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Francisco Pascual J, Jordan Marchite P, Rodríguez Silva J, Rivas Gándara N. Arrhythmic syncope: From diagnosis to management. World J Cardiol 2023; 15:119-141. [PMID: 37124975 PMCID: PMC10130893 DOI: 10.4330/wjc.v15.i4.119] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/02/2023] [Accepted: 04/10/2023] [Indexed: 04/20/2023] Open
Abstract
Syncope is a concerning symptom that affects a large proportion of patients. It can be related to a heterogeneous group of pathologies ranging from trivial causes to diseases with a high risk of sudden death. However, benign causes are the most frequent, and identifying high-risk patients with potentially severe etiologies is crucial to establish an accurate diagnosis, initiate effective therapy, and alter the prognosis. The term cardiac syncope refers to those episodes where the cause of the cerebral hypoperfusion is directly related to a cardiac disorder, while arrhythmic syncope is cardiac syncope specifically due to rhythm disorders. Indeed, arrhythmias are the most common cause of cardiac syncope. Both bradyarrhythmia and tachyarrhythmia can cause a sudden decrease in cardiac output and produce syncope. In this review, we summarized the main guidelines in the management of patients with syncope of presumed arrhythmic origin. Therefore, we presented a thorough approach to syncope work-up through different tests depending on the clinical characteristics of the patients, risk stratification, and the management of syncope in different scenarios such as structural heart disease and channelopathies.
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Affiliation(s)
- Jaume Francisco Pascual
- Unitat d’Arritmies Servei de Cardiologia VHIR, Hospital Universitari Vall d’Hebron, Barcelona 08035, Spain
- Grup de Recerca Cardiovascular, Vall d’Hebron Institut de Recerca, Barcelona 08035, Spain
- CIBER de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid 28029, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra 08193, Spain
| | - Pablo Jordan Marchite
- Unitat d’Arritmies Servei de Cardiologia VHIR, Hospital Universitari Vall d’Hebron, Barcelona 08035, Spain
| | - Jesús Rodríguez Silva
- Unitat d’Arritmies Servei de Cardiologia VHIR, Hospital Universitari Vall d’Hebron, Barcelona 08035, Spain
| | - Nuria Rivas Gándara
- Unitat d’Arritmies Servei de Cardiologia VHIR, Hospital Universitari Vall d’Hebron, Barcelona 08035, Spain
- CIBER de Enfermedades Cardiovasculares, Instituto de Salud Carlos III, Madrid 28029, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra 08193, Spain
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Scacchi S, Colli Franzone P, Pavarino LF, Gionti V, Storti C. Epicardial Dispersion of Repolarization Promotes the Onset of Reentry in Brugada Syndrome: A Numerical Simulation Study. Bull Math Biol 2023; 85:22. [PMID: 36790516 PMCID: PMC9931802 DOI: 10.1007/s11538-023-01124-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 01/17/2023] [Indexed: 02/16/2023]
Abstract
The Brugada syndrome (BrS) is a cardiac arrhythmic disorder responsible for sudden cardiac death associated with the onset of ventricular arrhythmias, such as reentrant ventricular tachycardia and fibrillation. The mechanisms which lead to the onset of such electrical disorders in patients affected by BrS are not completely understood, yet. The aim of the present study is to investigate by means of numerical simulations the electrophysiological mechanisms at the basis of the morphology of electrocardiogram (ECG) and the onset of reentry associated with BrS. To this end, we consider the Bidomain equations coupled with the ten Tusscher-Panfilov membrane model, on an idealized wedge of human right ventricular tissue. The results have shown that: (1) epicardial dispersion of repolarization, generated by the coexistence of regions of early and late repolarization, due to different modulation of the [Formula: see text] current, produces ECG waveforms exhibiting qualitatively the typical BrS morphology, characterized by ST elevation and partially negative T-waves; (2) epicardial dispersion of repolarization promotes the onset of reentry during the implementation of the programmed stimulation protocol, because of the conduction block occurring when a premature beat reaches the border of late repolarizing regions; and (3) the modulation of the [Formula: see text] current affects the duration of reentry, which becomes sustained with a remarkable increase of [Formula: see text] in the subepicardial layers.
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Affiliation(s)
- Simone Scacchi
- Dipartimento di Matematica, Università degli Studi di Milano, Via Saldini 50, 20133, Milan, Italy.
| | - Piero Colli Franzone
- Dipartimento di Matematica, Università degli Studi di Pavia, Via Ferrata 1, 27100, Pavia, