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Mariani MV, Pierucci N, Fanisio F, Laviola D, Silvetti G, Piro A, La Fazia VM, Chimenti C, Rebecchi M, Drago F, Miraldi F, Natale A, Vizza CD, Lavalle C. Inherited Arrhythmias in the Pediatric Population: An Updated Overview. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:94. [PMID: 38256355 PMCID: PMC10819657 DOI: 10.3390/medicina60010094] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/17/2023] [Accepted: 12/27/2023] [Indexed: 01/24/2024]
Abstract
Pediatric cardiomyopathies (CMs) and electrical diseases constitute a heterogeneous spectrum of disorders distinguished by structural and electrical abnormalities in the heart muscle, attributed to a genetic variant. They rank among the main causes of morbidity and mortality in the pediatric population, with an annual incidence of 1.1-1.5 per 100,000 in children under the age of 18. The most common conditions are dilated cardiomyopathy (DCM) and hypertrophic cardiomyopathy (HCM). Despite great enthusiasm for research in this field, studies in this population are still limited, and the management and treatment often follow adult recommendations, which have significantly more data on treatment benefits. Although adult and pediatric cardiac diseases share similar morphological and clinical manifestations, their outcomes significantly differ. This review summarizes the latest evidence on genetics, clinical characteristics, management, and updated outcomes of primary pediatric CMs and electrical diseases, including DCM, HCM, arrhythmogenic right ventricular cardiomyopathy (ARVC), Brugada syndrome (BrS), catecholaminergic polymorphic ventricular tachycardia (CPVT), long QT syndrome (LQTS), and short QT syndrome (SQTS).
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Affiliation(s)
- Marco Valerio Mariani
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (D.L.); (G.S.); (A.P.); (C.C.); (C.D.V.); (C.L.)
| | - Nicola Pierucci
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (D.L.); (G.S.); (A.P.); (C.C.); (C.D.V.); (C.L.)
| | - Francesca Fanisio
- Division of Cardiology, Policlinico Casilino, 00169 Rome, Italy; (F.F.); (M.R.)
| | - Domenico Laviola
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (D.L.); (G.S.); (A.P.); (C.C.); (C.D.V.); (C.L.)
| | - Giacomo Silvetti
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (D.L.); (G.S.); (A.P.); (C.C.); (C.D.V.); (C.L.)
| | - Agostino Piro
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (D.L.); (G.S.); (A.P.); (C.C.); (C.D.V.); (C.L.)
| | - Vincenzo Mirco La Fazia
- Department of Electrophysiology, St. David’s Medical Center, Texas Cardiac Arrhythmia Institute, Austin, TX 78705, USA; (V.M.L.F.); (A.N.)
| | - Cristina Chimenti
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (D.L.); (G.S.); (A.P.); (C.C.); (C.D.V.); (C.L.)
| | - Marco Rebecchi
- Division of Cardiology, Policlinico Casilino, 00169 Rome, Italy; (F.F.); (M.R.)
| | - Fabrizio Drago
- Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital and Research Institute, 00165 Rome, Italy;
| | - Fabio Miraldi
- Cardio Thoracic-Vascular and Organ Transplantation Surgery Department, Policlinico Umberto I Hospital, 00161 Rome, Italy;
| | - Andrea Natale
- Department of Electrophysiology, St. David’s Medical Center, Texas Cardiac Arrhythmia Institute, Austin, TX 78705, USA; (V.M.L.F.); (A.N.)
| | - Carmine Dario Vizza
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (D.L.); (G.S.); (A.P.); (C.C.); (C.D.V.); (C.L.)
| | - Carlo Lavalle
- Department of Cardiovascular, Respiratory, Nephrological, Aenesthesiological and Geriatric Sciences, “Sapienza” University of Rome, 00161 Rome, Italy; (N.P.); (D.L.); (G.S.); (A.P.); (C.C.); (C.D.V.); (C.L.)
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Zhang Z, Brugada P, Weiss JN, Qu Z. Phase 2 Re-Entry Without I to: Role of Sodium Channel Kinetics in Brugada Syndrome Arrhythmias. JACC Clin Electrophysiol 2023; 9:2459-2474. [PMID: 37831035 PMCID: PMC11348283 DOI: 10.1016/j.jacep.2023.08.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/27/2023] [Accepted: 08/23/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND In Brugada syndrome (BrS), phase 2 re-excitation/re-entry (P2R) induced by the transient outward potassium current (Ito) is a proposed arrhythmia mechanism; yet, the most common genetic defects are loss-of-function sodium channel mutations. OBJECTIVES The authors used computer simulations to investigate how sodium channel dysfunction affects P2R-mediated arrhythmogenesis in the presence and absence of Ito. METHODS Computer simulations were carried out in 1-dimensional cables and 2-dimensional tissue using guinea pig and human ventricular action potential models. RESULTS In the presence of Ito sufficient to generate robust P2R, reducing sodium current (INa) peak amplitude alone only slightly potentiated P2R. When INa inactivation kinetics were also altered to simulate reported effects of BrS mutations and sodium channel blockers, however, P2R occurred even in the absence of Ito. These effects could be potentiated by delaying L-type calcium channel activation or increasing ATP-sensitive potassium current, consistent with experimental and clinical findings. INa-mediated P2R also accounted for sex-related, day and night-related, and fever-related differences in arrhythmia risk in BrS patients. CONCLUSIONS Altered INa kinetics synergize powerfully with reduced INa amplitude to promote P2R-induced arrhythmias in BrS in the absence of Ito, establishing a robust mechanistic link between altered INa kinetics and the P2R-mediated arrhythmia mechanism.
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Affiliation(s)
- Zhaoyang Zhang
- Department of Physics, School of Physical Science and Technology, Ningbo University, Ningbo, Zhejiang, China; Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Pedro Brugada
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - James N Weiss
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Zhilin Qu
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, California, USA.
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3
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Huse S, Acharya S, Agrawal S, J H, Sachdev A, Ghulaxe Y, Sarda P, Chavada J. Recent Advances in Inherited Cardiac Arrhythmias and Their Genetic Testing. Cureus 2023; 15:e47653. [PMID: 38021622 PMCID: PMC10668889 DOI: 10.7759/cureus.47653] [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: 09/07/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Inherited arrhythmias, encompassing conditions such as cardiomyopathies, cardiac ion channel disorders, and coronary heart disease, represent the common causes that elevate the threat of sudden cardiac death among adults. Researchers have pinpointed the genes responsible for these hereditary arrhythmias in the last 30 years. Concurrently, it has become clear that the genetic makeup underlying these conditions is more intricate than previously understood. Evolution in DNA sequencing techniques, particularly next-generation sequencing, has empowered us to learn these intricate hereditary characteristics. Genetic testing is crucial in diagnosing, assessing risk, and determining treatment for individuals with these conditions and their family members. The need for collaborative endeavors to comprehend and address these uncommon yet potentially life-threatening disorders is becoming more evident. This review aims to inform readers of the latest advances in understanding hereditary arrhythmias and provide the groundwork for collaborative genetic testing initiatives to characterize these disorders in the general population.
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Affiliation(s)
- Shreyash Huse
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Sourya Acharya
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shashank Agrawal
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Harshita J
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ankita Sachdev
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Yash Ghulaxe
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Prayas Sarda
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Jay Chavada
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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4
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Renard E, Walton RD, Benoist D, Brette F, Bru-Mercier G, Chaigne S, Charron S, Constantin M, Douard M, Dubes V, Guillot B, Hof T, Magat J, Martinez ME, Michel C, Pallares-Lupon N, Pasdois P, Récalde A, Vaillant F, Sacher F, Labrousse L, Rogier J, Kyndt F, Baudic M, Schott JJ, Barc J, Probst V, Sarlandie M, Marionneau C, Ashton JL, Hocini M, Haïssaguerre M, Bernus O. Functional Epicardial Conduction Disturbances Due to a SCN5A Variant Associated With Brugada Syndrome. JACC Clin Electrophysiol 2023; 9:1248-1261. [PMID: 37227351 PMCID: PMC10406612 DOI: 10.1016/j.jacep.2023.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/06/2023] [Accepted: 03/10/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Brugada syndrome is a significant cause of sudden cardiac death (SCD), but the underlying mechanisms remain hypothetical. OBJECTIVES This study aimed to elucidate this knowledge gap through detailed ex vivo human heart studies. METHODS A heart was obtained from a 15-year-old adolescent boy with normal electrocardiogram who experienced SCD. Postmortem genotyping was performed, and clinical examinations were done on first-degree relatives. The right ventricle was optically mapped, followed by high-field magnetic resonance imaging and histology. Connexin-43 and NaV1.5 were localized by immunofluorescence, and RNA and protein expression levels were studied. HEK-293 cell surface biotinylation assays were performed to examine NaV1.5 trafficking. RESULTS A Brugada-related SCD diagnosis was established for the donor because of a SCN5A Brugada-related variant (p.D356N) inherited from his mother, together with a concomitant NKX2.5 variant of unknown significance. Optical mapping demonstrated a localized epicardial region of impaired conduction near the outflow tract, in the absence of repolarization alterations and microstructural defects, leading to conduction blocks and figure-of-8 patterns. NaV1.5 and connexin-43 localizations were normal in this region, consistent with the finding that the p.D356N variant does not affect the trafficking, nor the expression of NaV1.5. Trends of decreased NaV1.5, connexin-43, and desmoglein-2 protein levels were noted; however, the RT-qPCR results suggested that the NKX2-5 variant was unlikely to be involved. CONCLUSIONS This study demonstrates for the first time that SCD associated with a Brugada-SCN5A variant can be caused by localized functionally, not structurally, impaired conduction.
