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Hermida A, Jedraszak G, Ader F, Denjoy I, Fressart V, Maury P, Beyls C, Bloch A, Clerici G, Daire E, Defaye P, Dupin-Deguine D, Garçon L, Klug D, Ginglinger E, Hermida JS, Jesel L, Khraiche D, Kubala M, Lacotte J, Laredo M, Leenhardt A, Le Guillou X, Lesaffre F, Maltret A, Magnin-Poull I, Marijon E, Nambot S, Neyroud N, Ninni S, Palmyre A, Pasquie JL, Proukhnitzky J, Reant P, Richard P, Rollin A, Rooryck C, Sacher F, Schaefer E, Vernier A, Winum PF, Wahbi K, Waintraub X, Waldmann V, Weber S, Zouaghi A, Charron P, Extramiana F, Gandjbakhch E. Systematic analysis of SCN5A variants associated with inherited cardiac diseases. Heart Rhythm 2024:S1547-5271(24)03136-9. [PMID: 39134129 DOI: 10.1016/j.hrthm.2024.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 07/19/2024] [Accepted: 08/07/2024] [Indexed: 09/08/2024]
Abstract
BACKGROUND SCN5A variants are associated with a spectrum of cardiac electrical disorders with clear phenotypes. However, they may also be associated with complex phenotypic traits like overlap syndromes or pleiotropy, which have not been systematically described. In addition, the involvement of SCN5A in dilated cardiomyopathies (DCMs) remains controversial. OBJECTIVE We aimed to evaluate the different phenotypes associated with pathogenic (P)/likely pathogenic (LP) SCN5A variants and to determine the prevalence of pleiotropy in a large multicentric cohort of P/LP SCN5A variant carriers. METHODS The DNA of 13,510 consecutive probands (9960 with cardiomyopathies) was sequenced with a custom panel of genes. Individuals carrying a heterozygous single P/LP SCN5A variant were selected and phenotyped. RESULTS The study included 170 P/LP variants found in 495 patients. Of them, 119 (70%) were exclusively associated with a single well-established phenotype: 91 with Brugada syndrome, 15 with type 3 long QT syndrome, 6 with progressive cardiac conduction disease, 4 with multifocal ectopic Purkinje-related premature contractions, and 3 with sick sinus syndrome. Thirty-two variants (19%) were associated with overlap syndromes or pleiotropy. The 19 remaining variants (11%) were associated with atypical or unclear phenotypes. Of those, 8 were carried by 8 patients presenting with DCM with a debatable causative genotype/phenotype link. CONCLUSION Most P/LP SCN5A variants were found in patients with primary electrical disorders, mainly Brugada syndrome. Nearly 20% were associated with overlap syndromes or pleiotropy, underscoring the need for comprehensive phenotypic evaluation. The concept of SCN5A variants causing DCM is extremely rare (8/9960) if not questionable.
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Affiliation(s)
- Alexis Hermida
- Cardiology, Arrhythmia, and Cardiac Stimulation Service, Amiens-Picardie University Hospital, Amiens, France; EA4666 HEMATIM, University of Picardie-Jules Verne, Amiens, France; Institute of Cardiology and ICAN Institute for Cardiometabolism and Nutrition, APHP, Pitié-Salpêtrière Hospital, Paris, France; Department of Genetics, Department of Cardiology, and Referral center for hereditary cardiac diseases, APHP, Pitié-Salpêtrière Hospital, Paris, France.
| | - Guillaume Jedraszak
- EA4666 HEMATIM, University of Picardie-Jules Verne, Amiens, France; Molecular Genetics Laboratory, Amiens-Picardie University Hospital, Amiens, France
| | - Flavie Ader
- Unité Pédagogique de Biochimie, Département des Sciences Biologiques et Médicales, UFR de Pharmacie-Faculté de Santé, Paris, France; Unité Fonctionnelle de Cardiogénétique et Myogénétique Moléculaire et Cellulaire, DMU Biogem, Service de Biochimie Métabolique, AP-HP Sorbonne Université, Pitié-Salpêtrière-Charles Foix, Paris, France; Research Unit on Cardiovascular and Metabolic Diseases, Sorbonne Université, Inserm, UMRS-1166, Paris, France
| | - Isabelle Denjoy
- Research Unit on Cardiovascular and Metabolic Diseases, Sorbonne Université, Inserm, UMRS-1166, Paris, France; CNMR Maladies Cardiaques Héréditaires Rares, APHP, Hôpital Bichat, Paris, France
| | - Véronique Fressart
- Unité Fonctionnelle de Cardiogénétique et Myogénétique Moléculaire et Cellulaire, DMU Biogem, Service de Biochimie Métabolique, AP-HP Sorbonne Université, Pitié-Salpêtrière-Charles Foix, Paris, France; Research Unit on Cardiovascular and Metabolic Diseases, Sorbonne Université, Inserm, UMRS-1166, Paris, France
| | - Phillipe Maury
- Service de Cardiologie, Centre hospitalier universitaire, Toulouse, France
| | - Christophe Beyls
- Cardiology, Arrhythmia, and Cardiac Stimulation Service, Amiens-Picardie University Hospital, Amiens, France
| | - Adrien Bloch
- Unité Pédagogique de Biochimie, Département des Sciences Biologiques et Médicales, UFR de Pharmacie-Faculté de Santé, Paris, France; Unité Fonctionnelle de Cardiogénétique et Myogénétique Moléculaire et Cellulaire, DMU Biogem, Service de Biochimie Métabolique, AP-HP Sorbonne Université, Pitié-Salpêtrière-Charles Foix, Paris, France; Research Unit on Cardiovascular and Metabolic Diseases, Sorbonne Université, Inserm, UMRS-1166, Paris, France
| | - Gaël Clerici
- Service de Cardiologie, Centre Hospitalier Universitaire, Saint Pierre, La Réunion, France
