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Younis A, Wilkoff BL. Implantable Cardioverter-Defibrillator for Primary Prevention in Asia. JACC. ASIA 2023; 3:321-334. [PMID: 37323870 PMCID: PMC10261897 DOI: 10.1016/j.jacasi.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/16/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
In a contemporary setting, where the risk of sudden cardiac death (SCD) is low, heart failure management is improved, and technology is advanced, identifying the patients who would benefit the most from an implantable cardioverter-defibrillator (ICD) treatment for primary prevention remains a challenge. The prevalence of SCD is lower in Asia when compared with the United States/Europe (35-45 per 100,000 person-years vs 55-100 per 100,000 person-years, respectively). Nevertheless, this should not explain the enormous gap in ICD's utilization among eligible candidates (∼12% in Asia vs ∼45% in the United States/Europe). The disparity between Asia and Western countries, together with significant variation among the Asian population and the previously mentioned challenges, requires an individualized approach and specific regional recommendation, especially in countries with limited resources where ICDs are being extremely underutilized This review focuses on the current knowledge of ICD therapy for SCD prevention and how to improve patient and device selection.
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Affiliation(s)
| | - Bruce L. Wilkoff
- Address for correspondence: Dr Bruce L. Wilkoff, Department of Cardiovascular Medicine, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, 9500 Euclid Avenue, Desk J2-2, Cleveland, Ohio 44195, USA. @BruceWilkoff
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2
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Andrzejewska M, Żebrowski JJ, Rams K, Ozimek M, Baranowski R. Assessment of time irreversibility in a time series using visibility graphs. FRONTIERS IN NETWORK PHYSIOLOGY 2022; 2:877474. [PMID: 36926071 PMCID: PMC10013024 DOI: 10.3389/fnetp.2022.877474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 08/24/2022] [Indexed: 11/07/2022]
Abstract
In this paper, we studied the time-domain irreversibility of time series, which is a fundamental property of systems in a nonequilibrium state. We analyzed a subgroup of the databases provided by University of Rochester, namely from the THEW Project. Our data consists of LQTS (Long QT Syndrome) patients and healthy persons. LQTS may be associated with an increased risk of sudden cardiac death (SCD), which is still a big clinical problem. ECG-based artificial intelligence methods can identify sudden cardiac death with a high accuracy. It follows that heart rate variability contains information about the possibility of SCD, which may be extracted, provided that appropriate methods are developed for this purpose. Our aim was to assess the complexity of both groups using visibility graph (VG) methods. Multivariate analysis of connection patterns of graphs built from time series was performed using multiplex visibility graph methods. For univariate time series, time irreversibility of the ECG interval QT of patients with LQTS was lower than for the healthy. However, we did not observe statistically significant difference in the comparison of RR intervals time series of the two groups studied. The connection patterns retrieved from multiplex VGs have more similarity with each other in the case of LQTS patients. This observation may be used to develop better methods for SCD risk stratification.
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Affiliation(s)
- Małgorzata Andrzejewska
- Cardiovascular Physics Group, Physics of Complex Systems Division, Faculty of Physics, Warsaw University of Technology, Warszawa, Poland
| | - Jan J Żebrowski
- Cardiovascular Physics Group, Physics of Complex Systems Division, Faculty of Physics, Warsaw University of Technology, Warszawa, Poland
| | - Karolina Rams
- Cardiovascular Physics Group, Physics of Complex Systems Division, Faculty of Physics, Warsaw University of Technology, Warszawa, Poland
| | - Mateusz Ozimek
- Cardiovascular Physics Group, Physics of Complex Systems Division, Faculty of Physics, Warsaw University of Technology, Warszawa, Poland
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3
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Sharma AN, Baranchuk A. Ambulatory External Electrocardiography Monitoring: Holter, Extended Holter, Mobile Cardiac Telemetry Monitoring. Card Electrophysiol Clin 2021; 13:427-438. [PMID: 34330370 DOI: 10.1016/j.ccep.2021.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Ambulatory external electrocardiography (AECG) monitoring is effective as an evidence-based diagnostic tool when suspicion for cardiac arrhythmia is high. Multiple modalities of AECG monitoring exist, with unique advantages and limitations that predict effectiveness in a variety of clinical settings. Knowledge of these characteristics allows appropriate use of AECG, maximizing patient adherence, diagnostic yield, and cost-effectiveness. In addition, new technology has allowed the development of a modern generation of devices that offer increased efficacy and functionality compared with Holter monitors.