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Affiliation(s)
- Estelle Renard
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France.
| | - Richard D Walton
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - David Benoist
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - Fabien Brette
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - Gilles Bru-Mercier
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - Sébastien Chaigne
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - Sabine Charron
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - Marion Constantin
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - Matthieu Douard
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - Virginie Dubes
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - Bastien Guillot
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - Thomas Hof
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - Julie Magat
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - Marine E Martinez
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - Cindy Michel
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - Néstor Pallares-Lupon
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - Philippe Pasdois
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - Alice Récalde
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - Fanny Vaillant
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - Frédéric Sacher
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France; Centre Hospitalier Universitaire de Bordeaux, Département d'électrophysiologie et de stimulation cardiaques, Hôpital Cardiologique du Haut-Lévêque, Pessac, France
| | - Louis Labrousse
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Centre Hospitalier Universitaire de Bordeaux, Département de chirurgie cardiovasculaire, Hôpital Cardiologique du Haut-Lévêque, Pessac, France
| | - Julien Rogier
- Centre Hospitalier Universitaire de Bordeaux, Coordination des prélèvements d'organes et de tissus, Bordeaux, France
| | - Florence Kyndt
- Nantes Université, Centre Hospitalier Universitaire Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France; Centre Hospitalier Universitaire Nantes, Service de génétique médicale, Nantes, France
| | - Manon Baudic
- L'Institut du thorax, INSERM, CNRS, Université Nantes, Nantes, France
| | - Jean-Jacques Schott
- Nantes Université, Centre Hospitalier Universitaire Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Julien Barc
- Nantes Université, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Vincent Probst
- Nantes Université, Centre Hospitalier Universitaire Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Marine Sarlandie
- L'Institut du thorax, INSERM, CNRS, Université Nantes, Nantes, France
| | - Céline Marionneau
- L'Institut du thorax, INSERM, CNRS, Université Nantes, Nantes, France
| | - Jesse L Ashton
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Mélèze Hocini
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France; Centre Hospitalier Universitaire de Bordeaux, Département d'électrophysiologie et de stimulation cardiaques, Hôpital Cardiologique du Haut-Lévêque, Pessac, France
| | - Michel Haïssaguerre
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France; Centre Hospitalier Universitaire de Bordeaux, Département d'électrophysiologie et de stimulation cardiaques, Hôpital Cardiologique du Haut-Lévêque, Pessac, France
| | - Olivier Bernus
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
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5
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Casella M, Conti S, Compagnucci P, Ribatti V, Narducci ML, Marcon L, Massara F, Valeri Y, De Francesco L, Martino AM, Ghiglieno C, Schiavone M, Balla C, Dell'Era G, Pelargonio G, Forleo GB, Iacopino S, Sgarito G, Calò L, Tondo C, Russo AD, Patti G. Incidence of ventricular arrhythmias related to COVID infection and vaccination in patients with Brugada syndrome: Insights from a large Italian multicenter registry based on continuous rhythm monitoring. J Cardiovasc Electrophysiol 2023; 34:1386-1394. [PMID: 37194742 DOI: 10.1111/jce.15929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/04/2023] [Accepted: 05/03/2023] [Indexed: 05/18/2023]
Abstract
INTRODUCTION Brugada syndrome (BrS) has a dynamic ECG pattern that might be revealed by certain conditions such as fever. We evaluated the incidence and management of ventricular arrhythmias (VAs) related to COVID-19 infection and vaccination among BrS patients carriers of an implantable loop recorder (ILR) or implantable cardioverter-defibrillator (ICD) and followed by remote monitoring. METHODS This was a multicenter retrospective study. Patients were carriers of devices with remote monitoring follow-up. We recorded VAs 6 months before COVID-19 infection or vaccination, during infection, at each vaccination, and up to 6-month post-COVID-19 or 1 month after the last vaccination. In ICD carriers, we documented any device intervention. RESULTS We included 326 patients, 202 with an ICD and 124 with an ILR. One hundred and nine patients (33.4%) had COVID-19, 55% of whom developed fever. Hospitalization rate due to COVID-19 infection was 2.76%. After infection, we recorded only two ventricular tachycardias (VTs). After the first, second, and third vaccines, the incidence of non-sustained ventricular tachycardia (NSVT) was 1.5%, 2%, and 1%, respectively. The incidence of VT was 1% after the second dose. Six-month post-COVID-19 healing or 1 month after the last vaccine, we documented NSVT in 3.4%, VT in 0.5%, and ventricular fibrillation in 0.5% of patients. Overall, one patient received anti-tachycardia pacing and one a shock. ILR carriers had no VAs. No differences were found in VT before and after infection and before and after each vaccination. CONCLUSIONS From this large multicenter study conducted in BrS patients, followed by remote monitoring, the overall incidence of sustained VAs after COVID-19 infection and vaccination is relatively low.
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Affiliation(s)
- Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti Umberto I-Lancisi-Salesi, Ancona, Italy
- Department of Clinical, Special and Dental Sciences, Marche Polytechnic University, Ancona, Italy
| | - Sergio Conti
- Department of Electrophysiology, ARNAS Civico - Di Cristina - Benfratelli, Palermo, Italy
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti Umberto I-Lancisi-Salesi, Ancona, Italy
- Department of Biomedical Science and Public Health, Marche Polytechnic University, Ancona, Italy
| | | | | | | | - Francesca Massara
- Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti Umberto I-Lancisi-Salesi, Ancona, Italy
| | - Yari Valeri
- Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti Umberto I-Lancisi-Salesi, Ancona, Italy
| | - Luca De Francesco
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | | | - Chiara Ghiglieno
- Division of Cardiology, University Hospital Maggiore della Carità, University of Eastern Piedmont, Novara, Italy
| | | | - Cristina Balla
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, Cona, FE, Italy
| | - Gabriele Dell'Era
- Division of Cardiology, University Hospital Maggiore della Carità, University of Eastern Piedmont, Novara, Italy
| | - Gemma Pelargonio
- Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | | | | | - Giuseppe Sgarito
- Department of Electrophysiology, ARNAS Civico - Di Cristina - Benfratelli, Palermo, Italy
| | - Leonardo Calò
- Department of Cardiology, Policlinico Casilino, Rome, Italy
| | - Claudio Tondo
- Centro Cardiologico Monzino IRCCS, Milan, Italy
- Department of Biomedical, Surgery and Dental Sciences, University of Milan, Milan, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti Umberto I-Lancisi-Salesi, Ancona, Italy
- Department of Biomedical Science and Public Health, Marche Polytechnic University, Ancona, Italy
| | - Giuseppe Patti
- Division of Cardiology, University Hospital Maggiore della Carità, University of Eastern Piedmont, Novara, Italy
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6
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Yamane H, Seki M, Ikeda T, Matsumoto A, Furui S, Sato T, Muramatsu K, Tajima T, Yamagata T. An Adolescent Patient with Sick Sinus Syndrome Complicated by Hypothyroidism Carrying an SCN5A Variant. Int Heart J 2022; 63:627-632. [PMID: 35650162 DOI: 10.1536/ihj.21-722] [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: 11/18/2022]
Abstract
Previous studies have reported that hypothyroidism can lead to sick sinus syndrome (SSS) or other rhythm disturbances. Variants in the alpha subunit of the cardiac sodium channel (SCN5A) are known to be among the genetic causes of SSS. We encountered an adolescent patient with SSS and hypothyroidism who also harbored an SCN5A variant. The patient was a 13-year-old girl who was referred to our hospital because of bradycardia identified during a school electrocardiography screening. Clinical examination revealed severe hypothyroidism due to Hashimoto thyroiditis and SSS. After levothyroxine supplementation, her symptoms of hypothyroidism improved; however, the SSS did not. Genetic testing revealed a heterozygous variant (c.1066 G>A, p.Asp356Asn) in SCN5A. This is the first report of the coexistence of SSS due to an SCN5A variant and severe hypothyroidism in an adolescent patient. While patients with SCN5A variants exhibit phenotypic heterogeneity due to the presence of various modifiers, the presence of severe hypothyroidism may affect the development of SSS. This case highlights the importance of genetic analysis, including testing for SCN5A variants, in patients with hypothyroidism complicated by SSS or cardiac conduction disorders.
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Affiliation(s)
- Hiroaki Yamane
- Department of Pediatrics, Jichi Medical University.,Department of Pediatrics, Jichi Medical University Saitama Medical Center
| | - Mitsuru Seki
- Department of Pediatrics, Jichi Medical University
| | | | - Ayumi Matsumoto
- Department of Human Genetics, Center for Molecular Medicine, Jichi Medical University
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Olaopa MA, Ai T, Chao B, Xiao X, Vatta M, Habecker BA. Phosphorylation of Lamin A/C at serine 22 modulates Na v 1.5 function. Physiol Rep 2021; 9:e15121. [PMID: 34806324 PMCID: PMC8606869 DOI: 10.14814/phy2.15121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/29/2021] [Accepted: 10/31/2021] [Indexed: 12/17/2022] Open
Abstract
Variants in the LMNA gene, which encodes for Lamin A/C, are associated with cardiac conduction disease (CCD). We previously reported that Lamin A/C variants p.R545H and p.A287Lfs*193, which were identified in CCD patients, decreased peak INa in HEK-293 cells expressing Nav 1.5. Decreased peak INa in the cardiac conduction system could account for patients' atrioventricular block. We found that serine 22 (Ser 22) phosphorylation of Lamin A/C was decreased in the p.R545H variant and hypothesized that lamin phosphorylation modulated Nav 1.5 activity. To test this hypothesis, we assessed Nav 1.5 function in HEK-293 cells co-transfected with LMNA variants or treated with the small molecule LBL1 (lamin-binding ligand 1). LBL1 decreased Ser 22 phosphorylation by 65% but did not affect Nav 1.5 function. To test the complete loss of phosphorylation, we generated a version of LMNA with serine 22 converted to alanine 22 (S22A-LMNA); and a version of mutant R545H-LMNA that mimics phosphorylation via serine 22 to aspartic acid 22 substitution (S22D-R545H-LMNA). We found that S22A-LMNA inhibited Lamin-mediated activation of peak INa by 63% and shifted voltage-dependency of steady-state inactivation of Nav 1.5. Conversely, S22D-R545H-LMNA abolished the effects of mutant R545H-LMNA on voltage-dependency but not peak INa . We conclude that Lamin A/C Ser 22 phosphorylation can modulate Nav 1.5 function and contributes to the mechanism by which R545H-LMNA alters Nav 1.5 function. The differential impact of complete versus partial loss of Ser 22 phosphorylation suggests a threshold of phosphorylation that is required for full Nav 1.5 modulation. This is the first study to link Lamin A/C phosphorylation to Nav 1.5 function.
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Affiliation(s)
- Michael A. Olaopa
- Department of Chemical Physiology and BiochemistryOregon Health & Science UniversityPortlandOregonUSA
- Krannert Institute of CardiologyDepartment of MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Tomohiko Ai
- Krannert Institute of CardiologyDepartment of MedicineIndiana University School of MedicineIndianapolisIndianaUSA
- Department of Clinical Laboratory MedicineJuntendo UniversityTokyoJapan
| | - Bo Chao
- Department of Chemical Physiology and BiochemistryOregon Health & Science UniversityPortlandOregonUSA
| | - Xiangshu Xiao
- Department of Chemical Physiology and BiochemistryOregon Health & Science UniversityPortlandOregonUSA
| | - Matteo Vatta
- Krannert Institute of CardiologyDepartment of MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Beth A. Habecker
- Department of Chemical Physiology and BiochemistryOregon Health & Science UniversityPortlandOregonUSA
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Takla M, Edling CE, Zhang K, Saadeh K, Tse G, Salvage SC, Huang CL, Jeevaratnam K. Transcriptional profiles of genes related to electrophysiological function in Scn5a +/- murine hearts. Physiol Rep 2021; 9:e15043. [PMID: 34617689 PMCID: PMC8495800 DOI: 10.14814/phy2.15043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/13/2021] [Accepted: 08/13/2021] [Indexed: 11/24/2022] Open
Abstract
The Scn5a gene encodes the major pore-forming Nav 1.5 (α) subunit, of the voltage-gated Na+ channel in cardiomyocytes. The key role of Nav 1.5 in action potential initiation and propagation in both atria and ventricles predisposes organisms lacking Scn5a or carrying Scn5a mutations to cardiac arrhythmogenesis. Loss-of-function Nav 1.5 genetic abnormalities account for many cases of the human arrhythmic disorder Brugada syndrome (BrS) and related conduction disorders. A murine model with a heterozygous Scn5a deletion recapitulates many electrophysiological phenotypes of BrS. This study examines the relationships between its Scn5a+/- genotype, resulting transcriptional changes, and the consequent phenotypic presentations of BrS. Of 62 selected protein-coding genes related to cardiomyocyte electrophysiological or homeostatic function, concentrations of mRNA transcribed from 15 differed significantly from wild type (WT). Despite halving apparent ventricular Scn5a transcription heterozygous deletion did not significantly downregulate its atrial expression, raising possibilities of atria-specific feedback mechanisms. Most of the remaining 14 genes whose expression differed significantly between WT and Scn5a+/- animals involved Ca2+ homeostasis specifically in atrial tissue, with no overlap with any ventricular changes. All statistically significant changes in expression were upregulations in the atria and downregulations in the ventricles. This investigation demonstrates the value of future experiments exploring for and clarifying links between transcriptional control of Scn5a and of genes whose protein products coordinate Ca2+ regulation and examining their possible roles in BrS.
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Affiliation(s)
- Michael Takla
- Faculty of Health and Medical ScienceUniversity of SurreyGuildfordUK
- Christ’s CollegeUniversity of CambridgeCambridgeUK
| | | | - Kevin Zhang
- Faculty of Health and Medical ScienceUniversity of SurreyGuildfordUK
- School of MedicineImperial College LondonLondonUK
| | - Khalil Saadeh
- Faculty of Health and Medical ScienceUniversity of SurreyGuildfordUK
- Clinical SchoolUniversity of CambridgeCambridgeUK
| | - Gary Tse
- Faculty of Health and Medical ScienceUniversity of SurreyGuildfordUK
- Second Hospital of Tianjin Medical UniversityTianjinChina
| | | | - Christopher L.‐H. Huang
- Faculty of Health and Medical ScienceUniversity of SurreyGuildfordUK
- Department of BiochemistryUniversity of CambridgeCambridgeUK
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Sigmundsson F, Kuchalik J, Fadl S, Holy M, Joelson A. The unique challenges of Brugada syndrome in spinal deformity surgery. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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10
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Drago F, Bloise R, Bronzetti G, Leoni L, Porcedda G, Sarubbi B, De Filippo P, Gulletta S, Scaglione M. Italian recommendations for the management of pediatric patients under twelve years of age with suspected or manifest Brugada syndrome. Minerva Pediatr 2020; 72:1-13. [DOI: 10.23736/s0026-4946.19.05759-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Michowitz Y, Milman A, Andorin A, Sarquella-Brugada G, Gonzalez Corcia MC, Gourraud JB, Conte G, Sacher F, Juang JJM, Kim SH, Leshem E, Mabo P, Postema PG, Hochstadt A, Wijeyeratne YD, Denjoy I, Giustetto C, Mizusawa Y, Huang Z, Jespersen CH, Maeda S, Takahashi Y, Kamakura T, Aiba T, Arbelo E, Mazzanti A, Allocca G, Brugada R, Casado-Arroyo R, Champagne J, Priori SG, Veltmann C, Delise P, Corrado D, Brugada J, Kusano KF, Hirao K, Calo L, Takagi M, Tfelt-Hansen J, Yan GX, Gaita F, Leenhardt A, Behr ER, Wilde AAM, Nam GB, Brugada P, Probst V, Belhassen B. Characterization and Management of Arrhythmic Events in Young Patients With Brugada Syndrome. J Am Coll Cardiol 2019; 73:1756-1765. [PMID: 30975291 DOI: 10.1016/j.jacc.2019.01.048] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 12/29/2018] [Accepted: 01/08/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Information on young patients with Brugada syndrome (BrS) and arrhythmic events (AEs) is limited. OBJECTIVES The purpose of this study was to describe their characteristics and management as well as risk factors for AE recurrence. METHODS A total of 57 patients (age ≤20 years), all with BrS and AEs, were divided into pediatric (age ≤12 years; n = 26) and adolescents (age 13 to 20 years; n = 31). RESULTS Patients' median age at time of first AE was 14 years, with a majority of males (74%), Caucasians (70%), and probands (79%) who presented as aborted cardiac arrest (84%). A significant proportion of patients (28%) exhibited fever-related AE. Family history of sudden cardiac death (SCD), prior syncope, spontaneous type 1 Brugada electrocardiogram (ECG), inducible ventricular fibrillation at electrophysiological study, and SCN5A mutations were present in 26%, 49%, 65%, 28%, and 58% of patients, respectively. The pediatric group differed from the adolescents, with a greater proportion of females, Caucasians, fever-related AEs, and spontaneous type-1 ECG. During follow-up, 68% of pediatric and 64% of adolescents had recurrent AE, with median time of 9.9 and 27.0 months, respectively. Approximately one-third of recurrent AEs occurred on quinidine therapy, and among the pediatric group, 60% of recurrent AEs were fever-related. Risk factors for recurrent AE included sinus node dysfunction, atrial arrhythmias, intraventricular conduction delay, or large S-wave on ECG lead I in the pediatric group and the presence of SCN5A mutation among adolescents. CONCLUSIONS Young BrS patients with AE represent a very arrhythmogenic group. Current management after first arrhythmia episode is associated with high recurrence rate. Alternative therapies, besides defibrillator implantation, should be considered.