| | - Elise Daire
- EA4666 HEMATIM, University of Picardie-Jules Verne, Amiens, France; Service de Pédiatrie, CHU Amiens, Amiens, France
| | - Pascal Defaye
- Service de Cardiologie, Centre Hospitalier Universitaire, Grenoble, France
| | | | - Loic Garçon
- EA4666 HEMATIM, University of Picardie-Jules Verne, Amiens, France; Molecular Genetics Laboratory, Amiens-Picardie University Hospital, Amiens, France
| | - Didier Klug
- Service de Cardiologie, France CHU Lille, Inserm UMR1011, Institut Pasteur de Lille, Lille, France
| | | | - Jean-Sylvain Hermida
- Cardiology, Arrhythmia, and Cardiac Stimulation Service, Amiens-Picardie University Hospital, Amiens, France
| | - Laurence Jesel
- Service de Cardiologie, CHU Strasbourg, Strasbourg, France
| | | | - Maciej Kubala
- Cardiology, Arrhythmia, and Cardiac Stimulation Service, Amiens-Picardie University Hospital, Amiens, France
| | - Jérôme Lacotte
- Service de Cardiologie, Institut Jacques Cartier, Massy, France
| | - Mikael Laredo
- Institute of Cardiology and ICAN Institute for Cardiometabolism and Nutrition, APHP, Pitié-Salpêtrière Hospital, Paris, France; Department of Genetics, Department of Cardiology, and Referral center for hereditary cardiac diseases, APHP, Pitié-Salpêtrière Hospital, Paris, France; Research Unit on Cardiovascular and Metabolic Diseases, Sorbonne Université, Inserm, UMRS-1166, Paris, France
| | - Antoine Leenhardt
- Research Unit on Cardiovascular and Metabolic Diseases, Sorbonne Université, Inserm, UMRS-1166, Paris, France; CNMR Maladies Cardiaques Héréditaires Rares, APHP, Hôpital Bichat, Paris, France
| | | | | | - Alice Maltret
- Service de Cardiopathie Congénitale, GHPSJ Hôpital Marie Lannelongue, Le Plessis Robinson, France
| | | | - Eloi Marijon
- Service de Cardiologie, Hôpital Européen Georges Pompidou, APHP, France; Université Paris Cité, INSERM, PARCC, Paris, France
| | - Sophie Nambot
- Centre de Référence Anomalies du Développement et Syndromes Malformatifs, FHU TRANSLAD, Hôpital d'Enfants, Dijon, France
| | - Nathalie Neyroud
- Research Unit on Cardiovascular and Metabolic Diseases, Sorbonne Université, Inserm, UMRS-1166, Paris, France
| | - Sandro Ninni
- Service de Cardiologie, France CHU Lille, Inserm UMR1011, Institut Pasteur de Lille, Lille, France
| | - Aurélien Palmyre
- Department of Genetics and Referral center for cardiac hereditary cardiac diseases, APHP, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - Jean Luc Pasquie
- Service de Cardiologie, CHU Montpellier, Montpellier, France; PHYMEDEXP-CNRS UMR9214, Inserm U1046, Université de Montpellier et CHU de Montpellier, Montpellier, France
| | - Julie Proukhnitzky
- Institute of Cardiology and ICAN Institute for Cardiometabolism and Nutrition, APHP, Pitié-Salpêtrière Hospital, Paris, France; Department of Genetics, Department of Cardiology, and Referral center for hereditary cardiac diseases, APHP, Pitié-Salpêtrière Hospital, Paris, France; Research Unit on Cardiovascular and Metabolic Diseases, Sorbonne Université, Inserm, UMRS-1166, Paris, France
| | - Patricia Reant
- Service de Cardiologie, LIRYC Institute, Bordeaux University Hospital, University of Bordeaux, Referral center for rare and inherited cardiomyopathies, Bordeaux, France
| | - Pascale Richard
- Unité Fonctionnelle de Cardiogénétique et Myogénétique Moléculaire et Cellulaire, DMU Biogem, Service de Biochimie Métabolique, AP-HP Sorbonne Université, Pitié-Salpêtrière-Charles Foix, Paris, France; Research Unit on Cardiovascular and Metabolic Diseases, Sorbonne Université, Inserm, UMRS-1166, Paris, France
| | - Anne Rollin
- Service de Cardiologie, Centre hospitalier universitaire, Toulouse, France
| | | | - Frédéric Sacher
- Service de Rythmologie, LIRYC Institute, Bordeaux University Hospital, CRMR Cardiogen, ERN Guard-Heart, INSERM 1045 University of Bordeaux, Bordeaux, France
| | - Elise Schaefer
- Service de Génétique Médicale, Institut de Génétique Médicale d'Alsace, CHU Strasbourg, Strasbourg, France
| | | | | | - Karim Wahbi
- Service de Cardiologie, CHU Cochin, APHP, France
| | - Xavier Waintraub
- Institute of Cardiology and ICAN Institute for Cardiometabolism and Nutrition, APHP, Pitié-Salpêtrière Hospital, Paris, France; Department of Genetics, Department of Cardiology, and Referral center for hereditary cardiac diseases, APHP, Pitié-Salpêtrière Hospital, Paris, France
| | - Victor Waldmann
- Service de Cardiologie, Hôpital Européen Georges Pompidou, APHP, France; Université Paris Cité, INSERM, PARCC, Paris, France
| | - Sacha Weber
- Service de Génétique, CHU Caen, Caen, France
| | - Amir Zouaghi
- Service de Cardiologie, CH d'Antibes, Antibes, France
| | - Philippe Charron
- Department of Genetics, Department of Cardiology, and Referral center for hereditary cardiac diseases, APHP, Pitié-Salpêtrière Hospital, Paris, France; Research Unit on Cardiovascular and Metabolic Diseases, Sorbonne Université, Inserm, UMRS-1166, Paris, France; Department of Genetics and Referral center for cardiac hereditary cardiac diseases, APHP, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - Fabrice Extramiana