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Affiliation(s)
- Arjun N Sharma
- Internal Medicine, Department of Medicine, Kingston General Hospital, Queen's University, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada
| | - Adrian Baranchuk
- Department of Cardiac Electrophysiology and Pacing, Kingston General Hospital, Kingston, Ontario, Canada; Department of Cardiology, Kingston General Hospital, Queen's University, 76 Stuart Street, Kingston, Ontario K7L 2V7, Canada.
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4
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Micaglio E, Locati ET, Monasky MM, Romani F, Heilbron F, Pappone C. Role of Pharmacogenetics in Adverse Drug Reactions: An Update towards Personalized Medicine. Front Pharmacol 2021; 12:651720. [PMID: 33995067 PMCID: PMC8120428 DOI: 10.3389/fphar.2021.651720] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 03/29/2021] [Indexed: 12/28/2022] Open
Abstract
Adverse drug reactions (ADRs) are an important and frequent cause of morbidity and mortality. ADR can be related to a variety of drugs, including anticonvulsants, anaesthetics, antibiotics, antiretroviral, anticancer, and antiarrhythmics, and can involve every organ or apparatus. The causes of ADRs are still poorly understood due to their clinical heterogeneity and complexity. In this scenario, genetic predisposition toward ADRs is an emerging issue, not only in anticancer chemotherapy, but also in many other fields of medicine, including hemolytic anemia due to glucose-6-phosphate dehydrogenase (G6PD) deficiency, aplastic anemia, porphyria, malignant hyperthermia, epidermal tissue necrosis (Lyell's Syndrome and Stevens-Johnson Syndrome), epilepsy, thyroid diseases, diabetes, Long QT and Brugada Syndromes. The role of genetic mutations in the ADRs pathogenesis has been shown either for dose-dependent or for dose-independent reactions. In this review, we present an update of the genetic background of ADRs, with phenotypic manifestations involving blood, muscles, heart, thyroid, liver, and skin disorders. This review aims to illustrate the growing usefulness of genetics both to prevent ADRs and to optimize the safe therapeutic use of many common drugs. In this prospective, ADRs could become an untoward "stress test," leading to new diagnosis of genetic-determined diseases. Thus, the wider use of pharmacogenetic testing in the work-up of ADRs will lead to new clinical diagnosis of previously unsuspected diseases and to improved safety and efficacy of therapies. Improving the genotype-phenotype correlation through new lab techniques and implementation of artificial intelligence in the future may lead to personalized medicine, able to predict ADR and consequently to choose the appropriate compound and dosage for each patient.