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Affiliation(s)
- Yoav Michowitz
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anat Milman
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Cardiology, Leviev Heart Institute, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Antoine Andorin
- L'institut du Thorax, Service de Cardiologie, CHU de Nantes, Nantes, France; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart
| | - Georgia Sarquella-Brugada
- Pediatric Arrhythmias, Electrophysiology and Sudden Death Unit Cardiology, Department Hospital Sant Joan de Déu, Barcelona-Universitat de Barcelona, Barcelona, Spain
| | | | - Jean-Baptiste Gourraud
- L'institut du Thorax, Service de Cardiologie, CHU de Nantes, Nantes, France; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart
| | - Giulio Conte
- Heart Rhythm Management Centre, UZ-VUB, Brussels, Belgium
| | - Frederic Sacher
- Hôpital Cardiologique du Haut-Lévêque & Université Bordeaux, LIRYC Institute, Bordeaux, France
| | - Jimmy J M Juang
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Sung-Hwan Kim
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eran Leshem
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Philippe Mabo
- Cardiology and Vascular Disease Division, Rennes University Health Centre, Rennes, France
| | - Pieter G Postema
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart; Heart Centre AMC, Department of Clinical and Experimental Cardiology, AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Aviram Hochstadt
- Department of Internal Medicine J, Tel-Aviv Medical Center, Tel Aviv, Israel
| | - Yanushi D Wijeyeratne
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart; Cardiovascular Sciences, St. George's University of London and Cardiology Clinical Academic Group St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Isabelle Denjoy
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart; Service de Cardiologie et CNMR Maladies Cardiaques Héréditaires Rares, Hôpital Bichat, Paris, and Université Paris Diderot, Sorbonne, Paris, France
| | - Carla Giustetto
- Division of Cardiology, University of Torino, Department of Medical Sciences, Città della Salute e della Scienza Hospital, Torino, Italy
| | - Yuka Mizusawa
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart; Heart Centre AMC, Department of Clinical and Experimental Cardiology, AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Zhengrong Huang
- Department of Cardiology, the First Affiliated Hospital of Xiamen University, Xiamen, Fujian, China
| | - Camilla H Jespersen
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart; 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
| | - Shingo Maeda
- Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Tsukasa Kamakura
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Takeshi Aiba
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Elena Arbelo
- Cardiology Department, Cardiovascular Institute, Hospital Clinic and IDIBAPS, Barcelona, Catalonia, Spain
| | - Andrea Mazzanti
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart; Molecular Cardiology, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Giuseppe Allocca
- Division of Cardiology, Hospital of Peschiera del Garda, Veneto, Italy
| | - Ramon Brugada
- Cardiovascular Genetics Center, Medical Science Department, University of Girona-IDIBGI (CIBERCV) Cardiology Service, Hospital Josep Trueta, Girona, Spain
| | - Ruben Casado-Arroyo
- Department of Cardiology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean Champagne
- Quebec Heart and Lung Institute, Quebec City, Quebec, Canada
| | - Silvia G Priori
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart; Molecular Cardiology, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Christian Veltmann
- Rhythmology and Electrophysiology, Department of Cardiology, Hannover Medical School, Hannover, Germany
| | - Pietro Delise
- Division of Cardiology, Hospital of Peschiera del Garda, Veneto, Italy
| | - Domenico Corrado
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart; Department of Cardiac, Thoracic and Vascular Sciences University of Padova, Padova, Italy
| | - Josep Brugada
- Cardiology Department, Cardiovascular Institute, Hospital Clinic and IDIBAPS, Barcelona, Catalonia, Spain
| | - Kengo F Kusano
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Kenzo Hirao
- Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Leonardo Calo
- Division of Cardiology, Policlinico Casilino, Roma, Italy
| | - Masahiko Takagi
- Division of Cardiac Arrhythmia, Kansai Medical University Medical Center, Moriguchi, Japan
| | - Jacob Tfelt-Hansen
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart; 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
| | - Gan-Xin Yan
- Lankenau Medical Center, Wynnewood, Pennsylvania
| | - Fiorenzo Gaita
- Division of Cardiology, University of Torino, Department of Medical Sciences, Città della Salute e della Scienza Hospital, Torino, Italy
| | - Antoine Leenhardt
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart; Service de Cardiologie et CNMR Maladies Cardiaques Héréditaires Rares, Hôpital Bichat, Paris, and Université Paris Diderot, Sorbonne, Paris, France
| | - Elijah R Behr
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart; Cardiovascular Sciences, St. George's University of London and Cardiology Clinical Academic Group St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Arthur A M Wilde
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart; Heart Centre AMC, Department of Clinical and Experimental Cardiology, AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Gi-Byoung Nam
- Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Pedro Brugada
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart; Heart Rhythm Management Centre, UZ-VUB, Brussels, Belgium
| | - Vincent Probst
- L'institut du Thorax, Service de Cardiologie, CHU de Nantes, Nantes, France; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart
| | - Bernard Belhassen
- Department of Cardiology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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13
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Baruteau AE, Kyndt F, Behr ER, Vink AS, Lachaud M, Joong A, Schott JJ, Horie M, Denjoy I, Crotti L, Shimizu W, Bos JM, Stephenson EA, Wong L, Abrams DJ, Davis AM, Winbo A, Dubin AM, Sanatani S, Liberman L, Kaski JP, Rudic B, Kwok SY, Rieubland C, Tfelt-Hansen J, Van Hare GF, Guyomarc’h-Delasalle B, Blom NA, Wijeyeratne YD, Gourraud JB, Le Marec H, Ozawa J, Fressart V, Lupoglazoff JM, Dagradi F, Spazzolini C, Aiba T, Tester DJ, Zahavich LA, Beauséjour-Ladouceur V, Jadhav M, Skinner JR, Franciosi S, Krahn AD, Abdelsayed M, Ruben PC, Yung TC, Ackerman MJ, Wilde AA, Schwartz PJ, Probst V. SCN5A mutations in 442 neonates and children: genotype–phenotype correlation and identification of higher-risk subgroups. Eur Heart J 2018; 39:2879-2887. [DOI: 10.1093/eurheartj/ehy412] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 07/01/2018] [Indexed: 01/20/2023] Open
Affiliation(s)
- Alban-Elouen Baruteau
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George’s University of London, London, UK
- Department of Congenital Cardiology, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- M3C CHU de Nantes, Fédération des Cardiopathies Congénitales, Nantes, F-44000, France
- L’institut du thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, Nantes, France
| | - Florence Kyndt
- L’institut du thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, Nantes, France
| | - Elijah R Behr
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George’s University of London, London, UK
| | - Arja S Vink
- Department of Pediatric Cardiology, Academic Medical Center, Amsterdam, The Netherlands
- Department of Clinical and Experimental Cardiology, Heart Centre, Academic Medical Center, Amsterdam, The Netherlands
| | - Matthias Lachaud
- L’institut du thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, Nantes, France
| | - Anna Joong
- Division of Pediatric Cardiology, Morgan Stanley Children’s Hospital, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | | | - Minoru Horie
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Sciences, Otsu, Japan
| | - Isabelle Denjoy
- AP-HP, Hôpital Bichat, Service de Cardiologie, Université Denis Diderot, Paris, France
| | - Lia Crotti
- Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Istituto Auxologico Italiano, Milano, Italy
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Johan M Bos
- Division of Heart Rhythm Services, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
- Division of Pediatric Cardiology, Department of Pediatrics, Mayo Clinic, Rochester, MN, USA
- Department of Molecular Pharmacology & Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Elizabeth A Stephenson
- The Hospital for Sick Children, Labbatt Family, Heart Centre, University of Toronto, Toronto, Canada
| | - Leonie Wong
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George’s University of London, London, UK
| | - Dominic J Abrams
- Inherited Cardiac Arrhythmia Program, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrew M Davis
- Department of Cardiology, The Royal Children's Hospital, Melbourne, Australia
- Murdoch Children’s Research Institute and University of Melbourne, Melbourne, Australia
| | - Annika Winbo
- Greenlane Paediatric and Congenital Cardiac Services, Starship Childrens Hospital, Auckland, New Zealand
- Department of Congenital Cardiology, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George’s University of London, London, UK
| | - Anne M Dubin
- Division of Pediatric Electrophysiology, Lucile Packard Children’s Hospital, Stanford University, Palo Alto, CA, USA
| | - Shubhayan Sanatani
- Divisions of Cardiology, Department of Pediatrics and Medicine, British Columbia Children’s Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Leonardo Liberman
- Division of Pediatric Cardiology, Morgan Stanley Children’s Hospital, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Juan Pablo Kaski
- Department of Cardiology, Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital for Children, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Boris Rudic
- Medical Faculty Mannheim of the University of Heidelberg, 1st Department of Medicine, Mannheim, Germany