- Research Unit on Cardiovascular and Metabolic Diseases, Sorbonne Université, Inserm, UMRS-1166, Paris, France; CNMR Maladies Cardiaques Héréditaires Rares, APHP, Hôpital Bichat, Paris, France; Université Paris Cité, Paris, France
| | - Estelle Gandjbakhch
- Institute of Cardiology and ICAN Institute for Cardiometabolism and Nutrition, APHP, Pitié-Salpêtrière Hospital, Paris, France; Department of Genetics, Department of Cardiology, and Referral center for hereditary cardiac diseases, APHP, Pitié-Salpêtrière Hospital, Paris, France; Research Unit on Cardiovascular and Metabolic Diseases, Sorbonne Université, Inserm, UMRS-1166, Paris, France
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Belhassen B, Lellouche N, Frank R. Contributions of France to the field of clinical cardiac electrophysiology and pacing. Heart Rhythm O2 2024; 5:490-514. [PMID: 39119028 PMCID: PMC11305881 DOI: 10.1016/j.hroo.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024] Open
Affiliation(s)
- Bernard Belhassen
- Heart Institute, Hadassah Medical Center, Jerusalem, Israel
- Tel-Aviv University, Tel-Aviv, Israel
| | - Nicolas Lellouche
- Unité de Rythmologie, Service de Cardiologie, Centre Hospitalier Henri-Mondor, Université Paris-Est, Créteil, France
| | - Robert Frank
- Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Université de la Sorbonne, Paris, France
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Cutler MJ, Eckhardt LL, Kaufman ES, Arbelo E, Behr ER, Brugada P, Cerrone M, Crotti L, deAsmundis C, Gollob MH, Horie M, Huang DT, Krahn AD, London B, Lubitz SA, Mackall JA, Nademanee K, Perez MV, Probst V, Roden DM, Sacher F, Sarquella-Brugada G, Scheinman MM, Shimizu W, Shoemaker B, Sy RW, Watanabe A, Wilde AAM. Clinical Management of Brugada Syndrome: Commentary From the Experts. Circ Arrhythm Electrophysiol 2024; 17:e012072. [PMID: 38099441 PMCID: PMC10824563 DOI: 10.1161/circep.123.012072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
Although there is consensus on the management of patients with Brugada Syndrome with high risk for sudden cardiac arrest, asymptomatic or intermediate-risk patients present clinical management challenges. This document explores the management opinions of experts throughout the world for patients with Brugada Syndrome who do not fit guideline recommendations. Four real-world clinical scenarios were presented with commentary from small expert groups for each case. All authors voted on case-specific questions to evaluate the level of consensus among the entire group in nuanced diagnostic and management decisions relevant to each case. Points of agreement, points of controversy, and gaps in knowledge are highlighted.
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Affiliation(s)
- Michael J Cutler
- Intermountain Heart Institute, Intermountain Medical Center, Salt Lake City, UT (M.J.C.)
| | - Lee L Eckhardt
- Cellular and Molecular Arrhythmia Research Program, Division of CVM, Department of Medicine, University of Wisconsin-Madison (L.L.E.)
| | - Elizabeth S Kaufman
- Heart and Vascular Center, MetroHealth Campus, Case Western Reserve University, Cleveland, OH (E.S.K.)
| | - Elena Arbelo
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona (E.A.)
- Centro de Investigacion Biomedica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid (E.A.)
- IDIBAPS, Institut d'Investigacio August Pi I Sunyer, Barcelona, Spain (E.A.)
| | - Elijah R Behr
- Cardiovascular Clinical Academic Group, Cardiology Section, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust (E.R.B.)
- Mayo Clinic Healthcare, London, United Kingdom (E.R.B.)
| | - Pedro Brugada
- Cardiovascular Division, UZ Brussel-VUB, Belgium (P.B.)
- Arrhythmia Unit, Helicopteros Sanitarios Hospital (HSH), Puerto Banús, Marbella, Malaga, Spain (P.B.)
| | - Marina Cerrone
- New York Univ Grossman School of Medicine, Leon H. Charney Division of Cardiology (M.C.)
| | - Lia Crotti
- Department of Medicine and Surgery, University of Milano-Bicocca (L.C.)
- Istituto Auxologico Italiano IRCCS, Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, Milan, Italy (L.C.)
| | - Carlo deAsmundis
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Belgium (C.D.)
| | - Michael H Gollob
- Peter Munk Cardiac Center, Division of Cardiology, Toronto General Hospital, University Health Network, Canada (M.H.G.)
| | - Minoru Horie
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Ohtsu, Japan (M.H.)
| | | | - Andrew D Krahn
- Center for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, Canada (A.D.K.)
| | - Barry London
- Division of Cardiovascular Medicine, Department of Internal Medicine and Abboud Cardiovascular Research Center, University of Iowa Carver College of Medicine, Iowa City (B.L.)
| | - Steven A Lubitz
- Demoulas Center for Cardiac Arrhythmias, Massachusetts General Hospital, Boston (S.A.L.)
| | - Judith A Mackall
- Department of Medicine, Division of Cardiology, University Hospitals Harrington Heart and Vascular Institute, Case Western Reserve University School of Medicine, Cleveland, OH (J.A.M.)
| | - Koonlawee Nademanee
- Center of Excellence in Arrhythmia Research, Department of Medicine, Faculty of Medicine, Chulalongkorn University (K.N.)