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Affiliation(s)
- Emanuele Micaglio
- Arrhythmology and Electrophysiology Department, IRCCS Policlinico San Donato, Milan, Italy
| | - Emanuela T Locati
- Arrhythmology and Electrophysiology Department, IRCCS Policlinico San Donato, Milan, Italy
| | - Michelle M Monasky
- Arrhythmology and Electrophysiology Department, IRCCS Policlinico San Donato, Milan, Italy
| | - Federico Romani
- Arrhythmology and Electrophysiology Department, IRCCS Policlinico San Donato, Milan, Italy.,Vita-Salute San Raffaele University, (Vita-Salute University) for Federico Romani, Milan, Italy
| | | | - Carlo Pappone
- Arrhythmology and Electrophysiology Department, IRCCS Policlinico San Donato, Milan, Italy.,Vita-Salute San Raffaele University, (Vita-Salute University) for Federico Romani, Milan, Italy
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5
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Cortez D, Zareba W, McNitt S, Polonsky B, Rosero SZ, Platonov PG. Quantitative T-wave morphology assessment from surface ECG is linked with cardiac events risk in genotype-positive KCNH2 mutation carriers with normal QTc values. J Cardiovasc Electrophysiol 2019; 30:2907-2913. [PMID: 31579959 DOI: 10.1111/jce.14210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 09/14/2019] [Accepted: 09/18/2019] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Long QT syndrome (LQTS) mutation carriers have elevated the risk of cardiac events even in the absence of QTc prolongation; however, mutation penetrance in patients with normal QTc may be reflected in abnormal T-wave shape, particularly in KCNH2 mutation carriers. We aimed to assess whether the magnitude of a three-dimensional T-wave vector (TwVM) will identify KCNH2-mutation carriers with normal QTc at risk for cardiac events. METHODS Adult LQT2 patients with QTc < 460 ms in men and <470 ms in women (n = 113, age 42 ± 16 years, 43% male) were compared with genotype-negative family members (n = 1007). The TwVM was calculated using T-wave amplitudes in leads V6, II, and V2 as the square root of (TV62 + TII2 + (0.5*TV2)2 ). Cox regression analysis adjusted for gender and time-dependent beta-blocker use was performed to assess cardiac event (CE) risk, defined as syncope, aborted cardiac arrest, implantable cardioverter-defibrillator therapy, or sudden death. RESULTS Dichotomized by median of 0.30 mV, lower TwVM was associated with elevated CE risk compared to those with high TwVM (HR = 2.95, 95% CI, 1.25-6.98, P = .014) and also remained significant after including sex and time-dependent beta-blocker usage in the Cox regression analysis (HR = 2.64, 95% CI, 1.64-4.24, P < .001). However, these associations were found only in women but not in men who had low event rates. CONCLUSION T-wave morphology quantified as repolarization vector magnitude using T-wave amplitudes retrieved from standard 12-lead electrocardiogram predicts cardiac events risk in LQT2 women and appears useful for risk stratification of KCNH2-mutation carriers without QTc prolongation.
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Affiliation(s)
- Daniel Cortez
- Clinical Sciences, Cardiology, Lund University, Lund, Sweden.,Pediatric Cardiology and Electrophysiology, University of Minnesota/Masonic Children's Hospital, Minneapolis, Minnesota
| | - Wojciech Zareba
- Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, New York
| | - Scott McNitt
- Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, New York
| | - Bronislava Polonsky
- Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, New York
| | - Spencer Z Rosero
- Heart Research Follow-up Program, University of Rochester Medical Center, Rochester, New York
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6
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Pérez-Riera AR, Barbosa-Barros R, Daminello Raimundo R, da Costa de Rezende Barbosa MP, Esposito Sorpreso IC, de Abreu LC. The congenital long QT syndrome Type 3: An update. Indian Pacing Electrophysiol J 2018; 18:25-35. [PMID: 29101013 PMCID: PMC5840852 DOI: 10.1016/j.ipej.2017.10.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 10/27/2017] [Accepted: 10/30/2017] [Indexed: 01/28/2023] Open
Abstract
Congenital long QT syndrome type 3 (LQT3) is the third in frequency compared to the 15 forms known currently of congenital long QT syndrome (LQTS). Cardiac events are less frequent in LQT3 when compared with LQT1 and LQT2, but more likely to be lethal; the likelihood of dying during a cardiac event is 20% in families with an LQT3 mutation and 4% with either an LQT1 or an LQT2 mutation. LQT3 is consequence of mutation of gene SCN5A which codes for the Nav1.5 Na+ channel α-subunit and electrocardiographically characterized by a tendency to bradycardia related to age, prolonged QT/QTc interval (mean QTc value 478 ± 52 ms), accentuated QT dispersion consequence of prolonged ST segment, late onset of T wave and frequent prominent U wave because of longer repolarization of the M cell across left ventricular wall.