- DZHK (German Centre for Cardiovascular Research), Mannheim, Germany
| | - Sit Yee Kwok
- Department of Paediatric Cardiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Claudine Rieubland
- Division of Human Genetics, Department of Pediatrics, Inselspital, University of Bern, Switzerland
| | - Jacob Tfelt-Hansen
- Faculty of Health and Medical Science, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Denmark
| | - George F Van Hare
- Division of Cardiology, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | | | - Nico A Blom
- Department of Pediatric Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Yanushi D Wijeyeratne
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George’s University of London, London, UK
| | | | - Hervé Le Marec
- L’institut du thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, Nantes, France
| | - Junichi Ozawa
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Sciences, Otsu, Japan
| | - Véronique Fressart
- AP-HP, Hôpital Pitié Salpétrière, Service de Biologie Moléculaire, Paris, France
| | | | - Federica Dagradi
- Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Istituto Auxologico Italiano, Milano, Italy
| | - Carla Spazzolini
- Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Istituto Auxologico Italiano, Milano, Italy
| | - Takeshi Aiba
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - David J Tester
- Division of Heart Rhythm Services, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
- Division of Pediatric Cardiology, Department of Pediatrics, Mayo Clinic, Rochester, MN, USA
- Department of Molecular Pharmacology & Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Laura A Zahavich
- The Hospital for Sick Children, Labbatt Family, Heart Centre, University of Toronto, Toronto, Canada
| | | | - Mangesh Jadhav
- Department of Cardiology, The Royal Children's Hospital, Melbourne, Australia
| | - Jonathan R Skinner
- Greenlane Paediatric and Congenital Cardiac Services, Starship Childrens Hospital, Auckland, New Zealand
- Department of Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Sonia Franciosi
- Divisions of Cardiology, Department of Pediatrics and Medicine, British Columbia Children’s Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Andrew D Krahn
- Divisions of Cardiology, Department of Pediatrics and Medicine, British Columbia Children’s Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Mena Abdelsayed
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, Canada
| | - Peter C Ruben
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, Canada
| | - Tak-Cheung Yung
- Department of Paediatric Cardiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Michael J Ackerman
- Division of Heart Rhythm Services, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
- Division of Pediatric Cardiology, Department of Pediatrics, Mayo Clinic, Rochester, MN, USA
- Department of Molecular Pharmacology & Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Arthur A Wilde
- Department of Clinical and Experimental Cardiology, Heart Centre, Academic Medical Center, Amsterdam, The Netherlands
- Princess Al-Jawhara Al-Brahim Centre of Excellence in Research of Hereditary Disorders, Jeddah, Kingdom of Saudi Arabia
| | - Peter J Schwartz
- Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Istituto Auxologico Italiano, Milano, Italy
| | - Vincent Probst
- L’institut du thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, Nantes, France
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Robyns T, Nuyens D, Vandenberk B, Kuiperi C, Corveleyn A, Breckpot J, Garweg C, Ector J, Willems R. Genotype-phenotype relationship and risk stratification in loss-of-function SCN5A mutation carriers. Ann Noninvasive Electrocardiol 2018; 23:e12548. [PMID: 29709101 DOI: 10.1111/anec.12548] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 02/12/2018] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Loss-of-function (LoF) mutations in the SCN5A gene cause multiple phenotypes including Brugada Syndrome (BrS) and a diffuse cardiac conduction defect. Markers of increased risk for sudden cardiac death (SCD) in LoF SCN5A mutation carriers are ill defined. We hypothesized that late potentials and fragmented QRS would be more prevalent in SCN5A mutation carriers compared to SCN5A-negative BrS patients and evaluated risk markers for SCD in SCN5A mutation carriers. METHODS We included all SCN5A loss-of-function mutation carriers and SCN5A-negative BrS patients from our center. A combined arrhythmic endpoint was defined as appropriate ICD shock or SCD. RESULTS Late potentials were more prevalent in 79 SCN5A mutation carriers compared to 39 SCN5A-negative BrS patients (66% versus 44%, p = .021), while there was no difference in the prevalence of fragmented QRS. PR interval prolongation was the only parameter that predicted the presence of a SCN5A mutation in BrS (OR 1.08; p < .001). Four SCN5A mutation carriers, of whom three did not have a diagnostic type 1 ECG either spontaneously or after provocation with a sodium channel blocker, reached the combined arrhythmic endpoint during a follow-up of 44 ± 52 months resulting in an annual incidence rate of 1.37%. CONCLUSION LP were more frequently observed in SCN5A mutation carriers, while fQRS was not. In SCN5A mutation carriers, the annual incidence rate of SCD was non-negligible, even in the absence of a spontaneous or induced type 1 ECG. Therefore, proper follow-up of SCN5A mutation carriers without Brugada syndrome phenotype is warranted.
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Affiliation(s)
- Tomas Robyns
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Dieter Nuyens
- Department of Cardiology, Ziekenhuis Oost Limburg, Genk, Belgium
| | - Bert Vandenberk
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Cuno Kuiperi
- Department of Human Genetics, University Hospitals Leuven, Leuven, Belgium
| | - Anniek Corveleyn
- Department of Human Genetics, University Hospitals Leuven, Leuven, Belgium
| | - Jeroen Breckpot
- Department of Human Genetics, University Hospitals Leuven, Leuven, Belgium
| | - Christophe Garweg
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Joris Ector
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Rik Willems
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium.,Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
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15
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Abstract
Brugada syndrome (BrS) is one of the commonest inherited primary arrhythmia syndromes typically presenting with arrhythmic syncope or sudden cardiac death (SCD) due to polymorphic ventricular tachycardia and ventricular fibrillation precipitated by vagotonia or fever in apparently healthy adults, less frequently in children. The prevalence of the syndrome (0.01%-0.3%) varies among regions and ethnicities, being the highest in Southeast Asia. BrS is diagnosed by the "coved type" ST-segment elevation≥2mm followed by a negative T-wave in ≥1 of the right precordial leads V1-V2. The typical electrocardiogram in BrS is often concealed by fluctuations between normal, non-diagnostic and diagnostic ST-segment pattern in the same patient, thus hindering the diagnosis. Presently, the majority of BrS patients is incidentally diagnosed, and may remain asymptomatic for their lifetime. However, BrS is responsible for 4-12% of all SCDs and for ~20% of SCDs in patients with structurally normal hearts. Arrhythmic risk is the highest in SCD survivors and in patients with spontaneous BrS electrocardiogram and arrhythmic syncope, but risk stratification for SCD in asymptomatic subjects has not yet been fully defined. Recent achievements have expanded our understanding of the genetics and electrophysiological mechanisms underlying BrS, while radiofrequency catheter ablation may be an effective new approach to treat ventricular tachyarrhythmias in BrS patients with arrhythmic storms. The present review summarizes our contemporary understanding and recent advances in the inheritance, pathophysiology, clinical assessment and treatment of BrS patients.
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Affiliation(s)
- Marija M Polovina
- School of Medicine, Belgrade University, Belgrade, Serbia; Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | | | - Bojan Banko
- Centre for Radiology and MRI, Clinical Centre of Serbia, Belgrade, Serbia
| | - Gregory Y H Lip
- School of Medicine, Belgrade University, Belgrade, Serbia; University of Birmingham, Institute of Cardiovascular Science, City Hospital, Birmingham, United Kingdom
| | - Tatjana S Potpara
- School of Medicine, Belgrade University, Belgrade, Serbia; Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia.
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16
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Abstract
Brugada syndrome (BrS) is an autosomal dominant inherited channelopathy. It is associated with a typical pattern of ST-segment elevation in the precordial leads V1-V3 and potentially lethal ventricular arrhythmias in otherwise healthy patients. It is frequently seen in young Asian males, in whom it has previously been described as sudden unexplained nocturnal death syndrome. Although it typically presents in young adults, it is also known to present in children and infants, especially in the presence of fever. Our understanding of the genetic pathogenesis and management of BrS has grown substantially considering that it has only been 24 years since its first description as a unique clinical entity. However, there remains much to be learned, especially in the pediatric population. This review aims to discuss the epidemiology, genetics, and pathogenesis of BrS. We will also discuss established standards and new innovations in the diagnosis, prognostication, risk stratification, and management of BrS. Literature search was run on the National Center for Biotechnology Information's website, using the Medical Subject Headings (MeSH) database with the search term "Brugada Syndrome" (MeSH), and was run on the PubMed database using the age filter (birth-18 years), yielding 334 results. The abstracts of all these articles were studied, and the articles were categorized and organized. Articles of relevance were read in full. As and where applicable, relevant references and citations from the primary articles were further explored and read in full.
