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Pérez-Riera AR, Barbosa-Barros R, da Silva Rocha M, Paixão-Almeida A, Daminello-Raimundo R, de Abreu LC, Yanowitz F, Baranchuk A, Nikus K. Congenital short QT syndrome: A review focused on electrocardiographic features. J Electrocardiol 2024; 85:87-94. [PMID: 38714466 DOI: 10.1016/j.jelectrocard.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/20/2024] [Accepted: 04/27/2024] [Indexed: 05/09/2024]
Abstract
Congenital short QT syndrome is a very low prevalence inherited primary arrhythmia syndrome first reported in 2000 by Gussak et al., who described two families with a short QT interval, syncope, and sudden cardiac death. In 2004, Ramon Brugada et al. identified the first genetic type of this entity. To date, a total of nine genotypes have been described. The diagnosis is easy from the electrocardiogram (ECG), not only due to the short QT duration, but also based on other aspects covered in this review. During 24-h Holter monitoring, paroxysmal atrial fibrillation spontaneously converting to sinus rhythm may be found. Even though the T wave may appear symmetric on the ECG, the T loop of the vectorcardiogram confirms that the T wave is constantly asymmetric due to the presence of dashes closer to each other in the efferent branch. In this review, we also describe the minus-plus T wave sign that we have described in a previously published article. In addition to congenital causes, we briefly highlight the existence of numerous acquired causes of short QT interval.
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Affiliation(s)
- Andrés Ricardo Pérez-Riera
- Universidade Nove de Julho (UNINOVE), Mauá, SP, Brazil; Faculdade de Medicina FMABC, Santo André, SP, Brazil; Hospital do Coração (HCor), São Paulo, SP, Brazil.
| | | | | | | | | | - Luiz Carlos de Abreu
- Faculdade de Medicina FMABC, Santo André, SP, Brazil; Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Frank Yanowitz
- Intermountain Medical Center, Intermountain Heart Institute, Department of Internal Medicine, The University of Utah, Salt Lake City, UT, USA
| | | | - Kjell Nikus
- Faculty of Medicine and Life Sciences, Tampere University, and Heart Center, Tampere University Hospital, Tampere, Finland
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Asatryan B, Barth AS. Sex-related differences in incidence, phenotype and risk of sudden cardiac death in inherited arrhythmia syndromes. Front Cardiovasc Med 2023; 9:1010748. [PMID: 36684594 PMCID: PMC9845907 DOI: 10.3389/fcvm.2022.1010748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 12/08/2022] [Indexed: 01/06/2023] Open
Abstract
Inherited Arrhythmia Syndromes (IAS) including long QT and Brugada Syndrome, are characterized by life-threatening arrhythmias in the absence of apparent structural heart disease and are caused by pathogenic variants in genes encoding cardiac ion channels or associated proteins. Studies of large pedigrees of families affected by IAS have demonstrated incomplete penetrance and variable expressivity. Biological sex is one of several factors that have been recognized to modulate disease severity in IAS. There is a growing body of evidence linking sex hormones to the susceptibility to arrhythmias, yet, many sex-specific disease aspects remain underrecognized as female sex and women with IAS are underinvestigated and findings from male-predominant cohorts are often generalized to both sexes with minimal to no consideration of relevant sex-associated differences in prevalence, disease manifestations and outcome. In this review, we highlight current knowledge of sex-related biological differences in normal cardiac electrophysiology and sex-associated factors that influence IAS phenotypes.
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Affiliation(s)
- Babken Asatryan
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas S. Barth
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States,*Correspondence: Andreas S. Barth ✉
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Krahn AD, Tfelt-Hansen J, Tadros R, Steinberg C, Semsarian C, Han HC. Latent Causes of Sudden Cardiac Arrest. JACC Clin Electrophysiol 2022; 8:806-821. [PMID: 35738861 DOI: 10.1016/j.jacep.2021.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/09/2021] [Accepted: 12/29/2021] [Indexed: 11/30/2022]
Abstract
Inherited arrhythmia syndromes are a common cause of apparently unexplained cardiac arrest or sudden cardiac death. These include long QT syndrome and Brugada syndrome, with a well-recognized phenotype in most patients with sufficiently severe disease to lead to cardiac arrest. Less common and typically less apparent conditions that may not be readily evident include catecholaminergic polymorphic ventricular tachycardia, short QT syndrome and early repolarization syndrome. In cardiac arrest patients whose extensive testing does not reveal an underlying etiology, a diagnosis of idiopathic ventricular fibrillation or short-coupled ventricular fibrillation is assigned. This review summarizes our current understanding of the less common inherited arrhythmia syndromes and provides clinicians with a practical approach to diagnosis and management.
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Affiliation(s)
- Andrew D Krahn
- Center for Cardiovascular Innovation, Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Jacob Tfelt-Hansen
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rafik Tadros
- Cardiovascular Genetics Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Québec, Canada
| | - Christian Steinberg
- Institut universitaire de cardiologie et pneumologie de Québec (IUCPQ-UL), Laval University, Inherited Arrhythmia Services, Départment of Cardiology and Cardiac Surgery, Québec, Canada
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Hui-Chen Han
- Center for Cardiovascular Innovation, Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada; Victorian Heart Institute, Monash University, Clayton, Victoria, Australia
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Kamakura T, Gourraud JB, Clementy N, Maury P, Mansourati J, Klug D, Da Costa A, Pasquie JL, Mabo P, Chavernac P, Laurent G, Defaye P, Laborderie J, Leenhardt A, Sadoul N, Deharo JC, Giraudeau C, Quentin A, Jesel L, Thollet A, Tixier R, Derval N, Haissaguerre M, Probst V, Sacher F. Outcome of Patients with Early Repolarization Pattern and Syncope. Heart Rhythm 2022; 19:1306-1314. [PMID: 35395407 DOI: 10.1016/j.hrthm.2022.03.1233] [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: 02/10/2022] [Revised: 03/30/2022] [Accepted: 03/30/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Syncope in patients with an early repolarization (ER) pattern presents a challenge for clinicians as it has been identified as an indicator of a higher risk of life-threatening ventricular arrhythmias (VAs). OBJECTIVE This study aimed to analyze the outcome of patients with an ER pattern and syncope, and to evaluate the factors predictive of VAs. METHODS Over a period of 5 years, we enrolled 143 patients with an ER pattern and syncope in a multicenter prospective registry. RESULTS Following the initial examinations, 97 patients (67.8%) were implanted with a device allowing electrocardiogram monitoring, including 84 with an implantable loop recorder. During a mean follow-up of 68 ± 34 months, we documented 16 arrhythmias presumably responsible for syncope (5 VAs, 10 bradycardias, and 1 supraventricular tachycardia). Additionally, recurrent syncope not associated with electrocardiogram documentation occurred in 16 patients (11.2%). The cause of syncope was identified in 23 of 97 (23.8%) patients with a monitoring device. The 5-year incidence of VAs and arrhythmic events presumably responsible for syncope was 4.9% and 11.0%, respectively. Patients who developed VAs showed no prodromes or specific triggers at the time of syncope. Neither the presence of a family history of sudden cardiac death nor the previously reported high-risk electrocardiographic parameters differed between patients with and without VAs. CONCLUSIONS VAs occurred in 4.9% of patients with an ER pattern and syncope. Device implantation based on detailed history taking seems to be a reasonable strategy. Previously reported high-risk electrocardiographic patterns did not identify patients with VAs.
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Affiliation(s)
- Tsukasa Kamakura
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Univ. Bordeaux, Bordeaux University Hospital (CHU), F-33600 Pessac-Bordeaux, France
| | - Jean-Baptiste Gourraud
- Department of Cardiology, National Reference Centre for Inherited Cardiac Arrhythmia, L'institut du thorax, INSERM, CNRS, University of Nantes, Nantes University Hospital, Nantes, France
| | - Nicolas Clementy
- Department of Cardiology, University Hospital of Tours, Tours, France
| | - Philippe Maury
- Department of Cardiology, University Hospital Rangueil, Toulouse, France
| | | | - Didier Klug
- Department of Electrophysiology, Lille University Hospital, Lille, France
| | - Antoine Da Costa
- Department of Cardiology, Saint-Etienne University Hospital, France
| | - Jean-Luc Pasquie
- Department of Cardiology and PhyMedExp, Université Montpellier, INSERM, CNRS, CHRU Montpellier University Hospital, France
| | - Philippe Mabo
- Department of Cardiology, Rennes University Hospital, France
| | | | | | - Pascal Defaye
- Department of Cardiology, Grenoble University Hospital, France
| | | | | | - Nicolas Sadoul
- Department of Cardiology, Nancy University Hospital, France
| | | | | | - Anne Quentin
- Department of Cardiology, Centre Hospitalier de Saint Brieuc, France
| | - Laurence Jesel
- Department of Cardiology, Strasbourg University Hospital, France
| | - Aurelie Thollet
- Department of Cardiology, National Reference Centre for Inherited Cardiac Arrhythmia, L'institut du thorax, INSERM, CNRS, University of Nantes, Nantes University Hospital, Nantes, France
| | - Romain Tixier
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Univ. Bordeaux, Bordeaux University Hospital (CHU), F-33600 Pessac-Bordeaux, France
| | - Nicolas Derval
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Univ. Bordeaux, Bordeaux University Hospital (CHU), F-33600 Pessac-Bordeaux, France
| | - Michel Haissaguerre
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Univ. Bordeaux, Bordeaux University Hospital (CHU), F-33600 Pessac-Bordeaux, France
| | - Vincent Probst
- Department of Cardiology, National Reference Centre for Inherited Cardiac Arrhythmia, L'institut du thorax, INSERM, CNRS, University of Nantes, Nantes University Hospital, Nantes, France
| | - Frederic Sacher
- Department of Cardiac Pacing and Electrophysiology, IHU Liryc, Electrophysiology and Heart Modeling Institute, Univ. Bordeaux, Bordeaux University Hospital (CHU), F-33600 Pessac-Bordeaux, France.