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Affiliation(s)
- Andrés Ricardo Pérez-Riera
- Metodologia da Pesquisa e Escrita Científica da Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil.
| | - Raimundo Barbosa-Barros
- Centro Coronariano do Hospital de Messejana Dr. Carlos Alberto Studart Gomes, Fortaleza, Ceará, Brazil
| | - Rodrigo Daminello Raimundo
- Metodologia da Pesquisa e Escrita Científica da Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil
| | | | | | - Luiz Carlos de Abreu
- Program in Molecular and Integrative Physiological Sciences (MIPS), Department of Environmental Health, Harvard T.H. Chan School of Public Health, USA
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7
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Méndez-Giráldez R, Gogarten SM, Below JE, Yao J, Seyerle AA, Highland HM, Kooperberg C, Soliman EZ, Rotter JI, Kerr KF, Ryckman KK, Taylor KD, Petty LE, Shah SJ, Conomos MP, Sotoodehnia N, Cheng S, Heckbert SR, Sofer T, Guo X, Whitsel EA, Lin HJ, Hanis CL, Laurie CC, Avery CL. GWAS of the electrocardiographic QT interval in Hispanics/Latinos generalizes previously identified loci and identifies population-specific signals. Sci Rep 2017; 7:17075. [PMID: 29213071 PMCID: PMC5719082 DOI: 10.1038/s41598-017-17136-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 11/21/2017] [Indexed: 01/08/2023] Open
Abstract
QT interval prolongation is a heritable risk factor for ventricular arrhythmias and can predispose to sudden death. Most genome-wide association studies (GWAS) of QT were performed in European ancestral populations, leaving other groups uncharacterized. Herein we present the first QT GWAS of Hispanic/Latinos using data on 15,997 participants from four studies. Study-specific summary results of the association between 1000 Genomes Project (1000G) imputed SNPs and electrocardiographically measured QT were combined using fixed-effects meta-analysis. We identified 41 genome-wide significant SNPs that mapped to 13 previously identified QT loci. Conditional analyses distinguished six secondary signals at NOS1AP (n = 2), ATP1B1 (n = 2), SCN5A (n = 1), and KCNQ1 (n = 1). Comparison of linkage disequilibrium patterns between the 13 lead SNPs and six secondary signals with previously reported index SNPs in 1000G super populations suggested that the SCN5A and KCNE1 lead SNPs were potentially novel and population-specific. Finally, of the 42 suggestively associated loci, AJAP1 was suggestively associated with QT in a prior East Asian GWAS; in contrast BVES and CAP2 murine knockouts caused cardiac conduction defects. Our results indicate that whereas the same loci influence QT across populations, population-specific variation exists, motivating future trans-ethnic and ancestrally diverse QT GWAS.
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Affiliation(s)
| | | | - Jennifer E Below
- The Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jie Yao
- The Institute for Translational Genomics and Population Sciences and Department of Pediatrics, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Amanda A Seyerle
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA.,Division of Epidemiology and Community, University of Minnesota, Minneapolis, MN, USA
| | - Heather M Highland
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Charles Kooperberg
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Elsayed Z Soliman
- Department of Internal Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston-Salem, NC, USA.,Epidemiological Cardio Research Center (EPICARE), Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jerome I Rotter
- The Institute for Translational Genomics and Population Sciences and Department of Pediatrics, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Kathleen F Kerr
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Kelli K Ryckman
- Departments of Epidemiology and Pediatrics, University of Iowa, Iowa City, IA, USA
| | - Kent D Taylor
- The Institute for Translational Genomics and Population Sciences and Department of Pediatrics, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Lauren E Petty
- Human Genetics Center, University of Texas, Health Science Center at Houston, Houston, TX, USA.,Center for Precision Medicine, University of Texas, Health Science Center at Houston, Houston, TX, USA
| | - Sanjiv J Shah
- Division of Cardiology, Bluhm Cardiovascular Institute, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Matthew P Conomos
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Nona Sotoodehnia
- Cardiovascular Health Research Unit, University of Washington, Seattle, WA, USA.,Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Susan Cheng
- Brigham and Women's Hospital, Division of Cardiovascular Medicine, Boston, MA, USA
| | - Susan R Heckbert
- Cardiovascular Health Research Unit, University of Washington, Seattle, WA, USA.,Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Tamar Sofer
- Department of Biostatistics, University of Washington, Seattle, WA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA.,Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Boston, MA, USA
| | - Xiuqing Guo
- The Institute for Translational Genomics and Population Sciences and Department of Pediatrics, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Eric A Whitsel
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA.,Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Henry J Lin
- The Institute for Translational Genomics and Population Sciences and Department of Pediatrics, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA.,Division of Medical Genetics, Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Craig L Hanis
- Human Genetics Center, University of Texas, Health Science Center at Houston, Houston, TX, USA
| | - Cathy C Laurie
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Christy L Avery
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA. .,Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA.