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Affiliation(s)
- Shashank P Behere
- Nemours Cardiac Center, Nemours/Alfred I duPont Hospital for Children, Wilmington, DE, USA
| | - Steven N Weindling
- The Pediatric Specialty Clinic, Overland Park Regional Medical Center, Overland Park, KS 66215, USA
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17
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Van Malderen SCH, Daneels D, Kerkhove D, Peeters U, Theuns DAMJ, Droogmans S, Van Camp G, Weytjens C, Biervliet M, Bonduelle M, Van Dooren S, Brugada P. Prolonged Right Ventricular Ejection Delay in Brugada Syndrome Depends on the Type of SCN5A Variant - Electromechanical Coupling Through Tissue Velocity Imaging as a Bridge Between Genotyping and Phenotyping. Circ J 2017; 82:53-61. [PMID: 28781330 DOI: 10.1253/circj.cj-16-1279] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Patients with Brugada syndrome (BrS) and a history of syncope or sustained ventricular arrhythmia have longer right ventricular ejection delays (RVEDs) than asymptomatic BrS patients. Different types ofSCN5Avariants leading to different reductions in sodium current (INa) may have different effects on conduction delay, and consequently on electromechanical coupling (i.e., RVED). Thus, we investigated the genotype-phenotype relationship by measuring RVED to establish whether BrS patients carrying more severeSCN5Avariants leading to premature protein truncation (T) and presumably 100%INareduction have a longer RVED than patients carrying missense variants (M) with different degrees ofINareduction.Methods and Results:There were 34 BrS patients (mean [±SD] age 43.3±12.9 years; 52.9% male) carrying anSCN5Avariant and 66 non-carriers in this cross-sectional study. Patients carrying aSCN5Avariant were divided into T-carriers (n=13) and M-carriers (n=21). Using tissue velocity imaging, RVED and left ventricular ejection delay (LVED) were measured as the time from QRS onset to the onset of the systolic ejection wave at the end of the isovolumetric contraction. T-carriers had longer RVEDs than M-carriers (139.3±15.1 vs. 124.8±11.9 ms, respectively; P=0.008) and non-carriers (127.7±17.3 ms, P=0.027). There were no differences in LVED among groups. CONCLUSIONS Using the simple, non-invasive echocardiographic parameter RVED revealed a more pronounced 'electromechanical' delay in BrS patients carrying T variants ofSCN5A.
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Affiliation(s)
- Sophie C H Van Malderen
- Department of Electrophysiology (Heart Rhythm Management Centre), Vrije Universiteit Brussel, UZ Brussel.,Department of Cardiology, AZ Nikolaas.,Department of Electrophysiology, Thorax Centre, Erasmus MC
| | - Dorien Daneels
- Centre for Medical Genetics, Reproduction and Genetics, Reproduction Genetics and Regenerative Medicine, Vrije Universiteit Brussel, UZ Brussel
| | - Dirk Kerkhove
- Department of Non-invasive Cardiology, Vrije Universiteit Brussel, UZ Brussel
| | - Uschi Peeters
- Centre for Medical Genetics, Reproduction and Genetics, Reproduction Genetics and Regenerative Medicine, Vrije Universiteit Brussel, UZ Brussel
| | | | - Steven Droogmans
- Department of Non-invasive Cardiology, Vrije Universiteit Brussel, UZ Brussel
| | - Guy Van Camp
- Department of Non-invasive Cardiology, Vrije Universiteit Brussel, UZ Brussel
| | - Caroline Weytjens
- Department of Non-invasive Cardiology, Vrije Universiteit Brussel, UZ Brussel
| | - Martine Biervliet
- Centre for Medical Genetics, Reproduction and Genetics, Reproduction Genetics and Regenerative Medicine, Vrije Universiteit Brussel, UZ Brussel
| | - Maryse Bonduelle
- Centre for Medical Genetics, Reproduction and Genetics, Reproduction Genetics and Regenerative Medicine, Vrije Universiteit Brussel, UZ Brussel
| | - Sonia Van Dooren
- Centre for Medical Genetics, Reproduction and Genetics, Reproduction Genetics and Regenerative Medicine, Vrije Universiteit Brussel, UZ Brussel
| | - Pedro Brugada
- Department of Electrophysiology (Heart Rhythm Management Centre), Vrije Universiteit Brussel, UZ Brussel
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18
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Rai V, Agrawal DK. Role of risk stratification and genetics in sudden cardiac death. Can J Physiol Pharmacol 2016; 95:225-238. [PMID: 27875062 DOI: 10.1139/cjpp-2016-0457] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Sudden cardiac death (SCD) is a major public health issue due to its increasing incidence in the general population and the difficulty in identifying high-risk individuals. Nearly 300 000 - 350 000 patients in the United States and 4-5 million patients in the world die annually from SCD. Coronary artery disease and advanced heart failure are the main etiology for SCD. Ischemia of any cause precipitates lethal arrhythmias, and ventricular tachycardia and ventricular fibrillation are the most common lethal arrhythmias precipitating SCD. Pulseless electrical activity, bradyarrhythmia, and electromechanical dissociation also result in SCD. Most SCDs occur outside of the hospital setting, so it is difficult to estimate the public burden, which results in overestimating the incidence of SCD. The insufficiency and limited predictive value of various indicators and criteria for SCD result in the increasing incidence. As a result, there is a need to develop better risk stratification criteria and find modifiable variables to decrease the incidence. Primary and secondary prevention and treatment of SCD need further research. This critical review is focused on the etiology, risk factors, prognostic factors, and importance of risk stratification of SCD.
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Affiliation(s)
- Vikrant Rai
- Department of Clinical and Translational Science, Creighton University School of Medicine, Omaha, NE 68178, USA.,Department of Clinical and Translational Science, Creighton University School of Medicine, Omaha, NE 68178, USA
| | - Devendra K Agrawal
- Department of Clinical and Translational Science, Creighton University School of Medicine, Omaha, NE 68178, USA
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19
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Wang HG, Zhu W, Kanter RJ, Silva JR, Honeywell C, Gow RM, Pitt GS. A novel NaV1.5 voltage sensor mutation associated with severe atrial and ventricular arrhythmias. J Mol Cell Cardiol 2016; 92:52-62. [PMID: 26801742 PMCID: PMC4789166 DOI: 10.1016/j.yjmcc.2016.01.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 01/12/2016] [Accepted: 01/13/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Inherited autosomal dominant mutations in cardiac sodium channels (NaV1.5) cause various arrhythmias, such as long QT syndrome and Brugada syndrome. Although dozens of mutations throughout the protein have been reported, there are few reported mutations within a voltage sensor S4 transmembrane segment and few that are homozygous. Here we report analysis of a novel lidocaine-sensitive recessive mutation, p.R1309H, in the NaV1.5 DIII/S4 voltage sensor in a patient with a complex arrhythmia syndrome. METHODS AND RESULTS We expressed the wild type or mutant NaV1.5 heterologously for analysis with the patch-clamp and voltage clamp fluorometry (VCF) techniques. p.R1309H depolarized the voltage-dependence of activation, hyperpolarized the voltage-dependence of inactivation, and slowed recovery from inactivation, thereby reducing the channel availability at physiologic membrane potentials. Additionally, p.R1309H increased the "late" Na(+) current. The location of the mutation in DIIIS4 prompted testing for a gating pore current. We observed an inward current at hyperpolarizing voltages that likely exacerbates the loss-of-function defects at resting membrane potentials. Lidocaine reduced the gating pore current. CONCLUSIONS The p.R1309H homozygous NaV1.5 mutation conferred both gain-of-function and loss-of-function effects on NaV1.5 channel activity. Reduction of a mutation-induced gating pore current by lidocaine suggested a therapeutic mechanism.
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Affiliation(s)
- Hong-Gang Wang
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, United States; Ion Channel Research Unit, Duke University Medical Center, Durham, NC, United States
| | - Wandi Zhu
- Department of Biomedical Engineering, Washington University in St. Louis, United States
| | - Ronald J Kanter
- Division of Cardiology, Nicklaus Children's Hospital, Miami, FL, United States
| | - Jonathan R Silva
- Department of Biomedical Engineering, Washington University in St. Louis, United States
| | - Christina Honeywell
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Robert M Gow
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Geoffrey S Pitt
- Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, United States; Ion Channel Research Unit, Duke University Medical Center, Durham, NC, United States; Department of Neurobiology, Duke University Medical Center, Durham, NC, United States.