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A descriptive report on short QT interval in Kherameh branch of the PERSIAN cohort study. Sci Rep 2022; 12:2898. [PMID: 35190598 PMCID: PMC8861052 DOI: 10.1038/s41598-022-06835-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 02/07/2022] [Indexed: 11/24/2022] Open
Abstract
Short QT-interval is a condition that bear the suspicion of short QT syndrome (SQTS). SQTS is known to increase risk of life-threatening arrythmias and sudden cardiac death (SCD). Due to the insufficient population-based studies and use of various QT cut-off values, it accounts for as an undiagnosed condition. In this study, we sought for prevalence of short QT interval in Kherameh cohort study, one of the southern branches of the Prospective Epidemiological Research Studies in Iran (PERSIAN). Data of 4363 adult subjects were analyzed from phase 1 of the cohort during 2014–2017. The corrected QT (QTc) intervals were calculated and electrocardiograms (ECGs) with QTc of less than 370 ms (msec) were reanalyzed for bradycardia, early repolarization, atrial fibrillation (AF), arrhythmias, and other electrical conduction abnormalities. Seventy-two subjects (1.65%) had a QTc of less than 370 ms (mean QTc of 360.72 ± 11.72). A male predominance and a lower mean heart rate observed in SQTS susceptible group (M/F of 1/0.26 vs. 1/1.145, p-value < 0.0001; 58.389 ± 9.787 vs. 70.899 ± 11.775; p-value < 0.0001) compare to the subjects with normal QTc. At least, 2 subjects with high-probability SQTS and 3 with intermediate-probability SQTS identified. The frequency of AF, syncope, bradycardia, early repolarization, low voltage ECG, and infantile SCD in first- and second-degree relatives were 16.67, 4.17, 33.33, 11.11, 11.11, 11.11%, respectively. The prevalence of short QT interval in our cohort was in line with previous studies. The incidence of cardiac symptoms/events, familial SCDs and ECG derived specific findings were high amongst SQTS-susceptible index persons. However, these variables could not predict the symptomatic subjects, which emphasizes gene studies and family screening.
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Suzuki H, Horie M, Ozawa J, Sumitomo N, Ohno S, Hoshino K, Ehara E, Takahashi K, Maeda Y, Yoshinaga M, Tateno S, Takagi J, Doi S, Hoshina S, Sato I, Ishikawa T, Makita N, Chinushi M, Akazawa K, Nagashima M. Novel electrocardiographic criteria for short QT syndrome in children and adolescents. Europace 2021; 23:2029-2038. [PMID: 34179980 DOI: 10.1093/europace/euab097] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/25/2021] [Indexed: 11/12/2022] Open
Abstract
AIMS Although shortening of the corrected QT interval (QTc) is a key finding in the diagnosis of short QT syndrome (SQTS), there may be overlap of the QTc between SQTS patients and normal subjects in childhood and adolescence. We aimed to investigate electrocardiographic findings for differentiation of SQTS patients. METHODS AND RESULTS The SQTS group comprised 34 SQTS patients <20 years old, including 9 from our institutions and 25 from previous reports. The control group comprised 61 apparently healthy subjects with an QTc of <360 ms who were selected from 13 314 participants in a school-based screening programme. We compared electrocardiographic findings, including QT and Jpoint-Tpeak intervals (QT and J-Tpeak, respectively), those corrected by using the Bazett's and Fridericia's formulae (cB and cF, respectively) and early repolarization (ER) between the groups. QT, QTc by using Bazett's formula (QTcB), QTc by using Fridericia's formula (QTcF), J-Tpeak, J-Tpeak cB, and J-Tpeak cF were significantly shorter in the SQTS group than in the control group. On receiver operating characteristic curve analysis, the area under the curve (AUC) was largest for QTcB (0.888) among QT, QTcB, and QTcF, with a cut-off value of 316 ms (sensitivity: 79.4% and specificity: 96.7%). The AUC was largest for J-Tpeak cB (0.848) among J-Tpeak, J-Tpeak cB, and J-Tpeak cF, with a cut-off value of 181 ms (sensitivity: 80.8% and specificity: 91.8%). Early repolarization was found more frequently in the SQTS group than in the control group (67% vs. 23%, P = 0.001). CONCLUSION A QTcB <316 ms, J-Tpeak cB < 181 ms, and the presence of ER may indicate SQTS patients in childhood and adolescence.
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Affiliation(s)
- Hiroshi Suzuki
- Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, 1-754 Asahimachi-dori, Niigata 951-8520, Japan
| | - Minoru Horie
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan
| | - Junichi Ozawa
- Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Niigata 951-8510, Japan
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama 350-1298, Japan
| | - Seiko Ohno
- Center of Epidemiologic Research in Asia, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga 520-2192, Japan.,Department of Bioscience and Genetics, Research Institute, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan
| | - Kenji Hoshino
- Department of Pediatric Cardiology, Saitama Children's Medical Center, 1-2 Shintoshin, Chuo-ku, Saitama 330-8777, Japan
| | - Eiji Ehara
- Department of Pediatric Cardiology, Children's Medical Center, Osaka City General Hospital, 2-13-22 Miyakojima-hondori Miyakojima-ku, Osaka 531-0021, Japan
| | - Kazuhiro Takahashi
- Department of Pediatric Cardiology, Okinawa Nanbu and Children's Medical Center, 118-1 Arakawa, Haebaru-chou, Okinawa 901-1193, Japan
| | - Yoshichika Maeda
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Masao Yoshinaga
- Department of Pediatrics, National Hospital Organization Kagoshima Medical Center, 8-1 Shiroyamacho, Kagoshima 892-0853, Japan
| | - Shigeru Tateno
- Department of Pediatrics, Chiba Kaihin Municipal Hospital, 3-31-1 Isobe, Mihama-ku, Chiba 261-0012, Japan
| | - Junichi Takagi
- Division of Pediatrics, Developmental and Urological-Reproductive Medicine, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake-cho, Miyazaki 889-1692, Japan
| | - Shozaburo Doi
- Department of Pediatrics and Developmental Biology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8510, Japan
| | - Satoshi Hoshina
- Department of Pediatrics, Niigata City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata 950-1197, Japan
| | - Isamu Sato
- Yoikono-shounika-Sato, 1-5-47 Kandoji, Chuuou-ku, Niigata 950-0983, Japan
| | - Taisuke Ishikawa
- Omics Research Center, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan
| | - Naomasa Makita
- Omics Research Center, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka 564-8565, Japan
| | - Masaomi Chinushi
- Graduate School of Health Sciences, Niigata University School of Medicine, 2-746 Asahimachi-dori, Niigata 951-8518, Japan
| | - Kohei Akazawa
- Department of Medical Informatics, Niigata University Medical and Dental Hospital, 1-754 Asahimachi-dori, Niigata 951-8520, Japan
| | - Masami Nagashima
- Aichi Children's Health and Medical Center, 7-426 Morioka-cho, Ohfu, Aichi 474-8710, Japan
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Kim DY, Uhm JS, Kim M, Kim IS, Jin MN, Yu HT, Kim TH, Kim JY, Joung B, Pak HN, Lee MH. Long-term prognosis of short QT interval in Korean patients: a multicenter retrospective cohort study. BMC Cardiovasc Disord 2021; 21:17. [PMID: 33407155 PMCID: PMC7788900 DOI: 10.1186/s12872-020-01824-3] [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: 09/07/2020] [Accepted: 12/14/2020] [Indexed: 12/03/2022] Open
Abstract
Background Short QT syndrome is a rare, inherited channelopathy associated with sudden cardiac arrest (SCA) but the characteristics and prognosis of short QT interval (SQTI) in Korean patients remain unclear. This study aimed to determine the clinical characteristics and outcomes of SQTI in a Korean population. Methods Consecutive patients with SQTI from January 1999 to March 2019 in three university hospitals in South Korea were recruited.
SQTI was defined as a Bazett’s formula-corrected QT interval (QTc) ≤ 340 ms in serial electrocardiograms. Age- and sex-matched patients with a normal QTc and without overt cardiovascular disease were included in a 1:4 ratio. Clinical and ECG features and outcomes were compared between patients with and without SQTI. Results 34 patients with SQTI [age, 23.5 (21–30.5) years; 31 male] were followed up for 4.8 (2.0–7.8) years. Early repolarization, tall T wave, and U wave were significantly more frequent in patients with SQTI than in those without SQTI. QT dispersion [44.0 (28.0–73.0) vs. 20.0 (12.0–35.0) ms, P < 0.001] was significantly wider and heart rate [52.0 (47.0–58.0) vs. 70.0 (62.3–84.0)/min, P < 0.001] was significantly slower in patients with SQTI than in those without. Atrial fibrillation (AF, 11.8% vs. 2.2%, P = 0.030) and ventricular arrhythmia (VA)/SCA (8.7% vs. 0%, P = 0.007) were significantly more frequent in patients with SQTI than in those without. SQTI was significantly associated with AF [odds ratio, 5.911; 95% confidence interval, 1.257–27.808; P = 0.025] and VA/SCA. Conclusions In this subset of Korean population, SQTI was associated with AF and VA/SCA.
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Affiliation(s)
- Dae-Young Kim
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Jae-Sun Uhm
- Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si, Gyunggi-do, Republic of Korea
| | - Min Kim
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - In-Soo Kim
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Moo-Nyun Jin
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea.,Division of Cardiology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Hee Tae Yu
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Jong-Youn Kim
- Division of Cardiology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Moon-Hyoung Lee
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro Seodaemun-gu, Seoul, 03722, Republic of Korea.
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8
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Karadeniz C. Importance of electrocardiographic markers in predicting cardiac events in children. Biomark Med 2020; 14:1679-1689. [PMID: 33336595 DOI: 10.2217/bmm-2020-0391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ECG is a common diagnostic tool in medical practice. Sudden cardiac death (SCD) is a rare but devastating event. The most common cause of SCD in the young is a primary arrhythmic event, which is often produced by malignant ventricular arrhythmia. Several electrocardiographic markers for ventricular repolarization and depolarization have been proposed to predict this arrhythmic risk and SCD in children. Although many of these parameters can easily be used in clinical practice, some of them need specific techniques for interpretation. In this review, we summarized the current knowledge regarding the clinical importance and the ability of these ECG parameters to predict adverse cardiac events in the pediatric population.