- Pacific Rim Electrophysiology Research Institute at Bumrungrad Hospital, Bangkok, Thailand (K.N.)
| | - Marco V Perez
- Stanford Center for Inherited Cardiovascular Diseases, Stanford University, CA (M.V.P.)
| | - Vincent Probst
- Université Nantes, CHU Nantes, CNRS, INSERM, Service de Cardiologie, l'institut du thorax, Nantes, France (V.P.)
| | - Dan M Roden
- Departments of Medicine, Pharmacology and Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN (D.M.R.)
| | - Frederic Sacher
- Arrhythmia Department, Bordeaux University Hospital, IHU LIRYC, Pessac, France (F.S.)
| | - Georgia Sarquella-Brugada
- Pediatric Arrhythmias, Inherited Cardiac Diseases and Sudden Death Unit, Hospital Sant Joan de Déu, Universitat de Barcelona (G.S.-B.)
- Arrítmies Pediàtriques, Cardiologia Genètica i Mort sobtada, Malalties Cardiovasculars en el Desenvolupament, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain (G.S.-B.)
| | - Melvin M Scheinman
- Section of Cardiac Electrophysiology, Division of Cardiology, University of California-San Francisco (M.M.S.)
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan (W.S.)
| | - Benjamin Shoemaker
- Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN (B.S.)
| | - Raymond W Sy
- Faculty of Medicine and Heath, The University of Sydney (R.W.S.)
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia (R.W.S.)
| | - Atsuyuki Watanabe
- Department of Cardiology, National Hospital Organization Okayama Medical Center, Japan (A.W.)
| | - Arthur A M Wilde
- Department of Cardiology, University of Amsterdam (A.A.M.W.)
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, the Netherlands (A.A.M.W.)
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Janzen ML, Davies B, Laksman ZW, Roberts JD, Sanatani S, Steinberg C, Tadros R, Cadrin-Tourigny J, MacIntyre C, Atallah J, Fournier A, Green MS, Hamilton R, Khan HR, Kimber S, White S, Joza J, Makanjee B, Ilhan E, Lee D, Hansom S, Hadjis A, Arbour L, Leather R, Seifer C, Angaran P, Simpson CS, Healey JS, Gardner M, Talajic M, Krahn AD. Management of Inherited Arrhythmia Syndromes: a HiRO Consensus Handbook on Process of Care. CJC Open 2023; 5:268-284. [PMID: 37124966 PMCID: PMC10140751 DOI: 10.1016/j.cjco.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 02/14/2023] [Indexed: 02/27/2023] Open
Abstract
Inherited arrhythmia syndromes are rare genetic conditions that predispose seemingly healthy individuals to sudden cardiac arrest and death. The Hearts in Rhythm Organization is a multidisciplinary Canadian network of clinicians, researchers, patients, and families that aims to improve care for patients and families with inherited cardiac conditions, focused on those that confer predisposition to arrhythmia and sudden cardiac arrest and/or death. The field is rapidly evolving as research discoveries increase. A streamlined, practical guide for providers to diagnose and follow pediatric and adult patients with inherited cardiac conditions represents a useful tool to improve health system utilization, clinical management, and research related to these conditions. This review provides consensus care pathways for 7 conditions, including the 4 most common inherited cardiac conditions that confer predisposition to arrhythmia, with scenarios to guide investigation, diagnosis, risk stratification, and management. These conditions include Brugada syndrome, long QT syndrome, arrhythmogenic right ventricular cardiomyopathy and related arrhythmogenic cardiomyopathies, and catecholaminergic polymorphic ventricular tachycardia. In addition, an approach to investigating and managing sudden cardiac arrest, sudden unexpected death, and first-degree family members of affected individuals is provided. Referral to specialized cardiogenetic clinics should be considered in most cases. The intention of this review is to offer a framework for the process of care that is useful for both experts and nonexperts, and related allied disciplines such as hospital management, diagnostic services, coroners, and pathologists, in order to provide high-quality, multidisciplinary, standardized care.
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T-Peak to T-End Interval for Prediction of Positive Response to Ajmaline Challenge Test in Suspected Brugada Syndrome Patients. MEDICAL SCIENCES (BASEL, SWITZERLAND) 2022; 10:medsci10040069. [PMID: 36548004 PMCID: PMC9785618 DOI: 10.3390/medsci10040069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/06/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Brugada syndrome (BrS) is diagnosed in patients with ST-segment elevation with coved-type morphology in the right precordial leads, occurring spontaneously or after provocative drugs. Due to electrocardiographic (ECG) inconsistency, provocative drugs, such as sodium-channel blockers, are useful for unmasking BrS. Ajmaline is superior to flecainide and procainamide to provoke BrS. Prolonged T-peak to T-end (TpTe) is associated with an increased risk of ventricular arrhythmia and sudden cardiac death in Brugada syndrome patients. OBJECTIVE This study aimed to investigate the predictive value of T-peak to T-end interval and corrected T-peak to T-end interval for predicting the positive response of the ajmaline challenge test in suspected Brugada syndrome patients. METHODS Patients who underwent the ajmaline test in our center were enrolled. Clinical characteristics and electrocardiographic parameters were analyzed, including TpTe, corrected TpTe, QT, corrected QT(QTc) interval, and S-wave duration, compared with the result of the ajmaline challenge test. RESULTS The study found that TpTe and corrected TpTe interval in suspected BrS patients were not significantly associated with a positive response to the ajmaline challenge test. CONCLUSIONS The T-peak to T-end interval and corrected T-peak to T-end interval could not predict the positive response of the ajmaline challenge test in suspected Brugada syndrome patients.