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20
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Rodríguez-Mañero M, Sacher F, Asmundis CD, Maury P, Lambiase PD, Sarkozy A, Probst V, Gandjbakhch E, Castro-Hevia J, Saenen J, Fukushima Kusano K, Rollin A, Arbelo E, Valderrábano M, Arias MA, Mosquera-Pérez I, Schilling R, Chierchia GB, García-Bolao I, García-Seara J, Hernandez-Ojeda J, Kamakura T, Martínez-Sande L, González-Juanatey JR, Haïssaguerre M, Brugada J, Brugada P. Monomorphic ventricular tachycardia in patients with Brugada syndrome: A multicenter retrospective study. Heart Rhythm 2016; 13:669-82. [DOI: 10.1016/j.hrthm.2015.10.038] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Indexed: 10/22/2022]
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21
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Eckhardt LL. Monomorphic ventricular tachycardia in Brugada syndrome: True-true but related? Heart Rhythm 2015; 13:683-5. [PMID: 26632641 DOI: 10.1016/j.hrthm.2015.11.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Indexed: 01/09/2023]
Affiliation(s)
- Lee L Eckhardt
- Cardiac Electrophysiology, Cellular and Molecular Arrhythmia Research Program, Division of Cardiovascular Medicine, University of Wisconsin-Madison, Madison, Wisconsin.
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22
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Rattanawong P, Vutthikraivit W, Charoensri A, Jongraksak T, Prombandankul A, Kanjanahattakij N, Rungaramsin S, Wisaratapong T, Ngarmukos T. Fever-Induced Brugada Syndrome Is More Common Than Previously Suspected: A Cross-Sectional Study from an Endemic Area. Ann Noninvasive Electrocardiol 2015; 21:136-41. [PMID: 26178440 DOI: 10.1111/anec.12288] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 05/16/2015] [Accepted: 05/22/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Brugada syndrome (BrS) is defined as presenting of type-1 Brugada pattern (BrP). BrS can also be induced by fever. This study demonstrated a highest prevalence of fever-induced BrS ever reported. METHOD During May 2014, febrile (oral temperature ≥ 38 °C) and nonfebrile patients underwent standard and high leads (V1 and V2 at 2nd intercostal space) electrocardiogram. Risk factor and cardiac symptoms were recorded. Patients with a persistent of type-1 BrP after fever had subsided were excluded. The prevalence of BrS, type-2 BrP and early repolarization pattern (ERP) were demonstrated. RESULTS A total of 401 patients, 152 febrile, and 249 nonfebrile, were evaluated. BrS was identified in six febrile patients (five males and one female) and two males in nonfebrile patients. The study demonstrated higher prevalence of BrS in febrile group compared to nonfebrile group (4.0% vs 0.8%, respectively, P = 0.037). Among fever-induced BrS patients, three patients (50.0%) experienced cardiac symptoms before and at the time of presentation and two patients (33.3%) had history of first-degree relative sudden death. No ventricular arrhythmia was observed. All of type-1 BrP disappeared after fever had subsided. We found no difference in prevalence of type-2 BrP in febrile and nonfebrile group (2.0% vs 2.8%, respectively, P > 0.05) as well as ERP (3.3% vs 6.4%, respectively, P > 0.05). CONCLUSIONS Our study showed a highest prevalence of fever induced BrS ever reported. A larger study of prevalence, risk stratification, genetic test and management of fever-induced BrS should be done, especially in an endemic area.
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Affiliation(s)
- Pattara Rattanawong
- Division of Cardiovascular Disease, Department of Internal Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | | | | | | | - Napatt Kanjanahattakij
- Department of Internal Medicine, Queen Savang Vadhana Memorial Hospital, Chonburi, Thailand
| | - Sakda Rungaramsin
- Department of Internal Medicine, Buriram Hospital, Buriram, Thailand
| | - Treechada Wisaratapong
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Prince Songkla University, Songkhla, Thailand
| | - Tachapong Ngarmukos
- Division of Cardiovascular Disease, Department of Internal Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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23
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Daimi H, Khelil AH, Ben Hamda K, Aranega A, Chibani JBE, Franco D. Absence of family history and phenotype-genotype correlation in pediatric Brugada syndrome: more burden to bear in clinical and genetic diagnosis. Pediatr Cardiol 2015; 36:1090-6. [PMID: 25758664 DOI: 10.1007/s00246-015-1133-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 03/04/2015] [Indexed: 11/29/2022]
Abstract
Brugada syndrome (BrS) is an autosomal-dominant genetic cardiac disorder caused in 18-30 % of the cases by SCN5A gene mutations and manifested by an atypical right bundle block pattern with ST segment elevation and T wave inversion in the right precordial leads. The syndrome is usually detected after puberty. The identification of BrS in pediatric patients is thus a rare occurrence, and most of the reported cases are unmasked after febrile episodes. Usually, having a family history of sudden death represents the first reason to perform an ECG in febrile children. However, this practice makes the sporadic cases of cardiac disease and specially the asymptomatic ones excluded from this diagnosis. Here, we report a sporadic case of a 2-month-old male patient presented with vaccination-related fever and ventricular tachycardia associated with short breathing, palpitation and cold sweating. ECG changes were consistent with type 1 BrS. SCN5A gene analysis of the proband and his family revealed a set of mutations and polymorphisms differentially distributed among family members, however, without any clear genotype-phenotype correlation. Based on our findings, we think that genetic testing should be pursued as a routine practice in symptomatic and asymptomatic pediatric cases of BrS, with or without family history of sudden cardiac death. Similarly, our study suggests that pediatrician should be encouraged to perform an ECG profiling in suspicious febrile children and quickly manage fever since it is the most important factor unmasking BrS in children.
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Affiliation(s)
- Houria Daimi
- Department of Experimental Biology, University of Jaen, 23071, Jaén, Spain
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24
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25
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Wilde AAM, Postema PG. Bringing home the bacon? The next step in cardiac sodium channelopathies. J Clin Invest 2014; 125:99-101. [PMID: 25500878 DOI: 10.1172/jci80014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Mutations in SCN5A, which encodes the α subunit of the major cardiac sodium channel Na(V)1.5, are associated with multiple cardiac arrhythmias, including Brugada syndrome. It is not clear why mutations in SCN5A result in such a variety of cardiac phenotypes, and introduction of analogous Scn5a mutations into small-animal models has not recapitulated alterations in cardiac physiology associated with human disease. In this issue of the JCI, Park and colleagues present a pig model of cardiac sodium channelopathy that was generated by introducing a human Brugada syndrome-associated SCN5A allele. This large-animal model exhibits many phenotypes seen in patients with SCN5A loss-of-function mutations and has the potential to provide important insight into sodium channelopathies.
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26
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Park DS, Cerrone M, Morley G, Vasquez C, Fowler S, Liu N, Bernstein SA, Liu FY, Zhang J, Rogers CS, Priori SG, Chinitz LA, Fishman GI. Genetically engineered SCN5A mutant pig hearts exhibit conduction defects and arrhythmias. J Clin Invest 2014; 125:403-12. [PMID: 25500882 DOI: 10.1172/jci76919] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 10/16/2014] [Indexed: 12/19/2022] Open
Abstract
SCN5A encodes the α subunit of the major cardiac sodium channel Na(V)1.5. Mutations in SCN5A are associated with conduction disease and ventricular fibrillation (VF); however, the mechanisms that link loss of sodium channel function to arrhythmic instability remain unresolved. Here, we generated a large-animal model of a human cardiac sodium channelopathy in pigs, which have cardiac structure and function similar to humans, to better define the arrhythmic substrate. We introduced a nonsense mutation originally identified in a child with Brugada syndrome into the orthologous position (E558X) in the pig SCN5A gene. SCN5A(E558X/+) pigs exhibited conduction abnormalities in the absence of cardiac structural defects. Sudden cardiac death was not observed in young pigs; however, Langendorff-perfused SCN5A(E558X/+) hearts had an increased propensity for pacing-induced or spontaneous VF initiated by short-coupled ventricular premature beats. Optical mapping during VF showed that activity often began as an organized focal source or broad wavefront on the right ventricular (RV) free wall. Together, the results from this study demonstrate that the SCN5A(E558X/+) pig model accurately phenocopies many aspects of human cardiac sodium channelopathy, including conduction slowing and increased susceptibility to ventricular arrhythmias.
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27
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Kim G, Kyung YC, Kang IS, Song J, Huh J, On YK. A pediatric case of Brugada syndrome diagnosed by fever-provoked ventricular tachycardia. KOREAN JOURNAL OF PEDIATRICS 2014; 57:374-8. [PMID: 25210526 PMCID: PMC4155183 DOI: 10.3345/kjp.2014.57.8.374] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 09/09/2013] [Accepted: 10/13/2013] [Indexed: 12/01/2022]
Abstract
Brugada syndrome is a rare channelopathy associated with the SCN5A gene that causes fatal ventricular arrhythmias. This case of Brugada syndrome, in which ventricular tachycardia (VT) was provoked by high fever, is the first report in a Korean child. The boy had retinoblastoma of his left eye diagnosed at 16 months of age. After chemotherapy, he contracted a catheter-related infection with a high fever up to 41℃ leading to monomorphic VT. This was characterized as having right bundle branch block morphology, superior axis deviation, and a heart rate of 212/min. Direct current cardioversion recovered the VT to sinus rhythm after a lack of response to amiodarone and lidocaine. A second attack of VT that was not controlled by cardioversion, however, responded to lidocaine. The baseline electrocardiogram showed a long PR interval and QRS duration, and the patient's grandfather had a history of Brugada syndrome. A mutation in SCN5A was identified in this patient, his father, and his grandfather. The patient was treated with quinidine and followed up for 1 year.
