda T, Makiyama T, Tanaka T, Shimizu W, Horie M. Phenotypic Variability of ANK2 Mutations in Patients With Inherited Primary Arrhythmia Syndromes. Circ J 2016; 80:2435-2442. [PMID: 27784853 DOI: 10.1253/circj.cj-16-0486] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Mutations inANK2have been reported to cause various arrhythmia phenotypes. The prevalence ofANK2mutation carriers in inherited primary arrhythmia syndrome (IPAS), however, remains unknown in Japanese. Using a next-generation sequencer, we aimed to identifyANK2mutations in our cohort of IPAS patients, in whom conventional Sanger sequencing failed to identify pathogenic mutations in major causative genes, and to assess the clinical characteristics ofANK2mutation carriers.Methods and Results:We screened 535 probands with IPAS and analyzed 46 genes including wholeANK2exons using a bench-top NGS (MiSeq, Illumina) or performed whole-exome-sequencing using HiSeq2000 (Illumina). As a result, 12 of 535 probands (2.2%, aged 0-61 years, 5 males) were found to carry 7 different heterozygousANK2mutations.ANK2-W1535R was identified in 5 LQTS patients and 1 symptomatic BrS and was predicted as damaging by multiple prediction software. In total, as to phenotype, there were 8 LQTS, 2 BrS, 1 IVF, and 1 SSS/AF. Surprisingly, 4/8 LQTS patients had the acquired type of LQTS (aLQTS) and suffered torsades de pointes. A total of 7 of 12 patients had documented malignant ventricular tachyarrhythmias. CONCLUSIONS VariousANK2mutations are associated with a wide range of phenotypes, including aLQTS, especially with ventricular fibrillation, representing "ankyrin-B" syndrome. (Circ J 2016; 80: 2435-2442).
Collapse
Affiliation(s)
- Mari Ichikawa
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Visser M, van der Heijden JF, Doevendans PA, Loh P, Wilde AA, Hassink RJ. Idiopathic Ventricular Fibrillation: The Struggle for Definition, Diagnosis, and Follow-Up. Circ Arrhythm Electrophysiol 2016; 9:CIRCEP.115.003817. [PMID: 27103090 DOI: 10.1161/circep.115.003817] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 02/25/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Marloes Visser
- From the Department of Cardiology, University Medical Center, Utrecht, The Netherlands (M.V., J.F.v.d.H., P.A.D., P.L., R.J.H.); Department of Internal Medicine and Cardiology, Bergman Clinics, Bilthoven, The Netherlands (M.V., R.J.H.); and Department of Clinical and Experimental Cardiology, Heart Centre, AMC, Amsterdam, The Netherlands (A.A.W.)
| | - Jeroen F van der Heijden
- From the Department of Cardiology, University Medical Center, Utrecht, The Netherlands (M.V., J.F.v.d.H., P.A.D., P.L., R.J.H.); Department of Internal Medicine and Cardiology, Bergman Clinics, Bilthoven, The Netherlands (M.V., R.J.H.); and Department of Clinical and Experimental Cardiology, Heart Centre, AMC, Amsterdam, The Netherlands (A.A.W.)
| | - Pieter A Doevendans
- From the Department of Cardiology, University Medical Center, Utrecht, The Netherlands (M.V., J.F.v.d.H., P.A.D., P.L., R.J.H.); Department of Internal Medicine and Cardiology, Bergman Clinics, Bilthoven, The Netherlands (M.V., R.J.H.); and Department of Clinical and Experimental Cardiology, Heart Centre, AMC, Amsterdam, The Netherlands (A.A.W.)
| | - Peter Loh
- From the Department of Cardiology, University Medical Center, Utrecht, The Netherlands (M.V., J.F.v.d.H., P.A.D., P.L., R.J.H.); Department of Internal Medicine and Cardiology, Bergman Clinics, Bilthoven, The Netherlands (M.V., R.J.H.); and Department of Clinical and Experimental Cardiology, Heart Centre, AMC, Amsterdam, The Netherlands (A.A.W.)
| | - Arthur A Wilde
- From the Department of Cardiology, University Medical Center, Utrecht, The Netherlands (M.V., J.F.v.d.H., P.A.D., P.L., R.J.H.); Department of Internal Medicine and Cardiology, Bergman Clinics, Bilthoven, The Netherlands (M.V., R.J.H.); and Department of Clinical and Experimental Cardiology, Heart Centre, AMC, Amsterdam, The Netherlands (A.A.W.)
| | - Rutger J Hassink
- From the Department of Cardiology, University Medical Center, Utrecht, The Netherlands (M.V., J.F.v.d.H., P.A.D., P.L., R.J.H.); Department of Internal Medicine and Cardiology, Bergman Clinics, Bilthoven, The Netherlands (M.V., R.J.H.); and Department of Clinical and Experimental Cardiology, Heart Centre, AMC, Amsterdam, The Netherlands (A.A.W.).
| |
Collapse
|
39
|
Taniguchi Y, Miyazaki A, Sakaguchi H, Hayama Y, Ebishima N, Negishi J, Noritake K, Miyamoto Y, Shimizu W, Aiba T, Ohuchi H. Prominent QTc prolongation in a patient with a rare variant in the cardiac ryanodine receptor gene. Heart Vessels 2016; 32:229-233. [PMID: 27401738 DOI: 10.1007/s00380-016-0869-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 07/01/2016] [Indexed: 12/22/2022]
Abstract
We report the case of a 12-year-old female patient with a history of four syncopal episodes related to exercise over 2 years and who showed prominent QTc prolongation on electrocardiogram; therefore, she was clinically diagnosed with long QT syndrome type-1. However, genetic analysis did not identify any LQT-related genes but showed a rare missense variant in the cardiac ryanodine receptor gene. From the results of drug-loading tests, administration of oral propranolol was initiated; thereafter, she experienced no syncopal episodes. This is a case report demonstrating the "overlapping clinical features" of long QT syndrome and catecholaminergic polymorphic ventricular tachycardia.
Collapse
Affiliation(s)
- Yuki Taniguchi
- Department of Pediatric Cardiology, Division of Arrhythmias and Electrophysiology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, 565-8565, Osaka, Japan.,Department of Cardiovascular Medicine, Hyogo Prefectural Kobe Children's Hospital, 1-6-7 chuo-ku, Kobe, 650-0047, Hyogo, Japan
| | - Aya Miyazaki
- Department of Pediatric Cardiology, Division of Arrhythmias and Electrophysiology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, 565-8565, Osaka, Japan.
| | - Heima Sakaguchi
- Department of Pediatric Cardiology, Division of Arrhythmias and Electrophysiology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, 565-8565, Osaka, Japan
| | - Yousuke Hayama
- Department of Pediatric Cardiology, Division of Arrhythmias and Electrophysiology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, 565-8565, Osaka, Japan
| | - Norihiro Ebishima
- Department of Pediatric Cardiology, Division of Arrhythmias and Electrophysiology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, 565-8565, Osaka, Japan
| | - Jun Negishi
- Department of Pediatric Cardiology, Division of Arrhythmias and Electrophysiology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, 565-8565, Osaka, Japan
| | - Kanae Noritake
- Department of Pediatric Cardiology, Division of Arrhythmias and Electrophysiology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, 565-8565, Osaka, Japan
| | - Yoshihiro Miyamoto
- Department of Preventive Cardiology, Department of Medicine and Epidemiologic Informatics, Division of Arrhythmias and Electrophysiology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, 565-8565, Osaka, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Division of Arrhythmias and Electrophysiology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, 565-8565, Osaka, Japan.,Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, 113-8602, Tokyo, Japan
| | - Takeshi Aiba
- Department of Cardiovascular Medicine, Division of Arrhythmias and Electrophysiology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, 565-8565, Osaka, Japan
| | - Hideo Ohuchi
- Department of Pediatric Cardiology, Division of Arrhythmias and Electrophysiology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, 565-8565, Osaka, Japan
| |
Collapse
|
40
|
Tagawa M, Ochiai S, Nakamura Y, Sato A, Chinushi M. Secondly ECG recordings in the emergency room revealed Garenoxacin-induced abnormal QT interval prolongation in a patient with multiple syncopal attacks. Heart Vessels 2016; 31:1200-5. [DOI: 10.1007/s00380-015-0693-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 05/22/2015] [Indexed: 11/30/2022]
|
41
|
Adler A, Viskin S. Clinical Features of Genetic Cardiac Diseases Related to Potassium Channelopathies. Card Electrophysiol Clin 2016; 8:361-72. [PMID: 27261827 DOI: 10.1016/j.ccep.2016.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Genetic cardiac diseases related to potassium channelopathies are a group of relatively rare syndromes that includes long QT syndrome, short QT syndrome, Brugada syndrome, and early repolarization syndrome. Patients with these syndromes share a propensity for the development of life-threatening ventricular arrhythmias in the absence of significant cardiac structural abnormalities. Familial atrial fibrillation has also been associated with potassium channel dysfunction but differs from the other syndromes by being a rare cause of a common condition. This article focuses on the clinical features, diagnosis, and management of these syndromes.
Collapse
Affiliation(s)
- Arnon Adler
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv 64239, Israel
| | - Sami Viskin
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, 6 Weizmann Street, Tel Aviv 64239, Israel.
| |
Collapse
|
42
|
Yamaguchi Y, Mizumaki K, Hata Y, Sakamoto T, Nakatani Y, Kataoka N, Ichida F, Inoue H, Nishida N. Latent pathogenicity of the G38S polymorphism of KCNE1 K + channel modulator. Heart Vessels 2016; 32:186-192. [PMID: 27255646 DOI: 10.1007/s00380-016-0859-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 05/27/2016] [Indexed: 01/08/2023]
Abstract
KCNE1 encodes a modulator of KCNQ1 and KCNH2 channels. Although KCNE1(G38S), a single-nucleotide polymorphism (SNP) causing a G38S substitution in KCNE1, is found frequently, whether and how this SNP causes long QT syndrome (LQTS) remains unclear. We evaluated rate-dependent repolarization dynamics using Holter electrocardiogram (ECG) to assess the pathogenicity of KCNE1(G38S). Forty-five patients exhibiting long QT intervals, as assessed by their baseline ECGs, and 16 control subjects were enrolled. KCNE1(G38S) carriers were identified using genome sequencing. LQTS patients were classified into LQT1 or LQT2 using genetic analysis or epinephrine test. QT-RR relations were determined using 24-h Holter ECG recordings. Among the 15 patients (33.3 %) with KCNE1(G38S), four patients without any mutations or amino acid changes in other major cardiac ion channels were categorized as KCNE1(G38S) carriers. In the QT-RR regression lines, the QT-RR slope was greater in the KCNE1(G38S) carriers and the LQT2 patients (0.215 ± 0.021 and 0.207 ± 0.032, respectively) than in the LQT1 patients (0.163 ± 0.014, P < 0.05) and the control subjects (0.135 ± 0.025, P < 0.001). The calculated QT intervals at an RR interval of 1200 ms were longer in the KCNE1(G38S) carriers and LQT1 and LQT2 patients than in the control subjects. Patients with KCNE1(G38S) had a rate-dependent repolarization abnormality similar to patients with LQT2 and, therefore, may have a potential risk to develop lethal arrhythmias.
Collapse
Affiliation(s)
- Yoshiaki Yamaguchi
- Second Department of Internal Medicine, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Koichi Mizumaki
- Clinical Research and Ethics Center, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan.
| | - Yukiko Hata
- Department of Legal Medicine, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Tamotsu Sakamoto
- Second Department of Internal Medicine, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Yosuke Nakatani
- Second Department of Internal Medicine, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Naoya Kataoka
- Second Department of Internal Medicine, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Fukiko Ichida
- Department of Pediatrics, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Hiroshi Inoue
- Second Department of Internal Medicine, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Naoki Nishida
- Department of Legal Medicine, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| |
Collapse
|
43
|
Takahashi K, Nabeshima T, Nakayashiro M, Ganaha H. QT Dynamics During Exercise in Asymptomatic Children with Long QT Syndrome Type 3. Pediatr Cardiol 2016; 37:860-7. [PMID: 26921063 DOI: 10.1007/s00246-016-1360-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 02/13/2016] [Indexed: 01/08/2023]
Abstract
Sympathetic provocative testing is commonly used to detect the abnormal QT dynamics in long QT syndrome (LQTS) patients, particularly LQTS type 1 and type 2. However, little is known about LQTS type 3 (LQT3). We investigated QT dynamics during exercise testing in LQTS patients, particularly LQT3. This study included 37 subjects, comprising 16 genotyped LQTS patients and 21 unrelated healthy subjects without QT prolongation. LQTS patients were divided into LQT3 and non-LQT3 groups. During exercise tests using a modified Bruce protocol, 12-lead electrocardiogram monitoring was performed using a novel multifunctional electrocardiograph. QT intervals were automatically measured. The QT/heart rate (HR) relationship was visualized by plotting the beat-to-beat confluence of the recorded data. A linear regression analysis was performed to determine the QT/HR slope and intercept. Estimated QT intervals at HR 60 bpm (QT60) were calculated by the regression line formula. QT/HR slopes were steeper for each LQTS group than for the control group (P < 0.001). QT60 values demonstrated a moderate correlation with QT intervals at rest (P < 0.0001) for both groups. The corrected QT intervals (QTc) at 4 min of recovery after exercise were significantly longer in the non-LQT3 group than in the control group but were not different between the LQT3 and the control groups. Abnormal QT dynamics during exercise testing were observed in both LQT3 patients and other LQTS subtypes. This method may be useful for directing genetic testing in subjects with borderline prolonged QT intervals.
Collapse
Affiliation(s)
- Kazuhiro Takahashi
- Department of Pediatric Cardiology, Okinawa Children's Medical Center, 118-1 Arakawa, Haebaru-chou, Okinawa, 901-1193, Japan.
| | - Taisuke Nabeshima
- Department of Pediatric Cardiology, Okinawa Children's Medical Center, 118-1 Arakawa, Haebaru-chou, Okinawa, 901-1193, Japan
| | - Mami Nakayashiro
- Department of Pediatric Cardiology, Okinawa Children's Medical Center, 118-1 Arakawa, Haebaru-chou, Okinawa, 901-1193, Japan
| | - Hitoshi Ganaha
- Department of Pediatric Cardiology, Okinawa Children's Medical Center, 118-1 Arakawa, Haebaru-chou, Okinawa, 901-1193, Japan
| |
Collapse
|
44
|
Herman ARM, Cheung C, Gerull B, Simpson CS, Birnie DH, Klein GJ, Champagne J, Healey JS, Gibbs K, Talajic M, Gardner M, Bennett MT, Steinberg C, Janzen M, Gollob MH, Angaran P, Yee R, Leather R, Chakrabarti S, Sanatani S, Chauhan VS, Krahn AD. Outcome of Apparently Unexplained Cardiac Arrest: Results From Investigation and Follow-Up of the Prospective Cardiac Arrest Survivors With Preserved Ejection Fraction Registry. Circ Arrhythm Electrophysiol 2016; 9:e003619. [PMID: 26783233 DOI: 10.1161/circep.115.003619] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Cardiac Arrest Survivors with Preserved Ejection Fraction Registry (CASPER) enrolls patients with apparently unexplained cardiac arrest and no evident cardiac disease to identify the pathogenesis of cardiac arrest through systematic clinical testing. Exercise testing, drug provocation, advanced cardiac imaging, and genetic testing may be useful when a cause is not apparent. METHODS AND RESULTS The first 200 survivors of unexplained cardiac arrest from 14 centers across Canada were evaluated to determine the results of investigation and follow-up (age, 48.6±14.7 years, 41% female). Patients were free of evidence of coronary artery disease, left ventricular dysfunction, or evident repolarization syndromes. Advanced testing determined a diagnosis in 34% of patients at baseline, with a diagnosis emerging during follow-up in 7% of patients. Of those who were diagnosed, 28 (35%) had an underlying structural condition and 53 (65%) had a primary electric disease. During a mean follow-up of 3.15±2.34 years, 23% of patients had either a shock or an appropriate antitachycardia pacing from their implantable cardioverter defibrillator, or both. The implantable cardioverter defibrillator appropriate intervention rate was 8.4% at 1 year and 18.1% at 3 years, with no clear difference between diagnosed and undiagnosed subjects, or between those diagnosed with a primary electric versus structural pathogenesis. CONCLUSIONS Obtaining a diagnosis in previously unexplained cardiac arrest patients requires systematic clinical testing and regular follow-up to unmask the cause. Nearly half of apparently unexplained cardiac arrest patients ultimately received a diagnosis, allowing for improved treatment and family screening. A substantial proportion of patients received appropriate implantable cardioverter defibrillator therapy during medium-term follow-up. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00292032.
Collapse
Affiliation(s)
- Adam R M Herman
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Christopher Cheung
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Brenda Gerull
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Christopher S Simpson
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - David H Birnie
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - George J Klein
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Jean Champagne
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Jeffrey S Healey
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Karen Gibbs
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Mario Talajic
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Martin Gardner
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Matthew T Bennett
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Christian Steinberg
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Mikyla Janzen
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Michael H Gollob
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Paul Angaran
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Raymond Yee
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Richard Leather
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Santabhanu Chakrabarti
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Shubhayan Sanatani
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Vijay S Chauhan
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Andrew D Krahn
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.).
| |
Collapse
|
45
|
Funasako M, Aiba T, Ishibashi K, Nakajima I, Miyamoto K, Inoue Y, Okamura H, Noda T, Kamakura S, Anzai T, Noguchi T, Yasuda S, Miyamoto Y, Fukushima Kusano K, Ogawa H, Shimizu W. Pronounced Shortening of QT Interval With Mexiletine Infusion Test in Patients With Type 3 Congenital Long QT Syndrome. Circ J 2016; 80:340-5. [DOI: 10.1253/circj.cj-15-0984] [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] [Indexed: 11/09/2022]
Affiliation(s)
- Moritoshi Funasako
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
- Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | - Takeshi Aiba
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kohei Ishibashi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Ikutaro Nakajima
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Koji Miyamoto
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
- Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | - Yuko Inoue
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hideo Okamura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
- Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Shiro Kamakura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
- Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
- Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
- Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | - Yoshihiro Miyamoto
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center
| | - Kengo Fukushima Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
- Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | - Hisao Ogawa
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
- Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
- Department of Advanced Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| |
Collapse
|
46
|
Chen J, Makiyama T, Wuriyanghai Y, Ohno S, Sasaki K, Hayano M, Harita T, Nishiuchi S, Yuta Yamamoto, Ueyama T, Shimizu A, Horie M, Kimura T. Cardiac sodium channel mutation associated with epinephrine-induced QT prolongation and sinus node dysfunction. Heart Rhythm 2016; 13:289-98. [DOI: 10.1016/j.hrthm.2015.08.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Indexed: 12/19/2022]
|
47
|
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.
Collapse
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.).
| |
Collapse
|
48
|
Abstract
Molecular genetic studies in the last 2 decades have revealed a link between several inherited cardiac arrhythmias and genes encoding for ion channels or other membrane components. Two recent international expert consensus statements endorsed by 3 continental electrophysiology societies have updated the clinical and genetic diagnoses and management in patients with inherited arrhythmia syndromes, including congenital long QT syndrome (LQTS) and Brugada syndrome. Thirteen genotypes have been identified in 50% to 80% of clinically affected patients with congenital LQTS. Therefore, genotype-phenotype correlations have been investigated, especially, in the 3 major genotypes--LQT1, LQT2 and LQT3 syndromes--enabling genotype-specific management and therapy. On the other hand, less than half of patients with Brugada syndrome can be genotyped, and mainly for the sodium channel gene, SCN5A. However, recent advances in molecular genetic testing include genome-wide association studies using gene arrays and targeted, whole-exome and whole-genome next-generation sequencing techniques. In this article, I will review the clinical and genetic diagnoses in congenital LQTS and Brugada syndrome.
Collapse
Affiliation(s)
- Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
| |
Collapse
|
49
|
The potassium current carried by TREK-1 channels in rat cardiac ventricular muscle. Pflugers Arch 2014; 467:1069-79. [PMID: 25539776 DOI: 10.1007/s00424-014-1678-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 12/15/2014] [Accepted: 12/16/2014] [Indexed: 01/13/2023]
Abstract
We studied the potassium current flowing through TREK-1 channels in rat cardiac ventricular myocytes. We separated the TREK-1 current from other current components by blocking most other channels with a blocker cocktail. We tried to inhibit the TREK-1 current by activating protein kinase A (PKA) with a mixture of forskolin and isobutyl-methylxanthine (IBMX). Activation of PKA blocked an outwardly rectifying current component at membrane potentials positive to -40 mV. At 37 °C, application of forskolin plus IBMX reduced the steady-state outward current measured at positive voltages by about 52 %. Application of the potassium channel blockers quinidine or tetrahexylammonium also reduced the steady-state outward current by about 50 %. Taken together, our results suggest that the increase in temperature from 22 to 37 °C increased the TREK-1 current by a factor of at least 5 and that the average density of the TREK-1 current in rat cardiomyocytes at 37 °C is about 1.5 pA/pF at +30 mV. The contribution of TREK-1 to the action potential was assessed by using a dynamic patch clamp technique. After subtraction of simulated TREK-1 currents, action potential duration at 50 or 90 % repolarisation was increased by about 12 %, indicating that TREK-1 may be functionally important in rat ventricular muscle. During sympathetic stimulation, inhibition of TREK-1 channels via PKA is expected to prolong the action potential primarily in subendocardial myocytes; this may decrease the transmural dispersion of repolarisation and thus may serve to prevent the occurrence of arrhythmias.
Collapse
|
50
|
Pedersen CT, Kay GN, Kalman J, Borggrefe M, Della-Bella P, Dickfeld T, Dorian P, Huikuri H, Kim YH, Knight B, Marchlinski F, Ross D, Sacher F, Sapp J, Shivkumar K, Soejima K, Tada H, Alexander ME, Triedman JK, Yamada T, Kirchhof P, Lip GY, Kuck KH, Mont L, Haines D, Indik J, Dimarco J, Exner D, Iesaka Y, Savelieva I. EHRA/HRS/APHRS expert consensus on ventricular arrhythmias. J Arrhythm 2014. [DOI: 10.1016/j.joa.2014.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
|