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8
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Cortez D, Bos JM, Ackerman MJ. Vectorcardiography identifies patients with electrocardiographically concealed long QT syndrome. Heart Rhythm 2017; 14:894-899. [PMID: 28279743 DOI: 10.1016/j.hrthm.2017.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Long QT syndrome (LQTS) and genotypic subtypes are associated with distinctive T-wave patterns, arrhythmogenic triggers, and corrected QT (QTc) interval risk associations. Twenty percent of patients with LQTS have normal QTc values, defined as electrographically concealed LQTS (ecLQTS). Vectorcardiography (VCG) has value for sudden cardiac death risk assessment. OBJECTIVE The purpose of this study was to determine the use of VCG to identify patients with ecLQTS. METHODS We performed a retrospective analysis in patients with ecLQTS with resting QTc values <440 ms. Computerized derivation of the spatial mean and peak QRS-T angles, QTpeak, Tpeak-Tend (angle between QRS and T-wave peak amplitudes in 3-dimensional space), and T-wave eigenvalues (TwEVs; amplitudes [in microvolts] for each of the first 4 TwEVs were derived from the 12-lead electrocardiogram) was performed. The results were compared with those for healthy controls. Intergenotype differences were analyzed. RESULTS Of 610 patients with LQTS, 169 patients (28%) had ecLQTS (86 (51%) men; mean age 22 ± 16 years; mean QTc interval 422 ± 14 ms). There were 519 healthy controls (44% men; mean age 19.8 ± 13.8 years) with a mean QTc interval of 426 ± 28 ms. Among VCG parameters, QTpeak and TwEVs significantly differentiated patients with ecLQTS from controls (P ≤ .01 for each) as well as differentiated KCNQ1-encoded type 1 LQTS (ecLQT1), KCNH2-encoded type 2 LQTS (ecLQT2), and SCN5A-encoded type 3 LQTS (ecLQT3) from controls (P < .01). ecLQT3 was differentiated from controls and ecLQT1 and ecLQT2 by the fourth TwEV (P < .01 for each). The fourth TwEV differentiated symptomatic patients with ecLQTS from asymptomatic patients with ecLQTS (P < .01). CONCLUSION ecLQTS can be distinguished from controls using QTpeak. ecLQT3 was best differentiated by the fourth TwEV. VCG may facilitate familial diagnostic anticipation of LQTS status before the completion of mutation-specific genetic testing even with normal resting QTc values.
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Affiliation(s)
- Daniel Cortez
- Department of Electrophysiology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania; Clinical Sciences, Lund University, Lund, Sweden
| | - J Martijn Bos
- Departments of Cardiovascular Diseases, Pediatrics, and Molecular Pharmacology and Experimental Therapeutics, Divisions of Heart Rhythm Services and Pediatric Cardiology, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, Minnesota
| | - Michael J Ackerman
- Departments of Cardiovascular Diseases, Pediatrics, and Molecular Pharmacology and Experimental Therapeutics, Divisions of Heart Rhythm Services and Pediatric Cardiology, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, Minnesota.