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Affiliation(s)
- Cem Karadeniz
- Department of Pediatric Cardiology, Pediatric Arrhythmia & Electrophysiology, School of Medicine, Kâtip Celebi University, Izmir, Turkey
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9
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Fluids und Genetics in der EKG-Diagnostik. Notf Rett Med 2020. [DOI: 10.1007/s10049-020-00731-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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10
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Dewi IP, Dharmadjati BB. Short QT syndrome: The current evidences of diagnosis and management. J Arrhythm 2020; 36:962-966. [PMID: 33335610 PMCID: PMC7733558 DOI: 10.1002/joa3.12439] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 08/29/2020] [Accepted: 09/15/2020] [Indexed: 12/02/2022] Open
Abstract
There are many cardiac arrhythmias and sudden cardiac death (SCD) related to channelopathies or ion channel disorders. Short QT syndrome (SQTS) is an inherited cardiac channelopathy principally caused by defective functioning of both potassium-calcium ion channel that lead to abnormal shortening of QT interval, and an increased risk of ventricular and atrial arrhythmias. Tall T waves in all lead electrocardiogram (ECG), peaked T waves, and narrow-based T waves that are reminiscent of the typical "desert tent" T waves of hyperkalemia are frequently associated with SQTS. Diagnosis is based on patient's family history, evaluation of symptoms (palpitations and cardiac arrest), and 12-lead ECG. It can be time challenging because of the wide range of QT interval in healthy subjects. Implantable cardioverter defibrillator (ICD) is the first-line therapy in SQTS. Quinidine has the potential to be an effective pharmacological therapy for SQTS patients, especially in young children who are not feasible in ICD implantation, because of the ability to prolong QT interval.
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Affiliation(s)
- Ivana P. Dewi
- Faculty of MedicineUniversitas AirlanggaSurabayaIndonesia
- Faculty of MedicineDuta Wacana Christian UniversityYogyakartaIndonesia
- Department of Cardiology and Vascular MedicineDr. Soetomo General HospitalSurabayaIndonesia
| | - Budi B. Dharmadjati
- Faculty of MedicineUniversitas AirlanggaSurabayaIndonesia
- Department of Cardiology and Vascular MedicineDr. Soetomo General HospitalSurabayaIndonesia
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11
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Rabkin SW, Tang JKK. The Short QTc Is a Marker for the Development of Atrial Flutter and Atrial Fibrillation. Cardiol Res Pract 2020; 2020:2858149. [PMID: 33224525 PMCID: PMC7669358 DOI: 10.1155/2020/2858149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 06/23/2020] [Indexed: 11/18/2022] Open
Abstract
A short QT interval has been difficult to define, and there is debate whether it exists outside of an extremely small group of individuals with inherited channelopathies and whether it predicts cardiac arrhythmias. The objective was to identify cases with short QT and their consequences. Our hospital ECG database was screened for cases with a QTc based on the Bazett formula (QTcBZT) of less than 340 ms. The QTc was recalculated using the spline (QTcRBK) formula, which more accurately adjusts for the heart rate and identifies cases based on percentile distribution of the QT interval. The exclusion criteria were presence of bundle branch block, arrhythmias, or electronic pacemakers. An age- and sex-matched cohort was obtained from individuals with normal QT intervals with the same exclusion criteria. There were 28 cases with a short QTc (QTcRBK < 380 ms). The age was 69.6 ± 14.6 years (mean ± SD) (50% males). The QT interval was 305.7 ± 61.1 ms with QTcRBK 308.4 ± 31.4 ms. Subsequent ECGs showed atrial flutter in 21%, atrial fibrillation in 18%, and atrial tachycardia in 4% of cases. Thus, atrial arrhythmias occurred in 43% of cases. This incidence was significantly (p < 0.0001) greater than the incidence of atrial arrhythmias in age- and sex-matched controls. In conclusion, a short QT interval can be readily identified based on the first percentile of the new QTc formula. A short QTc is an important marker for the development of atrial arrhythmias, including atrial flutter and atrial fibrillation, with the former predominating. It should be part of patient assessment and warrants consideration to develop strategies for detection and prevention of atrial arrhythmias.
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Affiliation(s)
- Simon W. Rabkin
- Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Jacky K. K. Tang
- Division of Cardiology, University of British Columbia, Vancouver, Canada
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12
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Abstract
The main inherited cardiac arrhythmias are long QT syndrome, short QT syndrome, catecholaminergic polymorphic ventricular tachycardia and Brugada syndrome. These rare diseases are often the underlying cause of sudden cardiac death in young individuals and result from mutations in several genes encoding ion channels or proteins involved in their regulation. The genetic defects lead to alterations in the ionic currents that determine the morphology and duration of the cardiac action potential, and individuals with these disorders often present with syncope or a life-threatening arrhythmic episode. The diagnosis is based on clinical presentation and history, the characteristics of the electrocardiographic recording at rest and during exercise and genetic analyses. Management relies on pharmacological therapy, mostly β-adrenergic receptor blockers (specifically, propranolol and nadolol) and sodium and transient outward current blockers (such as quinidine), or surgical interventions, including left cardiac sympathetic denervation and implantation of a cardioverter-defibrillator. All these arrhythmias are potentially life-threatening and have substantial negative effects on the quality of life of patients. Future research should focus on the identification of genes associated with the diseases and other risk factors, improved risk stratification and, in particular for Brugada syndrome, effective therapies.
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13
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Iwakami N, Aiba T, Kamakura S, Takaki H, Furukawa TA, Sato T, Sun W, Shishido T, Nishimura K, Yamada-Inoue Y, Nagase S, Shimizu W, Yasuda S, Sugimachi M, Kusano K. Identification of malignant early repolarization pattern by late QRS activity in high-resolution magnetocardiography. Ann Noninvasive Electrocardiol 2020; 25:e12741. [PMID: 31955494 PMCID: PMC7358799 DOI: 10.1111/anec.12741] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 11/28/2019] [Accepted: 12/17/2019] [Indexed: 12/24/2022] Open
Abstract
Background The early repolarization pattern (ERP) in electrocardiography (ECG) has been considered as a risk for ventricular fibrillation (VF), but effective methods for identification of malignant ERP are still required. We investigated whether high spatiotemporal resolution 64‐channel magnetocardiography (MCG) would enable distinction between benign and malignant ERPs. Methods Among all 2,636 subjects who received MCG in our facility, we identified 116 subjects (43 ± 18 years old, 54% male) with inferior and/or lateral ERP in ECG and without structural heart disease, including 13 survivors of VF (ERP‐VF(+)) and 103 with no history of VF (ERP‐VF(−)). We measured the following MCG parameters in a time‐domain waveform of relative current magnitude: (a) QRS duration (MCG‐QRSD), (b) root‐mean‐square of the last 40 ms (MCG‐RMS40), and (c) low amplitude (<10% of maximal) signal duration (MCG‐LAS). Results Compared to ERP‐VF(−), ERP‐VF(+) subjects presented a significantly longer MCG‐QRS (108 ± 24 vs. 91 ± 23 ms, p = .02) and lower MCG‐RMS40 (0.10 ± 0.08 vs. 0.25 ± 0.20, p = .01) but no difference in MCG‐LAS (38 ± 22 vs. 29 ± 23 ms, p = .17). MCG‐QRSD and MCG‐RMS40 showed significantly larger area under the ROC curve compared to J‐peak amplitude in ECG (0.72 and 0.71 vs. 0.50; p = .04 and 0.03). The sensitivity, specificity, and odds ratio for identifying VF(+) based on MCG‐QRSD ≥ 100 ms and MCG‐RMS40 ≤ 0.24 were 69%, 74%, and 6.33 (95% CI, 1.80–22.3), and 92%, 48%, and 10.9 (95% CI, 1.37–86.8), respectively. Conclusion Magnetocardiography is an effective tool to distinguish malignant and benign ERPs.
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Affiliation(s)
- Naotsugu Iwakami
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.,Department of Research Promotion and Management, National Cerebral and Cardiovascular Center, Osaka, Japan.,Department of Health Promotion and Human Behavior, Kyoto University School of Public Health, Kyoto, Japan
| | - Takeshi Aiba
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Shiro Kamakura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Hiroshi Takaki
- Department of Cardiovascular Dynamics, Research Institute, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Toshiaki A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University School of Public Health, Kyoto, Japan
| | - Tosiya Sato
- Department of Biostatistics, Kyoto University School of Public Health, Kyoto, Japan
| | - Wenxu Sun
- Department of Research Promotion and Management, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Toshiaki Shishido
- Department of Research Promotion and Management, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiology Informatics, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yuko Yamada-Inoue
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Satoshi Nagase
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Masaru Sugimachi
- Department of Cardiovascular Dynamics, Research Institute, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
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Pathophysiology of Calcium Mediated Ventricular Arrhythmias and Novel Therapeutic Options with Focus on Gene Therapy. Int J Mol Sci 2019; 20:ijms20215304. [PMID: 31653119 PMCID: PMC6862059 DOI: 10.3390/ijms20215304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 10/16/2019] [Accepted: 10/21/2019] [Indexed: 12/19/2022] Open
Abstract
Cardiac arrhythmias constitute a major health problem with a huge impact on mortality rates and health care costs. Despite ongoing research efforts, the understanding of the molecular mechanisms and processes responsible for arrhythmogenesis remains incomplete. Given the crucial role of Ca2+-handling in action potential generation and cardiac contraction, Ca2+ channels and Ca2+ handling proteins represent promising targets for suppression of ventricular arrhythmias. Accordingly, we report the different roles of Ca2+-handling in the development of congenital as well as acquired ventricular arrhythmia syndromes. We highlight the therapeutic potential of gene therapy as a novel and innovative approach for future arrhythmia therapy. Furthermore, we discuss various promising cellular and mitochondrial targets for therapeutic gene transfer currently under investigation.