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Krahn AD, Behr ER, Hamilton R, Probst V, Laksman Z, Han HC. Brugada Syndrome. JACC Clin Electrophysiol 2022; 8:386-405. [PMID: 35331438 DOI: 10.1016/j.jacep.2021.12.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/09/2021] [Accepted: 12/15/2021] [Indexed: 12/15/2022]
Abstract
Brugada syndrome (BrS) is an "inherited" condition characterized by predisposition to syncope and cardiac arrest, predominantly during sleep. The prevalence is ∼1:2,000, and is more commonly diagnosed in young to middle-aged males, although patient sex does not appear to impact prognosis. Despite the perception of BrS being an inherited arrhythmia syndrome, most cases are not associated with a single causative gene variant. Electrocardiogram (ECG) findings support variable extent of depolarization and repolarization changes, with coved ST-segment elevation ≥2 mm and a negative T-wave in the right precordial leads. These ECG changes are often intermittent, and may be provoked by fever or sodium channel blocker challenge. Growing evidence from cardiac imaging, epicardial ablation, and pathology studies suggests the presence of an epicardial arrhythmic substrate within the right ventricular outflow tract. Risk stratification aims to identify those who are at increased risk of sudden cardiac death, with well-established factors being the presence of spontaneous ECG changes and a history of cardiac arrest or cardiogenic syncope. Current management involves conservative measures in asymptomatic patients, including fever management and drug avoidance. Symptomatic patients typically undergo implantable cardioverter defibrillator insertion, with quinidine and epicardial ablation used for patients with recurrent arrhythmia. This review summarizes our current understanding of BrS and provides clinicians with a practical approach to diagnosis and management.
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Affiliation(s)
- Andrew D Krahn
- Center for Cardiovascular Innovation, Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Elijah R Behr
- Cardiovascular Clinical Academic Group and Cardiology Research Centre, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Robert Hamilton
- Department of Pediatrics (Cardiology), The Labatt Family Heart Centre and Translational Medicine, The Hospital for Sick Children & Research Institute and the University of Toronto, Toronto, Canada
| | - Vincent Probst
- Cardiologic Department and Reference Center for Hereditary Arrhythmic Diseases, Nantes University Hospital, Nantes, France
| | - Zachary Laksman
- Center for Cardiovascular Innovation, Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hui-Chen Han
- Center for Cardiovascular Innovation, Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada; Victorian Heart Institute, Monash University, Clayton, Victoria, Australia
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Tadros R, Tan HL, El Mathari S, Kors JA, Postema PG, Lahrouchi N, Beekman L, Radivojkov-Blagojevic M, Amin AS, Meitinger T, Tanck MW, Wilde AA, Bezzina CR. Predicting cardiac electrical response to sodium-channel blockade and Brugada syndrome using polygenic risk scores. Eur Heart J 2020; 40:3097-3107. [PMID: 31504448 PMCID: PMC6769824 DOI: 10.1093/eurheartj/ehz435] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 02/11/2019] [Accepted: 06/04/2019] [Indexed: 12/19/2022] Open
Abstract
Aims Sodium-channel blockers (SCBs) are associated with arrhythmia, but variability of cardiac electrical response remains unexplained. We sought to identify predictors of ajmaline-induced PR and QRS changes and Type I Brugada syndrome (BrS) electrocardiogram (ECG). Methods and results In 1368 patients that underwent ajmaline infusion for suspected BrS, we performed measurements of 26 721 ECGs, dose–response mixed modelling and genotyping. We calculated polygenic risk scores (PRS) for PR interval (PRSPR), QRS duration (PRSQRS), and Brugada syndrome (PRSBrS) derived from published genome-wide association studies and used regression analysis to identify predictors of ajmaline dose related PR change (slope) and QRS slope. We derived and validated using bootstrapping a predictive model for ajmaline-induced Type I BrS ECG. Higher PRSPR, baseline PR, and female sex are associated with more pronounced PR slope, while PRSQRS and age are positively associated with QRS slope (P < 0.01 for all). PRSBrS, baseline QRS duration, presence of Type II or III BrS ECG at baseline, and family history of BrS are independently associated with the occurrence of a Type I BrS ECG, with good predictive accuracy (optimism-corrected C-statistic 0.74). Conclusion We show for the first time that genetic factors underlie the variability of cardiac electrical response to SCB. PRSBrS, family history, and a baseline ECG can predict the development of a diagnostic drug-induced Type I BrS ECG with clinically relevant accuracy. These findings could lead to the use of PRS in the diagnosis of BrS and, if confirmed in population studies, to identify patients at risk for toxicity when given SCB. ![]()
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Affiliation(s)
- Rafik Tadros
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam Cardiovascular Sciences, Meibergdreef 9, AZ Amsterdam, The Netherlands.,Department of Medicine, Cardiovascular Genetics Center, Montreal Heart Institute and Faculty of Medicine, Université de Montréal, 5000 Belanger, Montreal, QC, Canada
| | - Hanno L Tan
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam Cardiovascular Sciences, Meibergdreef 9, AZ Amsterdam, The Netherlands
| | | | - Sulayman El Mathari
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam Cardiovascular Sciences, Meibergdreef 9, AZ Amsterdam, The Netherlands
| | - Jan A Kors
- Department of Medical Informatics, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, GD Rotterdam, The Netherlands
| | - Pieter G Postema
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam Cardiovascular Sciences, Meibergdreef 9, AZ Amsterdam, The Netherlands
| | - Najim Lahrouchi
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam Cardiovascular Sciences, Meibergdreef 9, AZ Amsterdam, The Netherlands
| | - Leander Beekman
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam Cardiovascular Sciences, Meibergdreef 9, AZ Amsterdam, The Netherlands