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9
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Seidman M, Mitchell R. Fundamental Principles in Cardiovascular Genetics. Cardiovasc Pathol 2016. [DOI: 10.1016/b978-0-12-420219-1.00006-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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10
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Desimone CV, Bos JM, Bos KM, Liang JJ, Patel NA, Hodge DO, Noheria A, Asirvatham SJ, Ackerman MJ. Effects on repolarization using dynamic QT interval monitoring in long-QT patients following left cardiac sympathetic denervation. J Cardiovasc Electrophysiol 2015; 26:434-439. [PMID: 25559122 DOI: 10.1111/jce.12609] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 12/02/2014] [Accepted: 12/10/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND Videoscopic left cardiac sympathetic denervation (LCSD) is an adjunct therapy for reduction of arrhythmia-induced events in patients with long-QT syndrome (LQTS). LCSD reduces LQTS-triggered breakthrough cardiac events. The temporal effects of QTc changes post-LCSD have not been studied. METHODS We utilized continuous QTc monitoring on 72 patients with LQTS. We evaluated acute and long-term QTc changes in comparison to 12-lead ECG-derived QTc values prior to surgery, 24 hours postsurgery, and at follow up ≥3 months. RESULTS Seventy-two patients underwent LCSD at our institution (46% male, mean age at LCSD was 14 ± 10 years). The mean baseline, pre-LCSD QTc was 505 ± 56 ms, which had decreased significantly at ≥3 months post-LCSD to 491 ± 40 ms (P = 0.001). QTc monitoring revealed that the majority of the cohort (53/72; 74%) had a transient increase >30 ms in QTc from baseline, with an average maximum increase of 72 ± 30 ms. Resolution within 10 ms of baseline or less occurred in 57% (30/53) at 24 hours post-LCSD. CONCLUSIONS Although LQTS patients may have a paradoxically increased QTc post-LCSD, the effects are transient in most patients. Importantly, no patients experienced any arrhythmias in the postoperative setting related to this transient rise in QTc.
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Affiliation(s)
| | - J Martijn Bos
- Department of Pediatric and Adolescent Medicine, Mayo Clinic Rochester, Minnesota, USA
| | - Katy M Bos
- Department of Nursing, Mayo Clinic, Rochester, Minnesota, USA
| | - Jackson J Liang
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - David O Hodge
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida, USA
| | - Amit Noheria
- Division of Cardiovascular Diseases, Rochester, Minnesota, USA
| | - Samuel J Asirvatham
- Division of Cardiovascular Diseases, Rochester, Minnesota, USA.,Department of Pediatric and Adolescent Medicine, Mayo Clinic Rochester, Minnesota, USA
| | - Michael J Ackerman
- Division of Cardiovascular Diseases, Rochester, Minnesota, USA.,Department of Pediatric and Adolescent Medicine, Mayo Clinic Rochester, Minnesota, USA
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11
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Postema PG, Wilde AAM. The measurement of the QT interval. Curr Cardiol Rev 2014; 10:287-94. [PMID: 24827793 PMCID: PMC4040880 DOI: 10.2174/1573403x10666140514103612] [Citation(s) in RCA: 182] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 06/10/2013] [Accepted: 01/28/2014] [Indexed: 12/14/2022] Open
Abstract
The evaluation of every electrocardiogram should also include an effort to interpret the QT interval to assess the risk of malignant arrhythmias and sudden death associated with an aberrant QT interval. The QT interval is measured from the beginning of the QRS complex to the end of the T-wave, and should be corrected for heart rate to enable comparison with reference values. However, the correct determination of the QT interval, and its value, appears to be a daunting task. Although computerized analysis and interpretation of the QT interval are widely available, these might well over- or underestimate the QT interval and may thus either result in unnecessary treatment or preclude appropriate measures to be taken. This is particularly evident with difficult T-wave morphologies and technically suboptimal ECGs. Similarly, also accurate manual assessment of the QT interval appears to be difficult for many physicians worldwide. In this review we delineate the history of the measurement of the QT interval, its underlying pathophysiological mechanisms and the current standards of the measurement of the QT interval, we provide a glimpse into the future and we discuss several issues troubling accurate measurement of the QT interval. These issues include the lead choice, U-waves, determination of the end of the T-wave, different heart rate correction formulas, arrhythmias and the definition of normal and aberrant QT intervals. Furthermore, we provide recommendations that may serve as guidance to address these complexities and which support accurate assessment of the QT interval and its interpretation.
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Affiliation(s)
| | - Arthur A M Wilde
- Department of Cardiology, Academic Medical Center, P.O. box 22660, 1100 DD Amsterdam, The Netherlands.