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15
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Abstract
The primary electrical disorders are a group of inherited cardiac ventricular arrhythmias that are a major cause of sudden cardiac death in young individuals. Inherited ventricular arrhythmias result from mutations in genes encoding cardiac ion channels or their modulatory subunits. Advances in genetic screening in the past three decades have led to the assembly of large patient cohorts with these disorders. Studies in these patients, as well as in the general population, have striven to define the prevalence of these inherited arrhythmias and the characteristics of patients with different genetic subtypes of the disease. In this Review, we provide a comprehensive update on the epidemiology of inherited ventricular arrhythmias, focusing on natural history, prevalence and patient demographics. In addition, we summarize the various founder populations (groups of individuals with a disease that is caused by a genetic defect inherited from a common ancestor) that have been identified for some of these disorders and which lead to increased prevalence in some geographical regions. To date, although numerous studies have markedly increased our understanding of the epidemiology of these disorders, demographic data, especially from non-Western countries, remain scarce. Furthermore, defining the true prevalence of these disorders remains challenging. International collaboration will undoubtedly accelerate the collection of demographic information and improve the accuracy of prevalence data.
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16
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Hancox JC, Whittaker DG, Zhang H, Stuart AG. Learning from studying very rare cardiac conditions: the example of short QT syndrome. JOURNAL OF CONGENITAL CARDIOLOGY 2019. [DOI: 10.1186/s40949-019-0024-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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17
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Reynard JT, Oshodi OM, Lai JC, Lai RW, Bazoukis G, Fragakis N, Letsas KP, Korantzopoulos P, Liu FZ, Liu T, Xia Y, Tse G, Li CK. Electrocardiographic conduction and repolarization markers associated with sudden cardiac death: moving along the electrocardiography waveform. Minerva Cardioangiol 2019; 67:131-144. [PMID: 30260143 DOI: 10.23736/s0026-4725.18.04775-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
The QT interval along with its heart rate corrected form (QTc) are well-established ECG markers that have been found to be associated with malignant ventricular arrhythmogenesis. However, extensive preclinical and clinical investigations over the years have allowed for novel clinical ECG markers to be generated as predictors of arrhythmogenesis and sudden cardiac death. Repolarization markers include the older QTc, QT dispersion and newer Tpeak - Tend intervals, (Tpeak - Tend) / QT ratios, T-wave alternans (TWA), microvolt TWA and T-wave area dispersion. Meanwhile, conduction markers dissecting the QRS complex, such as QRS dispersion (QRSD) and fragmented QRS, were also found to correlate conduction velocity and unidirectional block with re-entrant substrates in various cardiac conditions. Both repolarization and conduction parameters can be combined into the excitation wavelength (λ). A surrogate marker for λ is the index of Cardiac Electrophysiological Balance (iCEB: QT / QRSd). Other markers based on conduction-repolarization are [QRSD x (Tpeak-Tend) / QRSd] and [QRSD x (Tpeak-Tend) / (QRSd x QT)]. Advancement in technology permitted sophisticated electrophysiological analyses such as principal component analysis and periodic repolarization dynamics to further improve risk stratification. This was closely followed by other novel indices including ventricular ectopic QRS interval, the f99 index and EntropyXQT, which integrates mathematical and physical calculations for determining the risk markers. Though proven to be effective in limited patient cohorts, more clinical studies across different cardiac pathologies are required to confirm their validity. As such, this review seeks to encapsulate the development of old and new ECG markers along with their associated utility and shortcomings in clinical practice.
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Affiliation(s)
- Jack T Reynard
- Faculty of Medicine, Newcastle University, Newcastle Upon Tyne, UK
| | | | - Jenny C Lai
- Faculty of Medicine, Li Ka Shing Institute of Health Sciences, Chinese University of Hong Kong, Hong Kong, China
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Rachel W Lai
- Faculty of Medicine, Li Ka Shing Institute of Health Sciences, Chinese University of Hong Kong, Hong Kong, China
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - George Bazoukis
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Nikolaos Fragakis
- Third Department of Cardiology, Hippokration Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
- First Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece
| | - Konstantinos P Letsas
- Laboratory of Cardiac Electrophysiology, Second Department of Cardiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Panagiotis Korantzopoulos
- Third Department of Cardiology, Hippokration Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
- First Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece
| | - Fang-Zhou Liu
- Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong General Hospital affiliated to South China University of Technology, Guangzhou, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Yunlong Xia
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Gary Tse
- Faculty of Medicine, Li Ka Shing Institute of Health Sciences, Chinese University of Hong Kong, Hong Kong, China
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
| | - Christien K Li
- Faculty of Medicine, Newcastle University, Newcastle Upon Tyne, UK -
- Faculty of Medicine, Li Ka Shing Institute of Health Sciences, Chinese University of Hong Kong, Hong Kong, China
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, China
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Hasegawa Y, Watanabe H, Ikami Y, Otsuki S, Iijima K, Yagihara N, Sato A, Izumi D, Minamino T. Early repolarization and risk of lone atrial fibrillation. J Cardiovasc Electrophysiol 2019; 30:565-568. [PMID: 30661277 DOI: 10.1111/jce.13848] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 01/10/2019] [Accepted: 01/13/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Early repolarization syndrome is a recently proposed condition characterized by an early repolarization pattern in the electrocardiogram (ECG) and ventricular fibrillation in the absence of structural heart abnormalities. Although some studies have suggested that early repolarization is associated with frequency of atrial fibrillation, the association of early repolarization with atrial fibrillation is not well known. HYPOTHESIS Early repolarization indicates the substrate for atrial fibrillation in addition to that for ventricular fibrillation. METHOD This study included 79 patients (57 men [72%]; age, 45 ± 12 years) aged less than 60 years who had paroxysmal lone atrial fibrillation and 395 age- and sex-matched healthy controls (patient:control ratio, 1:5). Patients who had structural heart disease, hypertension, diabetes, hyperthyroidism, history of successful resuscitation, or the Brugada type ECG were excluded. ECGs recorded during sinus rhythm were compared between patients with atrial fibrillation and healthy controls. RESULTS Early repolarization in the inferior and/or lateral leads was more common in patients with atrial fibrillation (25%) than controls (10%; P = 0.001). The location and magnitude of early repolarization were similar between the two groups. Other electrocardiographic measurements were not different between the two groups. Among patients with atrial fibrillation, there was no difference in clinical characteristics including age at atrial fibrillation development, sex, and body mass index between patients with early repolarization and those without early repolarization. Electrocardiographic measurements were not different between patients with early repolarization and those without early repolarization. CONCLUSION Early repolarization was associated with lone atrial fibrillation. Early repolarization may indicate increased susceptibility to atrial fibrillation.
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Affiliation(s)
- Yuki Hasegawa
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Hiroshi Watanabe
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yasuhiro Ikami
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Sou Otsuki
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Kenichi Iijima
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Nobue Yagihara
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Akinori Sato
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Daisuke Izumi
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Durak A, Olgar Y, Degirmenci S, Akkus E, Tuncay E, Turan B. A SGLT2 inhibitor dapagliflozin suppresses prolonged ventricular-repolarization through augmentation of mitochondrial function in insulin-resistant metabolic syndrome rats. Cardiovasc Diabetol 2018; 17:144. [PMID: 30447687 PMCID: PMC6240275 DOI: 10.1186/s12933-018-0790-0] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 11/14/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Metabolic syndrome (MetS) is a prevalent risk factor for cardiac dysfunction. Although SGLT2-inhibitors have important cardioprotective effects in hyperglycemia, their underlying mechanisms are complex and not completely understood. Therefore, we examined mechanisms of a SGLT2-inhibitor dapagliflozin (DAPA)-related cardioprotection in overweight insulin-resistant MetS-rats comparison with insulin (INSU), behind its glucose-lowering effect. METHODS A 28-week high-carbohydrate diet-induced MetS-rats received DAPA (5 mg/kg), INSU (0.15 mg/kg) or vehicle for 2 weeks. To validate MetS-induction, we monitored all animals weekly by measuring body weight, blood glucose and HOMO-IR index, electrocardiograms, heart rate, systolic and diastolic pressures. RESULTS DAPA-treatment of MetS-rats significantly augmented the increased blood pressure, prolonged Q-R interval, and low heart rate with depressed left ventricular function and relaxation of the aorta. Prolonged-action potentials were preserved with DAPA-treatment, more prominently than INSU-treatment, at most, through the augmentation in depressed voltage-gated K+-channel currents. DAPA, more prominently than INSU-treatment, preserved the depolarized mitochondrial membrane potential, and altered mitochondrial protein levels such as Mfn-1, Mfn-2, and Fis-1 as well as provided significant augmentation in cytosolic Ca2+-homeostasis. Furthermore, DAPA also induced significant augmentation in voltage-gated Na+-currents and intracellular pH, and the cellular levels of increased oxidative stress, protein-thiol oxidation and ADP/ATP ratio in cardiomyocytes from MetS rats. Moreover, DAPA-treatment normalized the increases in the mRNA level of SGLT2 in MetS-rat heart. CONCLUSIONS Overall, our data provided a new insight into DAPA-associated cardioprotection in MetS rats, including suppression of prolonged ventricular-repolarization through augmentation of mitochondrial function and oxidative stress followed by improvement of fusion-fission proteins, out of its glucose-lowering effect.
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Affiliation(s)
- Aysegul Durak
- Departments of Biophysics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Yusuf Olgar
- Departments of Biophysics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Sinan Degirmenci
- Departments of Biophysics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Erman Akkus
- Internal Medicine, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Erkan Tuncay
- Departments of Biophysics, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Belma Turan
- Departments of Biophysics, Faculty of Medicine, Ankara University, Ankara, Turkey.
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Di Stolfo G, Palumbo P, Castellana S, Mastroianno S, Biagini T, Palumbo O, Leone MP, De Luca G, Potenza DR, Mazza T, Russo AA, Carella M. Sudden cardiac death in J wave syndrome with short QT associated to a novel mutation in Nav 1.8 coding gene SCN10A: First case report for a possible pharmacogenomic role. J Electrocardiol 2018; 51:809-813. [DOI: 10.1016/j.jelectrocard.2018.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 06/08/2018] [Indexed: 11/16/2022]
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21
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Sugrue A, Rohatgi RK, Bos M, Vaidya VR, Asirvatham SJ, Noseworthy PA, Ackerman MJ. Clinical Significance of Early Repolarization in Long QT Syndrome. JACC Clin Electrophysiol 2018; 4:1238-1244. [DOI: 10.1016/j.jacep.2018.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 05/30/2018] [Accepted: 06/07/2018] [Indexed: 11/16/2022]
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22
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Gula LJ, Roberts JD. Early Repolarization in Long QT Syndrome. JACC Clin Electrophysiol 2018; 4:1245-1247. [DOI: 10.1016/j.jacep.2018.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 07/06/2018] [Indexed: 10/28/2022]
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Kimura Y, Yamada M, Hanada K, Endo T, Narita N, Narita M, Senoo M, Yonekura M, Ichikawa H, Kurauchi S, Nakaji S, Okumura K, Tomita H. Relationship Between Serum Eicosapentaenoic Acid Levels and J-Waves in a General Population in Japan. Int Heart J 2018; 59:736-740. [DOI: 10.1536/ihj.17-434] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Yoshihiro Kimura
- Department of Cardiology, Hirosaki University Graduate School of Medicine
| | - Masahiro Yamada
- Department of Cardiology, Hirosaki University Graduate School of Medicine
| | - Kenji Hanada
- Department of Cardiology, Hirosaki University Graduate School of Medicine
| | - Tomohide Endo
- Department of Cardiology, Hirosaki University Graduate School of Medicine
| | - Noritomo Narita
- Department of Cardiology, Hirosaki University Graduate School of Medicine
| | - Masato Narita
- Department of Cardiology, Hirosaki University Graduate School of Medicine
| | - Maiko Senoo
- Department of Cardiology, Hirosaki University Graduate School of Medicine
| | - Manabu Yonekura
- Department of Cardiology, Hirosaki University Graduate School of Medicine
| | - Hiroaki Ichikawa
- Department of Cardiology, Hirosaki University Graduate School of Medicine
| | - Shizuka Kurauchi
- Department of Social Medicine, Hirosaki University Graduate School of Medicine
| | - Shigeyuki Nakaji
- Department of Social Medicine, Hirosaki University Graduate School of Medicine
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital
| | - Hirofumi Tomita
- Department of Cardiology, Hirosaki University Graduate School of Medicine
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25
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Abstract
Early repolarization, Brugada syndrome, and pathologic J waves have been described for decades, but only recently experimental and clinical data have allowed reconciliation of Brugada and Early Repolarization under the common definition of J-wave syndromes. The concept was derived from studies showing, in both conditions, the presence of transmural dispersion of repolarization, localized conduction abnormalities, and abnormal transition between QRS and ST segment on electrocardiogram. Although several clinical studies have addressed the clinical presentation and epidemiology of J-wave syndromes, relevant knowledge gaps exist. Incomplete pathophysiologic understanding and uncertain electrocardiographic definitions limit effective risk stratification. Here, we review the current knowledge and recommendations for diagnosis and clinical management of these arrhythmogenic disorders.
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Affiliation(s)
- Silvia G Priori
- Molecular Cardiology, ICS Maugeri, IRCCS, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Pavia, Italy.
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26
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Hancox JC, Whittaker DG, Du C, Stuart AG, Zhang H. Emerging therapeutic targets in the short QT syndrome. Expert Opin Ther Targets 2018; 22:439-451. [DOI: 10.1080/14728222.2018.1470621] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Jules C Hancox
- School of Physiology, Pharmacology and Neuroscience, Medical Sciences Building, University Walk, Bristol, United Kingdom
- Biological Physics Group, School of Physics and Astronomy, University of Manchester, Manchester, United Kingdom
| | - Dominic G Whittaker
- Biological Physics Group, School of Physics and Astronomy, University of Manchester, Manchester, United Kingdom
- School of Biomedical Sciences, University of Leeds, Leeds, United Kingdom
| | - Chunyun Du
- School of Physiology, Pharmacology and Neuroscience, Medical Sciences Building, University Walk, Bristol, United Kingdom
| | - A. Graham Stuart
- Cardiology, Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Henggui Zhang
- Biological Physics Group, School of Physics and Astronomy, University of Manchester, Manchester, United Kingdom
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27
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Tse G, Yan BP. Traditional and novel electrocardiographic conduction and repolarization markers of sudden cardiac death. Europace 2018; 19:712-721. [PMID: 27702850 DOI: 10.1093/europace/euw280] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 08/11/2016] [Indexed: 12/20/2022] Open
Abstract
Sudden cardiac death, frequently due to ventricular arrhythmias, is a significant problem globally. Most affected individuals do not arrive at hospital in time for medical treatment. Therefore, there is an urgent need to identify the most-at-risk patients for insertion of prophylactic implantable cardioverter defibrillators. Clinical risk markers derived from electrocardiography are important for this purpose. They can be based on repolarization, including corrected QT (QTc) interval, QT dispersion (QTD), interval from the peak to the end of the T-wave (Tpeak - Tend), (Tpeak - Tend)/QT, T-wave alternans (TWA), and microvolt TWA. Abnormal repolarization properties can increase the risk of triggered activity and re-entrant arrhythmias. Other risk markers are based solely on conduction, such as QRS duration (QRSd), which is a surrogate marker of conduction velocity (CV) and QRS dispersion (QRSD) reflecting CV dispersion. Conduction abnormalities in the form of reduced CV, unidirectional block, together with a functional or a structural obstacle, are conditions required for circus-type or spiral wave re-entry. Conduction and repolarization can be represented by a single parameter, excitation wavelength (λ = CV × effective refractory period). λ is an important determinant of arrhythmogenesis in different settings. Novel conduction-repolarization markers incorporating λ include Lu et al.' index of cardiac electrophysiological balance (iCEB: QT/QRSd), [QRSD× (Tpeak - Tend)/QRSd] and [QRSD × (Tpeak - Tend)/(QRSd × QT)] recently proposed by Tse and Yan. The aim of this review is to provide up to date information on traditional and novel markers and discuss their utility and downfalls for risk stratification.
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Affiliation(s)
- Gary Tse
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, SAR, P.R. China
| | - Bryan P Yan
- Department of Medicine and Therapeutics, Chinese University of Hong Kong, Hong Kong, SAR, P.R. China.,Department of Epidemiology and Preventive Medicine, Monash University, Clayton, VIC, Australia
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Meta-analysis of T peak-T end and T peak-T end/QT ratio for risk stratification in congenital long QT syndrome. J Electrocardiol 2018; 51:396-401. [PMID: 29550106 DOI: 10.1016/j.jelectrocard.2018.03.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 02/13/2018] [Accepted: 03/06/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND OBJECTIVES Congenital long QT syndrome (LQTS) predisposes affected individuals to ventricular tachycardia/fibrillation (VF/VF), potentially resulting in sudden cardiac death. The Tpeak-Tend interval and the Tpeak-Tend/QT ratio, electrocardiographic markers of dispersion of ventricular repolarization, were proposed for risk stratification but their predictive values in LQTS have been controversial. A systematic review and meta-analysis was conducted to examine the value of Tpeak-Tend intervals and Tpeak-Tend/QT ratios in predicting arrhythmic and mortality outcomes in congenital LQTS. METHOD PubMed and Embase databases were searched until 9th May 2017, identifying 199 studies. RESULTS Five studies on long QT syndrome were included in the final meta-analysis. Tpeak-Tend intervals were longer (mean difference [MD]: 13ms, standard error [SE]: 4ms, P=0.002; I2=34%) in congenital LQTS patients with adverse events [syncope, ventricular arrhythmias or sudden cardiac death] compared to LQTS patients without such events. By contrast, Tpeak-Tend/QT ratios were not significantly different between the two groups (MD: 0.02, SE: 0.02, P=0.26; I2=0%). CONCLUSION This meta-analysis showed that Tpeak-Tend interval is significant higher in individuals who are at elevated risk of adverse events in congenital LQTS, offering incremental value for risk stratification.
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Kalinauskiene E, Jucevicius J, Vencloviene J, Jankauskas A, Navickaite I, Naudziunas A. Early repolarization with a constant ST-segment elevation in leads II, III, and AVF: Heritability and follow-up results. HEART AND MIND 2018. [DOI: 10.4103/hm.hm_6_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Marzlin KM. Early Repolarization: From Benign Variant to Marker of Risk. AACN Adv Crit Care 2017; 28:297-300. [DOI: 10.4037/aacnacc2017383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Karen M. Marzlin
- Karen M. Marzlin is Cardiology APRN, Aultman Hospital, Canton, Ohio, and Business Owner/Author/Educator/Consultant, Key Choice/Cardiovascular Nursing Education Associates, 4565 Venus Rd, Uniontown, OH 44685
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In silico investigation of a KCNQ1 mutation associated with short QT syndrome. Sci Rep 2017; 7:8469. [PMID: 28814790 PMCID: PMC5559555 DOI: 10.1038/s41598-017-08367-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 07/11/2017] [Indexed: 11/08/2022] Open
Abstract
Short QT syndrome (SQTS) is a rare condition characterized by abnormally 'short' QT intervals on the ECG and increased susceptibility to cardiac arrhythmias and sudden death. This simulation study investigated arrhythmia dynamics in multi-scale human ventricle models associated with the SQT2-related V307L KCNQ1 'gain-of-function' mutation, which increases slow-delayed rectifier potassium current (IKs). A Markov chain (MC) model recapitulating wild type (WT) and V307L mutant IKs kinetics was incorporated into a model of the human ventricular action potential (AP) for investigation of QT interval changes and arrhythmia substrates. In addition, the degree of simulated IKs inhibition necessary to normalize the QT interval and terminate re-entry in SQT2 conditions was quantified. The developed MC model accurately reproduced AP shortening and reduced effective refractory period associated with altered IKs kinetics in homozygous (V307L) and heterozygous (WT-V307L) mutation conditions, which increased the lifespan and dominant frequency of re-entry in 3D human ventricle models. IKs reductions of 58% and 65% were sufficient to terminate re-entry in WT-V307L and V307L conditions, respectively. This study further substantiates a causal link between the V307L KCNQ1 mutation and pro-arrhythmia in human ventricles, and establishes partial inhibition of IKs as a potential anti-arrhythmic strategy in SQT2.
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Hu D, Li Y, Zhang J, Pfeiffer R, Gollob MH, Healey J, Harrell DT, Makita N, Abe H, Sun Y, Guo J, Zhang L, Yan G, Mah D, Walsh EP, Leopold HB, Giustetto C, Gaita F, Zienciuk-Krajka A, Mazzanti A, Priori SG, Antzelevitch C, Barajas-Martinez H. The Phenotypic Spectrum of a Mutation Hotspot Responsible for the Short QT Syndrome. JACC Clin Electrophysiol 2017; 3:727-743. [DOI: 10.1016/j.jacep.2016.11.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 11/18/2016] [Accepted: 11/22/2016] [Indexed: 10/20/2022]
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Mazzanti A, Underwood K, Nevelev D, Kofman S, Priori SG. The new kids on the block of arrhythmogenic disorders: Short QT syndrome and early repolarization. J Cardiovasc Electrophysiol 2017; 28:1226-1236. [PMID: 28569435 DOI: 10.1111/jce.13265] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 05/10/2017] [Accepted: 05/25/2017] [Indexed: 12/20/2022]
Abstract
Short QT syndrome (SQTS) is one of the rarest inheritable cardiac channelopathies, characterized by an accelerated cardiac repolarization, which is also the substrate for the development of life-threatening ventricular arrhythmias. Up to this date, fewer than 200 SQTS cases have been reported in the literature worldwide. Patients with SQTS may experience a cardiac arrest as early as in the neonatal period or as late as 80 years old. The cumulative probability of experiencing a cardiac arrest by the fifth decade of life approaches 40%, highlighting the importance of early recognition and management. SQTS is an autosomal dominant disease with five identified causative genes, including three that encode for potassium channels (KCNH2, KCNQ1, and KCNJ2) and two that encode for subunits of the L-type calcium channels (CACNA1C and CACNB2). The term "early repolarization" (ER) has long been used to refer to a heterogeneous group of specific QRS-T junction patterns that are commonly found on the electrocardiograms of young healthy subjects. In the last decade, it has been suggested that in some individuals, the presence of ER may be associated with an increased risk of sudden cardiac death, and thus the term "early repolarization syndrome" (ERS) has progressively entered into use. Up to this point, however, whether ER constitutes a true primary arrhythmic disorder or whether it is simply a predisposing substrate that facilitates arrhythmias in the presence of other triggers remains an unresolved issue. In this review paper, we aim to integrate the current literature on SQTS and ERS. For each, we will describe the key steps that first led to the identification of the syndrome before moving into a discussion of our current understanding of each entity, including the epidemiology, genetics, diagnosis, clinical manifestations, and management.
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Affiliation(s)
| | | | | | - Shanna Kofman
- Molecular Cardiology, IRCCS ICS Maugeri, Pavia, Italy
| | - Silvia G Priori
- Molecular Cardiology, IRCCS ICS Maugeri, Pavia, Italy.,Department of Molecular Medicine, University of Pavia, Pavia, Italy.,Fundación Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
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Braschi A, Abrignani MG, Francavilla VC, Abrignani V, Francavilla G. Age- and sex-based reference ranges for non-invasive ventricular repolarisation parameters. Int J Clin Pract 2017; 71. [PMID: 28508456 DOI: 10.1111/ijcp.12949] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 03/12/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Some electrocardiographic parameters are able to assess indirectly ventricular repolarisation homogeneity. It is consequently essential to discriminate between normal and abnormal values in clinical decision-making. Considering there is still not a consensus about normal cut-off values, the aim of this study was to document reference intervals in all age groups of a healthy population, providing for age- and sex-percentile tables, which can be used easily and quickly in clinical practice. METHODS We evaluated repolarisation markers in 606 sex-matched participants aged 1 day-94 years. Each subject underwent a 12-lead electrocardiogram at rest, and the following parameters were measured: QT, corrected QT, QTpeak, Tpeak-Tend, Tpeak-Tend dispersion, Tpeak-Tend/QT and QTpeak/QT ratio. RESULTS A relationship was demonstrated between age and QTpeak, Tpeak-Tend, QT and QTc. In children, QTpeak, Tpeak-Tend and QT intervals increased linearly with age. In adolescents, all the three parameters remained stable. In adults, QTpeak and QT showed a further significant increase. On the contrary, Tpeak-Tend interval was longer in adults aged between 20 and 64 years than in participants aged 65 years or over, but the difference was not statistically significant. Male vs female participants showed longer Tpeak-Tend intervals; this sex difference was not statistically significant at birth and during childhood, whereas it was in adolescents and in adults. CONCLUSIONS Repolarisation parameters showed age- and sex-based variations, which are important to know to differentiate normal from pathological values.
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Affiliation(s)
- Annabella Braschi
- Department of Internal and Specialistic Medicine, Palermo University Hospital, Palermo, Italy
| | | | - Vincenzo C Francavilla
- Department of Internal and Specialistic Medicine, Palermo University Hospital, Palermo, Italy
| | | | - Giuseppe Francavilla
- Department of Internal and Specialistic Medicine, Palermo University Hospital, Palermo, Italy
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Chen Y, Barajas-Martinez H, Zhu D, Wang X, Chen C, Zhuang R, Shi J, Wu X, Tao Y, Jin W, Wang X, Hu D. Novel trigenic CACNA1C/DES/MYPN mutations in a family of hypertrophic cardiomyopathy with early repolarization and short QT syndrome. J Transl Med 2017; 15:78. [PMID: 28427417 PMCID: PMC5399316 DOI: 10.1186/s12967-017-1180-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 04/10/2017] [Indexed: 01/12/2023] Open
Abstract
Background Hypertrophic cardiomyopathy (HCM) patients with early repolarization (ER) pattern are at higher risk of ventricular arrhythmia, yet the genetic background of this situation has not been well investigated. Here we report novel trigenic mutations detected in a Chinese family of obstructive HCM with ER and short QT syndrome (SQTS). Methods Proband and family members underwent detailed medical assessments. DNAs were extracted from peripheral blood leukocytes for genetic screening with next generation method. The functional characterization of the mutation was conducted in TSA201 cells with patch-clamp experiment. Results The proband was a 52-year-old male who had a ER pattern ECG in inferioral-lateral leads with atrioventricular block and QTc of 356 ms. He also suffered from severe left ventricular hypertrophy and dysfunction. Targeted sequencing revealed trigenic mutations: c.700G>A/p.E234K in DES, c.2966G>A/p.R989H in MYPN, and c.5918G>C/p.R1973P in CACNA1C. All mutations were also detected in his daughter with ER and mild myocardium hypertrophy. The CACNA1C-R1973P mutation caused significant reduction (68.4%) of ICa compared to CACNA1C-WT (n = 14 and 14, P < 0.05). The computer modeling showed that all 3 mutations were highly disease-causing. The proband received the CRT-D (cardiac resynchronizing therapy) implantation, which lowered the left ventricular outflow tract gradient (LVOTG, 124 mmHg pre vs. 27 mmHg post) and restored the LV function (LVEF 40% pre vs. 63% post). Conclusions The study reveals a novel CACNA1C mutation underlying the unique ER pattern ECGs with SQTS. It also shows the rare trigenic mutations are the pathogenic substrates for the complicated clinical manifestation in HCM patients. Electronic supplementary material The online version of this article (doi:10.1186/s12967-017-1180-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yanhong Chen
- Department of Cardiology, Wuhan Asia Heart Hospital, Wuhan University, Wuhan, 430022, China.,Department of Cardiology, Nantong University, 3rd People's Hospital of Wuxi Affiliated To Nantong University, 585 Xingyuan Road, Wuxi, 214043, Jiangsu, China
| | | | - Dongxiao Zhu
- Department of Cardiology, Nantong University, 3rd People's Hospital of Wuxi Affiliated To Nantong University, 585 Xingyuan Road, Wuxi, 214043, Jiangsu, China
| | - Xihui Wang
- Department of Cardiology, Nantong University, 3rd People's Hospital of Wuxi Affiliated To Nantong University, 585 Xingyuan Road, Wuxi, 214043, Jiangsu, China
| | - Chonghao Chen
- Department of Cardiology, Nantong University, 3rd People's Hospital of Wuxi Affiliated To Nantong University, 585 Xingyuan Road, Wuxi, 214043, Jiangsu, China
| | - Ruijuan Zhuang
- Department of Cardiology, Nantong University, 3rd People's Hospital of Wuxi Affiliated To Nantong University, 585 Xingyuan Road, Wuxi, 214043, Jiangsu, China
| | - Jingjing Shi
- Department of Cardiology, Nantong University, 3rd People's Hospital of Wuxi Affiliated To Nantong University, 585 Xingyuan Road, Wuxi, 214043, Jiangsu, China
| | - Xueming Wu
- Department of Cardiology, Nantong University, 3rd People's Hospital of Wuxi Affiliated To Nantong University, 585 Xingyuan Road, Wuxi, 214043, Jiangsu, China
| | - Yijia Tao
- Department of Cardiology, Nantong University, 3rd People's Hospital of Wuxi Affiliated To Nantong University, 585 Xingyuan Road, Wuxi, 214043, Jiangsu, China
| | - Weidong Jin
- Department of Cardiology, Nantong University, 3rd People's Hospital of Wuxi Affiliated To Nantong University, 585 Xingyuan Road, Wuxi, 214043, Jiangsu, China
| | - Xiaoyan Wang
- Department of Cardiology, Nantong University, 3rd People's Hospital of Wuxi Affiliated To Nantong University, 585 Xingyuan Road, Wuxi, 214043, Jiangsu, China.
| | - Dan Hu
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, 430060, China. .,Masonic Medical Research Laboratory, 2150 Bleecker St, Utica, NY, 13501, USA. .,Molecular Genetics Department, SCRO Chair of Stem Cell Center, Masonic Medical Research Laboratory, 2150 Bleecker St, Utica, NY, 13501, USA.
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36
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Antzelevitch C, Yan GX, Ackerman MJ, Borggrefe M, Corrado D, Guo J, Gussak I, Hasdemir C, Horie M, Huikuri H, Ma C, Morita H, Nam GB, Sacher F, Shimizu W, Viskin S, Wilde AA. J-Wave syndromes expert consensus conference report: Emerging concepts and gaps in knowledge. Europace 2017; 19:665-694. [PMID: 28431071 PMCID: PMC5834028 DOI: 10.1093/europace/euw235] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
| | - Gan-Xin Yan
- Lankenau Medical Center, Wynnewood, Pennsylvania
| | - Michael J. Ackerman
- Departments of Cardiovascular Diseases, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics, Divisions of Heart Rhythm Services and Pediatric Cardiology, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester,Minnesota
| | - Martin Borggrefe
- 1st Department of Medicine–Cardiology, University Medical Centre Mannheim, and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Jihong Guo
- Division of Cardiology, Peking University of People's Hospital, Beijing, China
| | - Ihor Gussak
- Rutgers University, New Brunswick, New Jersey
| | - Can Hasdemir
- Department of Cardiology, Ege University School of Medicine, Izmir, Turkey
| | - Minoru Horie
- Shiga University of Medical Sciences, Ohtsu, Shiga, Japan
| | - Heikki Huikuri
- Research Unit of Internal Medicine, Medical Research Center, Oulu University Hospital, and University of Oulu, Oulu, Finland
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Hiroshi Morita
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Gi-Byoung Nam
- Heart Institute, Asan Medical Center, and Department of Internal Medicine, University of Ulsan College of Medicine Seoul, Seoul, Korea
| | - Frederic Sacher
- Bordeaux University Hospital, LIRYC Institute/INSERM 1045, Bordeaux, France
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Sami Viskin
- Tel-Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arthur A.M. Wilde
- Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center, University of Amsterdam, the Netherlands and Princess Al-Jawhara Al-Brahim Centre of Excellence in Research of Hereditary Disorders, Jeddah, Kingdom of Saudi Arabia
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Abstract
Short QT syndrome is a malignant cardiac disease characterized by the presence of ventricular tachyarrhythmias leading to syncope and sudden cardiac death. Currently, international guidelines establish diagnostic criteria when QTc is below 340 ms. This entity is one of the main diseases responsible for sudden cardiac death in the pediatric population. In recent years, clinical, genetic and molecular advances in pathophysiological mechanisms related to short QT syndrome have improved diagnosis, risk stratification, and preventive measures. Despite these advances, automatic implantable cardiac defibrillator remains the most effective measure. Currently, six genes have been associated with short QT syndrome, which account for nearly 60% of clinically diagnosed families. Here, we review the main clinical hallmarks of the disease, focusing on the pediatric population.
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Hasegawa K, Watanabe H, Hisamatsu T, Ohno S, Itoh H, Ashihara T, Hayashi H, Makiyama T, Minamino T, Horie M. Early repolarization and risk of arrhythmia events in long QT syndrome. Int J Cardiol 2016; 223:540-542. [DOI: 10.1016/j.ijcard.2016.08.215] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 08/11/2016] [Indexed: 11/24/2022]
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39
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Antzelevitch C, Yan GX, Ackerman MJ, Borggrefe M, Corrado D, Guo J, Gussak I, Hasdemir C, Horie M, Huikuri H, Ma C, Morita H, Nam GB, Sacher F, Shimizu W, Viskin S, Wilde AA. J-Wave syndromes expert consensus conference report: Emerging concepts and gaps in knowledge. J Arrhythm 2016; 32:315-339. [PMID: 27761155 PMCID: PMC5063270 DOI: 10.1016/j.joa.2016.07.002] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
| | - Gan-Xin Yan
- Lankenau Medical Center, Wynnewood, PA, United States
| | - Michael J. Ackerman
- Departments of Cardiovascular Diseases, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics, Divisions of Heart Rhythm Services and Pediatric Cardiology, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN, United States
| | - Martin Borggrefe
- 1st Department of Medicine–Cardiology, University Medical Centre Mannheim, and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Jihong Guo
- Division of Cardiology, Peking University of People׳s Hospital, Beijing, China
| | - Ihor Gussak
- Rutgers University, New Brunswick, NJ, United States
| | - Can Hasdemir
- Department of Cardiology, Ege University School of Medicine, Izmir, Turkey
| | - Minoru Horie
- Shiga University of Medical Sciences, Ohtsu, Shiga, Japan
| | - Heikki Huikuri
- Research Unit of Internal Medicine, Medical Research Center, Oulu University Hospital, and University of Oulu, Oulu, Finland
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Hiroshi Morita
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Gi-Byoung Nam
- Heart Institute, Asian Medical Center, and Department of Internal Medicine, University of Ulsan College of Medicine Seoul, Seoul, South Korea
| | - Frederic Sacher
- Bordeaux University Hospital, LIRYC Institute/INSERM 1045, Bordeaux, France
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Sami Viskin
- Tel-Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arthur A.M. Wilde
- Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center, University of Amsterdam, The Netherlands
- Jawhara Al-Brahim Centre of Excellence in Research of Hereditary Disorders, Jeddah, Saudi Arabia
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40
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Antzelevitch C, Yan GX, Ackerman MJ, Borggrefe M, Corrado D, Guo J, Gussak I, Hasdemir C, Horie M, Huikuri H, Ma C, Morita H, Nam GB, Sacher F, Shimizu W, Viskin S, Wilde AAM. J-Wave syndromes expert consensus conference report: Emerging concepts and gaps in knowledge. Heart Rhythm 2016; 13:e295-324. [PMID: 27423412 PMCID: PMC5035208 DOI: 10.1016/j.hrthm.2016.05.024] [Citation(s) in RCA: 226] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Indexed: 12/16/2022]
Affiliation(s)
| | - Gan-Xin Yan
- Lankenau Medical Center, Wynnewood, Pennsylvania
| | - Michael J Ackerman
- Departments of Cardiovascular Diseases, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics, Divisions of Heart Rhythm Services and Pediatric Cardiology, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester,Minnesota
| | - Martin Borggrefe
- 1st Department of Medicine-Cardiology, University Medical Centre Mannheim, and DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Mannheim, Germany
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Jihong Guo
- Division of Cardiology, Peking University of People's Hospital, Beijing, China
| | - Ihor Gussak
- Rutgers University, New Brunswick, New Jersey
| | - Can Hasdemir
- Department of Cardiology, Ege University School of Medicine, Izmir, Turkey
| | - Minoru Horie
- Shiga University of Medical Sciences, Ohtsu, Shiga, Japan
| | - Heikki Huikuri
- Research Unit of Internal Medicine, Medical Research Center, Oulu University Hospital, and University of Oulu, Oulu, Finland
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Hiroshi Morita
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Gi-Byoung Nam
- Heart Institute, Asan Medical Center, and Department of Internal Medicine, University of Ulsan College of Medicine Seoul, Seoul, Korea
| | - Frederic Sacher
- Bordeaux University Hospital, LIRYC Institute/INSERM 1045, Bordeaux, France
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Sami Viskin
- Tel-Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Arthur A M Wilde
- Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center, University of Amsterdam, the Netherlands and Princess Al-Jawhara Al-Brahim Centre of Excellence in Research of Hereditary Disorders, Jeddah, Kingdom of Saudi Arabia
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41
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Naruse Y, Nogami A, Shinoda Y, Hanaki Y, Shirai Y, Kowase S, Kurosaki K, Machino T, Kuroki K, Yamasaki H, Igarashi M, Sekiguchi Y, Aonuma K. J Waves Are Associated With the Increased Occurrence of Life-Threatening Ventricular Tachyarrhythmia in Patients With Nonischemic Cardiomyopathy. J Cardiovasc Electrophysiol 2016; 27:1448-1453. [PMID: 27593399 DOI: 10.1111/jce.13096] [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: 05/17/2016] [Revised: 08/25/2016] [Accepted: 08/29/2016] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Recent studies showed that J waves were associated with higher incidence of ventricular tachyarrhythmia (VT/VF) in patients with idiopathic ventricular fibrillation (VF) and myocardial infarction. We sought to assess the association between J waves and VT/VF in patients with nonischemic cardiomyopathy (NICM). METHODS AND RESULTS We retrospectively enrolled 109 patients (79 men; mean age, 60 ± 15 years) with NICM who underwent implantable cardioverter defibrillator (ICD) implantation. The primary endpoint of this study was the occurrence of appropriate device therapy due to sustained VT/VF. The J wave was electrocardiographically defined as an elevation of the terminal portion of the QRS complex of >0.1 mV in at least 2 contiguous inferior or lateral leads. Among the 109 patients, 37 (34%) experienced an episode of appropriate device therapy during a median follow-up period of 25.9 (IQR 11.5-54.3) months. Kaplan-Meier curves showed that the presence of J waves on the 12-lead ECG obtained before device implantation was associated with an increased occurrence of appropriate device therapy (P < 0.001). Multivariate Cox proportional regression analysis revealed that the presence of J waves (HR 2.95; 95% CI 1.31-6.64; P = 0.009) was an independent predictor for the occurrence of appropriate device therapy. In the subgroup analysis of the patients with dilated or hypertrophic cardiomyopathy, J wave tended to increase the occurrence of appropriate device therapy (P = 0.056 and P = 0.092, respectively). CONCLUSIONS The presence of J waves was an independent predictor for the occurrence of appropriate device therapy in patients with NICM who underwent ICD implantation.
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Affiliation(s)
- Yoshihisa Naruse
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Akihiko Nogami
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yasutoshi Shinoda
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yuichi Hanaki
- Department of Cardiovascular Medicine, Yokohama Rosai Hospital, Yokohama, Kanagawa, Japan
| | - Yasuhiro Shirai
- Department of Cardiovascular Medicine, Yokohama Rosai Hospital, Yokohama, Kanagawa, Japan
| | - Shinya Kowase
- Department of Cardiovascular Medicine, Yokohama Rosai Hospital, Yokohama, Kanagawa, Japan
| | - Kenji Kurosaki
- Department of Cardiovascular Medicine, Yokohama Rosai Hospital, Yokohama, Kanagawa, Japan
| | - Takeshi Machino
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Kenji Kuroki
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hiro Yamasaki
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Miyako Igarashi
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yukio Sekiguchi
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Kazutaka Aonuma
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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42
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Patton KK, Ellinor PT, Ezekowitz M, Kowey P, Lubitz SA, Perez M, Piccini J, Turakhia M, Wang P, Viskin S. Electrocardiographic Early Repolarization. Circulation 2016; 133:1520-9. [DOI: 10.1161/cir.0000000000000388] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Abstract
The early repolarisation (ER) pattern is a common ECG finding. Most individuals with the ER pattern are at minimal risk for arrhythmic events. In others, ER increases the arrhythmic risk of underlying cardiac pathology. Rarely ER syndrome will manifest as a primary arrhythmogenic disorder causing ventricular fibrillation (VF). ER syndrome is defined as syncope attributed to ventricular arrhythmias or cardiac arrest attributed to ER following systematic exclusion of other etiologies. Some ECG features associated with ER portend a higher risk. However, clinically useful risk-stratifying tools to identify the asymptomatic patient at high risk are lacking. Patients with asymptomatic ER and no family history of malignant ER should be reassured. All patients with ER should continue to have modifiable cardiac risk factors addressed. Symptomatic patients should be systematically investigated, directed by symptoms.