| | | | - Ahmad S Amin
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam Cardiovascular Sciences, Meibergdreef 9, AZ Amsterdam, The Netherlands
| | - Thomas Meitinger
- Institute of Human Genetics, Helmholtz Zentrum München, Ingolstädter Landstraße 1, Neuherberg, Germany.,Institute of Human Genetics, Technical University of Munich, Trogerstraße 32, Munich, Germany
| | - Michael W Tanck
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, AZ Amsterdam, The Netherlands
| | - Arthur A Wilde
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam Cardiovascular Sciences, Meibergdreef 9, AZ Amsterdam, The Netherlands.,Princess Al-Jawhara Al-Brahim Centre of Excellence in Research of Hereditary Disorders, 7393 Al-Malae'b St, King Abdul Aziz University, Jeddah, Saudi Arabia
| | - Connie R Bezzina
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam Cardiovascular Sciences, Meibergdreef 9, AZ Amsterdam, The Netherlands
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8
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Arnaud M, Berthome P, Tixier R, Briand J, Geoffroy O, Le Guillou X, Babuty D, Mansourati J, Jesel L, Dupuis JM, Bru P, Kyndt F, Guyomarch B, Thollet A, Behar N, Mabo P, Sacher F, Probst V, Gourraud JB. Number of electrocardiogram leads in the diagnosis of spontaneous Brugada syndrome. Arch Cardiovasc Dis 2019; 113:152-158. [PMID: 31787523 DOI: 10.1016/j.acvd.2019.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 09/24/2019] [Accepted: 10/01/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND The recently recommended single lead-based criterion for the diagnosis of Brugada syndrome may lead to overdiagnosis of this disorder and overestimation of the risk of sudden cardiac death. AIM To investigate the value of a single-lead diagnosis in patients with Brugada syndrome and a spontaneous type 1 electrocardiogram. METHODS Consecutive patients with Brugada syndrome were included in a multicentre prospective registry; only those with a spontaneous type 1 electrocardiogram were enrolled. Clinical and electrocardiogram data were reviewed by two physicians blinded to the patients' clinical and genetic status. RESULTS Among 1613 patients, 505 (31%) were enrolled (79% male; mean age 46±15 years). A spontaneous type 1 electrocardiogram pattern was found in one lead in 250 patients (group 1), in two leads in 227 patients (group 2) and in three leads in 27 patients (group 3). Groups were similar except for individuals in group 3, who presented more frequently a fragmented QRS complex, an early repolarization pattern and a prolonged Tpeak-Tend interval. After a mean follow-up of 6.4±4.7 years, ventricular arrhythmia, sudden cardiac death or implantable cardiac defibrillator shock occurred in 46 (9%) patients, without differences between groups. CONCLUSION The prognosis of Brugada syndrome with a spontaneous type 1 electrocardiogram pattern does not appear to be affected by the number of leads required for the diagnosis.
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Affiliation(s)
- Marine Arnaud
- L'Institut du thorax, Inserm, CNRS, université de Nantes, CHU de Nantes, 44093 Nantes, France
| | | | - Romain Tixier
- Service de cardiologie, Liryc, CHU de Bordeaux, 33600 Pessac, France
| | - Jean Briand
- Service de cardiologie, CHU de Rennes, 35000 Rennes, France
| | - Olivier Geoffroy
- Service de cardiologie, CHU de La Réunion, 97400 Saint-Denis, Reunion
| | - Xavier Le Guillou
- L'Institut du thorax, Inserm, CNRS, université de Nantes, CHU de Nantes, 44093 Nantes, France
| | | | | | - Laurence Jesel
- Service de cardiologie, CHRU de Strasbourg, 67091 Strasbourg, France
| | | | - Paul Bru
- Service de cardiologie, GH La Rochelle, 17019 La Rochelle, France
| | - Florence Kyndt
- L'Institut du thorax, Inserm, CNRS, université de Nantes, CHU de Nantes, 44093 Nantes, France
| | - Béatrice Guyomarch
- L'Institut du thorax, Inserm, CNRS, université de Nantes, CHU de Nantes, 44093 Nantes, France
| | - Aurélie Thollet
- L'Institut du thorax, Inserm, CNRS, université de Nantes, CHU de Nantes, 44093 Nantes, France
| | - Nathalie Behar
- Service de cardiologie, CHU de Rennes, 35000 Rennes, France
| | - Philippe Mabo
- Service de cardiologie, CHU de Rennes, 35000 Rennes, France
| | - Frédéric Sacher
- Service de cardiologie, Liryc, CHU de Bordeaux, 33600 Pessac, France
| | - Vincent Probst
- L'Institut du thorax, Inserm, CNRS, université de Nantes, CHU de Nantes, 44093 Nantes, France
| | - Jean-Baptiste Gourraud
- L'Institut du thorax, Inserm, CNRS, université de Nantes, CHU de Nantes, 44093 Nantes, France.
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9
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de Oliveira Neto NR, de Oliveira WS, Mastrocola F, Sacilotto L. Brugada phenocopy: Mechanisms, diagnosis, and implications. J Electrocardiol 2019; 55:45-50. [DOI: 10.1016/j.jelectrocard.2019.04.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 04/08/2019] [Accepted: 04/30/2019] [Indexed: 02/06/2023]
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10
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Pérez-Riera AR, Barbosa-Barros R, Daminello-Raimundo R, de Abreu LC, García-Niebla J, de Deus Morais MJ, Nikus K, Marcus FI. Epsilon wave: A review of historical aspects. Indian Pacing Electrophysiol J 2019; 19:63-67. [PMID: 30796961 PMCID: PMC6450822 DOI: 10.1016/j.ipej.2019.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 02/18/2019] [Indexed: 11/28/2022] Open
Abstract
The epsilon wave of the electrocardiogram (ECG) together with fragmented QRS (fQRS), the terminal conduction delay, incomplete right bundle branch block (IRBBB) and complete/advanced RBBB (CRBBB) of peripheral origin are part of a spectrum of ventricular depolarization abnormalities of arrhythmogenic cardiomyopathy(AC). Although the epsilon wave is considered a major diagnostic criterion for AC since 2010 (AC Task Force Criteria), its diagnostic value is limited because it is a sign of the later stage of the disease. It would be more appropriate to say that the epsilon wave is a “hallmark” of AC, but is of low diagnostic sensitivity. Although the epsilon wave has high specificity for AC, it can be present in other pathological conditions. In this update we will cover the nomenclature, association with disease states and electrocardiographic aspects of the epsilon wave.