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Affiliation(s)
- Geena Kim
- Department of Pediatrics, Pusan National University Children's Hospital, Pusan National University School of Medicine, Yangsan, Korea
| | - Ye-Chan Kyung
- Division of Cardiology, Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - I-Seok Kang
- Division of Cardiology, Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jinyoung Song
- Division of Cardiology, Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - June Huh
- Division of Cardiology, Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Keun On
- Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
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28
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Wolpert C, Parade U, Herrera-Siklody C, Strotmann C, Rüb N. [Ion channel diseases in children]. Herzschrittmacherther Elektrophysiol 2014; 25:148-57. [PMID: 25148918 DOI: 10.1007/s00399-014-0325-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 06/02/2014] [Indexed: 11/30/2022]
Abstract
Ion channel diseases are responsible for the occurrence of supraventricular bradycardia and tachycardia, ventricular tachycardia, syncope and sudden death. In the present paper the specific considerations for diagnostic pathways and therapeutic decision making will be focused on for the largest clinical entities, such as the long QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia and Andersen-Tawil syndrome. All diseases are characterized by a specific pathognomic electrocardiographic (ECG) alteration. For most of the diseases a variety of mutations have been identified that code for different ion channel proteins. All have a high potential of arrhythmogenicity in common. It is important to know that the ECG alterations are often only transient, which makes repetitive recordings and sometimes provocation maneuvers necessary. The time of onset of disease varies so that the initiation of diagnostics starts at different ages. Therapy often remains an individual choice and is influenced by a number of factors, such as a family history of sudden death.
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Affiliation(s)
- Christian Wolpert
- Klinik für Innere Medizin, Kardiologie, Nephrologie und internistische Intensivmedizin, Klinikum Ludwigsburg, Posilipostraße 4, 71640, Ludwigsburg, Deutschland,
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29
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Inherited arrhythmia syndromes leading to sudden cardiac death in the young: a global update and an Indian perspective. Indian Heart J 2013; 66 Suppl 1:S49-57. [PMID: 24568830 DOI: 10.1016/j.ihj.2013.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 11/07/2013] [Indexed: 12/15/2022] Open
Abstract
Inherited primary arrhythmias, namely congenital long QT syndrome, Brugada syndrome and catecholaminergic polymorphic ventricular tachycardia, account for a significant proportion of sudden cardiac deaths in young and apparently healthy individuals. Genetic testing plays an integral role in the diagnosis, risk-stratification and treatment of probands and family members. It is increasingly obvious that collaborative efforts are required to understand and manage these relatively rare but potentially lethal diseases. This article aims to update readers on the recent developments in our knowledge of inherited arrhythmias and to lay the foundation for a national synergistic effort to characterize them in the Indian population.
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31
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KATO KOICHI, MAKIYAMA TAKERU, WU JIE, DING WEIGUANG, KIMURA HIROMI, NAIKI NOBU, OHNO SEIKO, ITOH HIDEKI, NAKANISHI TOSHIO, MATSUURA HIROSHI, HORIE MINORU. Cardiac Channelopathies Associated with Infantile Fatal Ventricular Arrhythmias: From the Cradle to the Bench. J Cardiovasc Electrophysiol 2013; 25:66-73. [DOI: 10.1111/jce.12270] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 07/16/2013] [Accepted: 08/12/2013] [Indexed: 11/29/2022]
Affiliation(s)
- KOICHI KATO
- Department of Cardiovascular and Respiratory Medicine; Shiga University of Medical Science; Shiga Japan
| | - TAKERU MAKIYAMA
- Department of Cardiovascular Medicine; Kyoto University Graduate School of Medicine; Kyoto Japan
| | - JIE WU
- Department of Cardiovascular and Respiratory Medicine; Shiga University of Medical Science; Shiga Japan
- Department of Pharmacology; Medical School of Xi'an Jiaotong University; Xi'an China
| | - WEI-GUANG DING
- Department of Physiology; Shiga University of Medical Science; Shiga Japan
| | - HIROMI KIMURA
- Department of Cardiovascular and Respiratory Medicine; Shiga University of Medical Science; Shiga Japan
| | - NOBU NAIKI
- Department of Cardiovascular and Respiratory Medicine; Shiga University of Medical Science; Shiga Japan
| | - SEIKO OHNO
- Department of Cardiovascular and Respiratory Medicine; Shiga University of Medical Science; Shiga Japan
| | - HIDEKI ITOH
- Department of Cardiovascular and Respiratory Medicine; Shiga University of Medical Science; Shiga Japan
| | - TOSHIO NAKANISHI
- Department of Pediatric Cardiology; Tokyo Women's Medical University; Tokyo Japan
| | - HIROSHI MATSUURA
- Department of Physiology; Shiga University of Medical Science; Shiga Japan
| | - MINORU HORIE
- Department of Cardiovascular and Respiratory Medicine; Shiga University of Medical Science; Shiga Japan
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Adler A, Topaz G, Heller K, Zeltser D, Ohayon T, Rozovski U, Halkin A, Rosso R, Ben-Shachar S, Antzelevitch C, Viskin S. Fever-induced Brugada pattern: how common is it and what does it mean? Heart Rhythm 2013; 10:1375-82. [PMID: 23872691 DOI: 10.1016/j.hrthm.2013.07.030] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Indexed: 01/08/2023]
Abstract
BACKGROUND Fever is known to unmask the Brugada pattern on the electrocardiogram (ECG) and trigger ventricular arrhythmias in patients with Brugada syndrome. Genetic studies in selected cases with fever-induced Brugada pattern have identified disease-causing mutations. Thus, "fever-induced Brugada" is a recognized clinical entity. However, its prevalence has not been systematically evaluated. OBJECTIVE The purpose of this study was to assess the prevalence of Brugada pattern in consecutive patients with fever. METHODS ECGs of patients with fever admitted to the emergency department were evaluated for the presence of Brugada pattern and compared with ECGs of consecutive nonfebrile patients. RESULTS ECGs of 402 patients with fever and 909 without were evaluated. Type I Brugada pattern was 20 times more common in the febrile group than in the afebrile group (2% vs. 0.1%, respectively, P = .0001). All patients with fever-induced type I Brugada pattern were asymptomatic and remained so during 30 months of follow-up. CONCLUSION Type I Brugada pattern is definitively more common among patients with fever, suggesting that asymptomatic Brugada syndrome is more prevalent than previously estimated.
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Affiliation(s)
- Arnon Adler
- Department of Cardiology, Tel-Aviv Sourasky Medical Center and Sackler School of Medicine, Tel-Aviv University, Israel
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Wilders R. Cardiac ion channelopathies and the sudden infant death syndrome. ISRN CARDIOLOGY 2012; 2012:846171. [PMID: 23304551 PMCID: PMC3529486 DOI: 10.5402/2012/846171] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 10/23/2012] [Indexed: 12/13/2022]
Abstract
The sudden infant death syndrome (SIDS) causes the sudden death of an apparently healthy infant, which remains unexplained despite a thorough investigation, including the performance of a complete autopsy. The triple risk model for the pathogenesis of SIDS points to the coincidence of a vulnerable infant, a critical developmental period, and an exogenous stressor. Primary electrical diseases of the heart, which may cause lethal arrhythmias as a result of dysfunctioning cardiac ion channels (“cardiac ion channelopathies”) and are not detectable during a standard postmortem examination, may create the vulnerable infant and thus contribute to SIDS. Evidence comes from clinical correlations between the long QT syndrome and SIDS as well as genetic analyses in cohorts of SIDS victims (“molecular autopsy”), which have revealed a large number of mutations in ion channel-related genes linked to inheritable arrhythmogenic syndromes, in particular the long QT syndrome, the short QT syndrome, the Brugada syndrome, and catecholaminergic polymorphic ventricular tachycardia. Combining data from population-based cohort studies, it can be concluded that at least one out of five SIDS victims carries a mutation in a cardiac ion channel-related gene and that the majority of these mutations are of a known malignant phenotype.
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Affiliation(s)
- Ronald Wilders
- Department of Anatomy, Embryology and Physiology, Heart Failure Research Center, Academic Medical Center, University of Amsterdam, P.O. Box 22700, 1100 DE Amsterdam, The Netherlands
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Eckhardt LL. Phenotype, genotype, and cellular physiology: Need for clarity in characterization. Heart Rhythm 2012; 9:1993-4. [DOI: 10.1016/j.hrthm.2012.08.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Indexed: 11/27/2022]
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