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12
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13
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Vickers Saarel E, Etheridge SP. Congenital long QT syndrome: The race to refine risk. Heart Rhythm 2014; 11:83-4. [DOI: 10.1016/j.hrthm.2013.10.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Indexed: 11/25/2022]
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14
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Abstract
Over the past 2 decades, a number of inherited cardiac arrhythmias, including congenital long QT syndrome (LQTS) and Brugada syndrome (BrS), have been shown to have a link to mutations in genes encoding for ion channels or other membrane components. The recent HRS/EHRA/APHRS expert consensus statement on the diagnosis and management of patients with inherited arrhythmia syndromes has updated the clinical diagnosis of congenital LQTS and BrS. Genetic studies have identified 13 forms of congenital LQTS in 50-80% of clinically affected patients. Genotype-phenotype correlations have been investigated in the 3 major genotypes, LQT1, LQT2 and LQT3 syndromes, resulting in genotype-specific management and therapy. More detailed analyses of each genotype have suggested mutation location-, type-, or function-specific differences in clinical phenotype among the LQT1, LQT2, and possibly LQT3 genotypes. In BrS, only one-third of affected patients can be genotyped, mainly in the sodium channel gene, SCN5A; therefore, clinical studies of genotype-phenotype relationships have been limited. More recently, a genome-wide association study using a gene array explored the role of common genetic variants (polymorphisms) as the susceptible or modifier gene in both congenital LQTS and BrS.
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Affiliation(s)
- Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School
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Cooper DN, Krawczak M, Polychronakos C, Tyler-Smith C, Kehrer-Sawatzki H. Where genotype is not predictive of phenotype: towards an understanding of the molecular basis of reduced penetrance in human inherited disease. Hum Genet 2013; 132:1077-130. [PMID: 23820649 PMCID: PMC3778950 DOI: 10.1007/s00439-013-1331-2] [Citation(s) in RCA: 407] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 06/15/2013] [Indexed: 02/06/2023]
Abstract
Some individuals with a particular disease-causing mutation or genotype fail to express most if not all features of the disease in question, a phenomenon that is known as 'reduced (or incomplete) penetrance'. Reduced penetrance is not uncommon; indeed, there are many known examples of 'disease-causing mutations' that fail to cause disease in at least a proportion of the individuals who carry them. Reduced penetrance may therefore explain not only why genetic diseases are occasionally transmitted through unaffected parents, but also why healthy individuals can harbour quite large numbers of potentially disadvantageous variants in their genomes without suffering any obvious ill effects. Reduced penetrance can be a function of the specific mutation(s) involved or of allele dosage. It may also result from differential allelic expression, copy number variation or the modulating influence of additional genetic variants in cis or in trans. The penetrance of some pathogenic genotypes is known to be age- and/or sex-dependent. Variable penetrance may also reflect the action of unlinked modifier genes, epigenetic changes or environmental factors. At least in some cases, complete penetrance appears to require the presence of one or more genetic variants at other loci. In this review, we summarize the evidence for reduced penetrance being a widespread phenomenon in human genetics and explore some of the molecular mechanisms that may help to explain this enigmatic characteristic of human inherited disease.
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Affiliation(s)
- David N. Cooper
- Institute of Medical Genetics, School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4XN UK
| | - Michael Krawczak
- Institute of Medical Informatics and Statistics, Christian-Albrechts University, 24105 Kiel, Germany
| | | | - Chris Tyler-Smith
- The Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, Cambridge, CB10 1SA UK
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Instability of ventricular repolarization in long QT syndrome: Is the corrected QT interval sufficient for risk assessment? Heart Rhythm 2013; 10:1176-7. [DOI: 10.1016/j.hrthm.2013.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Indexed: 11/18/2022]
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Odening KE, Brunner M. Risk stratification in long QT syndrome: Are we finally getting closer to a mutation-specific assessment of an individual patient’s arrhythmogenic risk? Heart Rhythm 2013; 10:726-7. [DOI: 10.1016/j.hrthm.2013.02.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Indexed: 01/06/2023]
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