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Affiliation(s)
- Andrés Ricardo Pérez-Riera
- Laboratório de Pesquisa e Escrita Científica da Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil.
| | - Raimundo Barbosa-Barros
- Coronary Center of the Messejana Hospital Dr. Carlos Alberto Studart Gomes, Fortaleza, Ceará, Brazil
| | - Rodrigo Daminello-Raimundo
- Laboratório de Pesquisa e Escrita Científica da Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil
| | - Luiz Carlos de Abreu
- Laboratório de Pesquisa e Escrita Científica da Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil
| | - Javier García-Niebla
- Servicios Sanitarios del Área de Salud de El Hierro, Valle del Golfo Health Center, Islas Canarias, Spain
| | - Mauro José de Deus Morais
- Laboratório de Pesquisa e Escrita Científica da Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil; Centro de Ciências da Saúde e Desporto, Universidade Federal do Acre, Rio Branco, Acre, Brazil
| | - Kjell Nikus
- Heart Center, Tampere University Hospital and Faculty of Medicine and Life Sciences, University of Tampere, Finland
| | - Frank I Marcus
- Sarver Heart Center, The University of Arizona Health Sciences Hospital, Tucson, AZ, USA
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11
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Berthome P, Tixier R, Briand J, Geoffroy O, Babuty D, Mansourati J, Jesel L, Dupuis JM, Bru P, Kyndt F, Guyomarch B, Thollet A, Behar N, Mabo P, Sacher F, Probst V, Gourraud JB. Clinical presentation and follow-up of women affected by Brugada syndrome. Heart Rhythm 2019; 16:260-267. [DOI: 10.1016/j.hrthm.2018.08.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Indexed: 01/16/2023]
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12
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Thomas D, Christ T, Fabritz L, Goette A, Hammwöhner M, Heijman J, Kockskämper J, Linz D, Odening KE, Schweizer PA, Wakili R, Voigt N. German Cardiac Society Working Group on Cellular Electrophysiology state-of-the-art paper: impact of molecular mechanisms on clinical arrhythmia management. Clin Res Cardiol 2018; 108:577-599. [PMID: 30306295 DOI: 10.1007/s00392-018-1377-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 09/24/2018] [Indexed: 12/19/2022]
Abstract
Cardiac arrhythmias remain a common challenge and are associated with significant morbidity and mortality. Effective and safe rhythm control strategies are a primary, yet unmet need in everyday clinical practice. Despite significant pharmacological and technological advances, including catheter ablation and device-based therapies, the development of more effective alternatives is of significant interest to increase quality of life and to reduce symptom burden, hospitalizations and mortality. The mechanistic understanding of pathophysiological pathways underlying cardiac arrhythmias has advanced profoundly, opening up novel avenues for mechanism-based therapeutic approaches. Current management of arrhythmias, however, is primarily guided by clinical and demographic characteristics of patient groups as opposed to individual, patient-specific mechanisms and pheno-/genotyping. With this state-of-the-art paper, the Working Group on Cellular Electrophysiology of the German Cardiac Society aims to close the gap between advanced molecular understanding and clinical decision-making in cardiac electrophysiology. The significance of cellular electrophysiological findings for clinical arrhythmia management constitutes the main focus of this document. Clinically relevant knowledge of pathophysiological pathways of arrhythmias and cellular mechanisms of antiarrhythmic interventions are summarized. Furthermore, the specific molecular background for the initiation and perpetuation of atrial and ventricular arrhythmias and mechanism-based strategies for therapeutic interventions are highlighted. Current "hot topics" in atrial fibrillation are critically appraised. Finally, the establishment and support of cellular and translational electrophysiology programs in clinical rhythmology departments is called for to improve basic-science-guided patient management.
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Affiliation(s)
- Dierk Thomas
- Department of Cardiology, Medical University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany. .,HCR (Heidelberg Center for Heart Rhythm Disorders), Heidelberg, Germany. .,DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany.
| | - Torsten Christ
- Department of Experimental Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Larissa Fabritz
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.,Department of Cardiology, UHB NHS Trust, Birmingham, UK.,Department of Cardiovascular Medicine, Division of Rhythmology, University Hospital Münster, Münster, Germany
| | - Andreas Goette
- St. Vincenz-Hospital, Paderborn, Germany.,Working Group: Molecular Electrophysiology, University Hospital Magdeburg, Magdeburg, Germany
| | - Matthias Hammwöhner
- St. Vincenz-Hospital, Paderborn, Germany.,Working Group: Molecular Electrophysiology, University Hospital Magdeburg, Magdeburg, Germany
| | - Jordi Heijman
- Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany.,Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Jens Kockskämper
- Biochemical and Pharmacological Center (BPC) Marburg, Institute of Pharmacology and Clinical Pharmacy, University of Marburg, Marburg, Germany
| | - Dominik Linz
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, SA, Australia.,Experimental Electrophysiology, University Hospital of Saarland, Homburg, Saar, Germany
| | - Katja E Odening
- Department of Cardiology and Angiology I, Heart Center University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Institute for Experimental Cardiovascular Medicine, Heart Center University of Freiburg, Freiburg, Germany
| | - Patrick A Schweizer
- Department of Cardiology, Medical University Hospital, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.,HCR (Heidelberg Center for Heart Rhythm Disorders), Heidelberg, Germany.,DZHK (German Center for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany.,Heidelberg Research Center for Molecular Medicine (HRCMM), Heidelberg, Germany
| | - Reza Wakili
- Department of Cardiology and Vascular Medicine, Medical Faculty, West German Heart Center, University Hospital Essen, Essen, Germany
| | - Niels Voigt
- Institute of Pharmacology and Toxicology, University Medical Center Göttingen, Georg-August University Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany. .,DZHK (German Center for Cardiovascular Research), partner site Göttingen, Göttingen, Germany.