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Affiliation(s)
| | - Andrew D Krahn
- The Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
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44
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Tülümen E, Schulze-Bahr E, Zumhagen S, Stallmeyer B, Seebohm G, Beckmann BM, Kääb S, Rudic B, Liebe V, Wolpert C, Herrera-Siklody C, Veltmann C, Schimpf R, Borggrefe M. Early repolarization pattern: a marker of increased risk in patients with catecholaminergic polymorphic ventricular tachycardia. Europace 2015; 18:1587-1592. [DOI: 10.1093/europace/euv357] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Accepted: 09/28/2015] [Indexed: 11/13/2022] Open
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45
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Sonoda K, Watanabe H, Hisamatsu T, Ashihara T, Ohno S, Hayashi H, Horie M, Minamino T. High Frequency of Early Repolarization and Brugada-Type Electrocardiograms in Hypercalcemia. Ann Noninvasive Electrocardiol 2015; 21:30-40. [PMID: 26263049 DOI: 10.1111/anec.12303] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 06/26/2015] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND J wave, or early repolarization has recently been associated with an increased risk of lethal arrhythmia and sudden death, both in idiopathic ventricular fibrillation and in the general population. Hypercalcemia is one of the causes of J point and ST segment elevation, but the relationship has not been well studied. The aim of this study was to examine the effects of hypercalcemia on J point elevation. METHODS Electrocardiographic findings were compared in 89 patients with hypercalcemia and 267 age- and sex-matched healthy controls with normocalcemia. The association of J point elevation with arrhythmia events in patients with hypercalcemia was also studied. RESULTS The PR interval and the QRS duration were longer in patients with hypercalcemia than in normocalcemic controls. Both the QT and the corrected QT intervals were shorter in patients with hypercalcemia compared with normocalcemic controls. Conduction disorders, ST-T abnormalities, and J point elevation were more common in patients with hypercalcemia than normocalcemic controls. Following the resolution of hypercalcemia, the frequency of J point elevation decreased to a level similar to that noted in controls. During hospitalization, no arrhythmia event occurred in patients with hypercalcemia. CONCLUSION Hypercalcemia was associated with J point elevation.
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Affiliation(s)
- Keiko Sonoda
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Hiroshi Watanabe
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takashi Hisamatsu
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan.,Department of Public Health, Shiga University of Medical Science, Otsu, Japan.,Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Takashi Ashihara
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Seiko Ohno
- Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Otsu, Japan.,Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Hideki Hayashi
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Minoru Horie
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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46
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Abstract
A prominent J wave is encountered in a number of life-threatening cardiac arrhythmia syndromes, including the Brugada syndrome and early repolarization syndromes. Brugada syndrome and early repolarization syndromes differ with respect to the magnitude and lead location of abnormal J waves and are thought to represent a continuous spectrum of phenotypic expression termed J-wave syndromes. Despite two decades of intensive research, risk stratification and the approach to therapy of these 2 inherited cardiac arrhythmia syndromes are still undergoing rapid evolution. Our objective in this review is to provide an integrated synopsis of the clinical characteristics, risk stratifiers, and molecular, ionic, cellular, and genetic mechanisms underlying these 2 fascinating syndromes that have captured the interest and attention of the cardiology community in recent years.
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Affiliation(s)
| | - Gan-Xin Yan
- Lankenau Institute for Medical Research and Lankenau Medical Center, Wynnewood, Pennsylvania; Jefferson Medical College, Philadelphia, Pennsylvania; The First Affiliated Hospital, Medical School of Xi'an Jiaotong University, Xi'an, China
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47
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Adler A, Viskin S. Syncope in Hereditary Arrhythmogenic Syndromes. Cardiol Clin 2015; 33:433-40. [PMID: 26115829 DOI: 10.1016/j.ccl.2015.04.011] [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] [Indexed: 11/29/2022]
Abstract
Since the discovery of the first mutation causing long QT syndrome (LQTS) in 1995, the field of hereditary arrhythmogenic syndromes has expanded greatly. Today, these syndromes include LQTS, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia, and short QT syndrome. There is also evidence suggesting that the newly described malignant early repolarization syndrome also has a genetic cause.
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Affiliation(s)
- Arnon Adler
- Sackler School of Medicine, Tel Aviv Medical Center, Tel Aviv University, Israel
| | - Sami Viskin
- Sackler School of Medicine, Tel Aviv Medical Center, Tel Aviv University, Israel.
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Tikkanen J, Huikuri H. Characteristics of “malignant” vs. “benign” electrocardiographic patterns of early repolarization. J Electrocardiol 2015; 48:390-4. [DOI: 10.1016/j.jelectrocard.2014.12.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Indexed: 12/19/2022]
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49
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Naruse Y, Nogami A, Harimura Y, Ishibashi M, Noguchi Y, Sekiguchi Y, Sato A, Aonuma K. Difference in the Clinical Characteristics of Ventricular Fibrillation Occurrence in the Early Phase of an Acute Myocardial Infarction Between Patients With and Without J Waves. J Cardiovasc Electrophysiol 2015; 26:872-878. [PMID: 25895076 DOI: 10.1111/jce.12691] [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: 11/24/2014] [Revised: 04/08/2015] [Accepted: 04/14/2015] [Indexed: 01/27/2023]
Abstract
INTRODUCTION We recently showed that the presence of J waves increases the risk of ventricular fibrillation (VF) occurrence in the early phase of an acute myocardial infarction (AMI). This study aimed to evaluate the clinical characteristics of VF occurrences in the early phase of an AMI between patients with and without J waves. METHODS AND RESULTS This retrospective, observational study included 281 consecutive patients with an AMI (69 ± 12 years; 207 men) in whom 12-lead ECGs before AMI onset could be evaluated. The patients were classified based on a VF occurrence <48 hours after AMI onset and the presence of J waves. J waves were electrocardiographically defined as an elevation of the terminal portion of the QRS complex of >0.1 mV from baseline in at least 2 contiguous inferior or lateral leads. VF occurred in 24 patients, and J waves were present in 37. VF occurrence was more prevalent in the patients with than without J waves (27% vs. 6%; P < 0.001). Among the 244 patients without J waves, peak creatine kinase level (P < 0.01), number of diseased coronary arteries (P < 0.01), and male sex (P < 0.05) were higher in the patients with than without VF occurrence. However, among the 37 patients with J waves, there was no significant difference in these variables. There was no association between the location of J waves and the infarct area. CONCLUSIONS In patients with AMI, those with J waves were more likely to develop VF and less likely to have high-risk clinical characteristics than those without J waves.
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Affiliation(s)
- Yoshihisa Naruse
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Akihiko Nogami
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yoshie Harimura
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Mayu Ishibashi
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yuichi Noguchi
- Cardiovascular Division, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
| | - Yukio Sekiguchi
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Akira Sato
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Kazutaka Aonuma
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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50
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Makarawate P, Chaosuwannakit N, Ruamcharoen Y, Panthongviriyakul A, Pongchaiyakul C, Tharaksa P, Sripo T, Sawanyawisuth K. Prevalence and associated factors of early repolarization pattern in healthy young northeastern Thai men: A correlation study with Brugada electrocardiography. J Arrhythm 2015; 31:215-20. [PMID: 26336562 DOI: 10.1016/j.joa.2014.12.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Revised: 12/10/2014] [Accepted: 12/16/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Early repolarization pattern (ERP) is characterized by J-point elevation with QRS notching or slurring in the terminal portion of the QRS complex. It may be associated with sudden death. Brugada syndrome (BS) is a genetic and fatal disease commonly found in northeastern Thai men. Data on the rate and predictors of ERP in Asian populations are limited. In addition, the correlation between ERP and BS has never been studied in an endemic area of BS. This study aimed to evaluate the prevalence of ERP and its associated factors in young, healthy male Asian subjects. METHODS Between June 2011 and May 2012, 282 young, healthy men aged 20-45 years were enrolled at check-up clinics in Khon Kaen, Thailand. Subjects were divided into the ERP and non-ERP groups. RESULTS There were 29 subjects with ERP (10.3%). The Sokolow-Lyon index was an independent factor for ERP with an adjusted odds ratio of 1.090 (95% CI: 1.027, 1.159). The Brugada ECG pattern was found in 11 (37.9%) subjects in the ERP group. The Brugada ECG pattern (non-type 1) was commonly found in lateral ERP patients. After the placement of high intercostal leads, the Brugada ECG pattern was dramatically increased compared with results obtained during standard ECG lead placement. CONCLUSIONS The ERP rate in young, healthy men from northeastern Thailand was 10.3%. A higher Sokolow-Lyon index was the only independent factor associated with ERP. Subjects with ERP should be examined with high intercostal leads to uncover Brugada ECG.
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Affiliation(s)
- Pattarapong Makarawate
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Narumol Chaosuwannakit
- Department of Radiology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Yossavadee Ruamcharoen
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Aunejit Panthongviriyakul
- Electrocardiography and Echocardiogram Unit, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Choowong Pongchaiyakul
- Electrocardiography and Echocardiogram Unit, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Prapapan Tharaksa
- Electrocardiography and Echocardiogram Unit, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Temsiri Sripo
- Electrocardiography and Echocardiogram Unit, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Kittisak Sawanyawisuth
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand ; Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH), Khon Kaen University, Khon Kaen 40002, Thailand
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