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13
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Ozeke O, Aras D, Cay S, Ozcan F, Acar B, Topaloglu S. Ajmaline-induced Epsilon wave: Its role is not only for diagnosis but also for risk stratification. Int J Cardiol 2018; 264:99. [PMID: 29776580 DOI: 10.1016/j.ijcard.2018.03.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 03/09/2018] [Indexed: 10/16/2022]
Affiliation(s)
- Ozcan Ozeke
- Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Electrophysiology, Ankara, Turkey.
| | - Dursun Aras
- Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Electrophysiology, Ankara, Turkey
| | - Serkan Cay
- Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Electrophysiology, Ankara, Turkey
| | - Firat Ozcan
- Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Electrophysiology, Ankara, Turkey
| | - Burak Acar
- Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Electrophysiology, Ankara, Turkey
| | - Serkan Topaloglu
- Turkiye Yuksek Ihtisas Training and Research Hospital, Department of Electrophysiology, Ankara, Turkey
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14
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Therasse D, Probst V, Gourraud JB. Sodium channel blocker challenge in Brugada syndrome: Role in risk stratification. Int J Cardiol 2018; 264:100-101. [DOI: 10.1016/j.ijcard.2018.04.012] [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: 03/30/2018] [Accepted: 04/05/2018] [Indexed: 10/16/2022]
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15
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Gourraud JB, Khairy P, Abadir S, Tadros R, Cadrin-Tourigny J, Macle L, Dyrda K, Mondesert B, Dubuc M, Guerra PG, Thibault B, Roy D, Talajic M, Rivard L. Atrial fibrillation in young patients. Expert Rev Cardiovasc Ther 2018; 16:489-500. [DOI: 10.1080/14779072.2018.1490644] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Jean-Baptiste Gourraud
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Paul Khairy
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Canada
- Department of Pediatric Cardiology, Sainte-Justine Hospital, Université de Montréal, Montreal Canada
| | - Sylvia Abadir
- Department of Pediatric Cardiology, Sainte-Justine Hospital, Université de Montréal, Montreal Canada
| | - Rafik Tadros
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Julia Cadrin-Tourigny
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Laurent Macle
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | | | - Blandine Mondesert
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Marc Dubuc
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Peter G. Guerra
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Bernard Thibault
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Denis Roy
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Mario Talajic
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - Lena Rivard
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Canada
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16
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Ding DB, Fan LL, Xiao Z, Huang H, Chen YQ, Guo S, Liu ZH, Xiang R. A novel mutation of dipeptidyl aminopeptidase-like protein-6 in a family with suspicious idiopathic ventricular fibrillation. QJM 2018; 111:373-377. [PMID: 29474731 DOI: 10.1093/qjmed/hcy033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Sudden cardiac death (SCD) occurs in a broad spectrum of cardiac pathologies and is an important cause of mortality in the general population. Idiopathic ventricular fibrillation (IVF) is a rare but important factor resulting in SCD. It is diagnosed in a resuscitated cardiac arrest victim underlying unknown cause, with documented ventricular fibrillation. Previous studies have demonstrated that mutations in dipeptidyl aminopeptidase-like protein-6 (DPP6) and cardiac sodium channel Nav1.5 (SCN5A) are the most important genetic factors involve in IVF. AIM By using whole sequencing to identify the genetic lesion of a family with suspicious idiopathic ventricular fibrillation. DESIGN Prospective genetic study. METHODS In this study, we employed whole-exome sequencing in combination with arrhythmia-related gene filtering to identify the genetic lesion for a family suffering from suspicious IVF, syncope and SCD. We then generated the plasmids of DPP6-pcDNA3.1+ (WT and c.1578G>C/p.Q526H). Kv4.3-pcDNA3.1+ was co-transfected together with/without DPP6-pcDNA3.1+ (WT and/or c.1578G>C/p.Q526H) into HEK293 cells to perform the patch clamp experiments. RESULTS A novel missense mutation (c.1578G>C/p.Q526H) of DPP6 was identified and co-segregated with affected patients in this family. Patch clamp experiments suggested that this novel mutation might result in a gain of function and disturb the efflux of potassium ion. CONCLUSION Our study not only reported the second missense mutation of DPP6 in heart disease and expanded the spectrum of DPP6 mutations, but also contribute to the genetic diagnosis and counseling of families with suspicious IVF, syncope and SCD.
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Affiliation(s)
- D-B Ding
- Department of Cell Biology, School of Life Sciences, Central South University, Changsha 410013, China
| | - L-L Fan
- Department of Cell Biology, School of Life Sciences, Central South University, Changsha 410013, China
| | - Z Xiao
- National and Local Joint Engineering Laboratory for Animal Peptide Drug development, College of Life Sciences, Hunan Normal University, Changsha 410011, China
| | - H Huang
- Department of Cell Biology, School of Life Sciences, Central South University, Changsha 410013, China
| | - Y-Q Chen
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
| | - S Guo
- Department of Cell Biology, School of Life Sciences, Central South University, Changsha 410013, China
| | - Z-H Liu
- National and Local Joint Engineering Laboratory for Animal Peptide Drug development, College of Life Sciences, Hunan Normal University, Changsha 410011, China
| | - R Xiang
- Department of Cell Biology, School of Life Sciences, Central South University, Changsha 410013, China
- Department of Cardiology, The Second Xiangya Hospital of Central South University, Changsha 410011, China
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17
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Tadros R, Wilde AAM. Revisiting the sensitivity of sodium channel blocker testing in Brugada syndrome using obligate transmittance. Int J Cardiol 2017; 245:183-184. [PMID: 28709698 DOI: 10.1016/j.ijcard.2017.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 07/04/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Rafik Tadros
- Heart Centre, Department of Cardiology, Academic Medical Center, The Netherlands; Cardiovascular Genetics Center, Department of Medicine, Montreal Heart Institute and Université de Montréal, Canada
| | - Arthur A M Wilde
- Heart Centre, Department of Cardiology, Academic Medical Center, The Netherlands; Princess Al-Jawhara Al-Brahim Centre of Excellence in Research of Hereditary Disorders, Jeddah, Saudi Arabia.
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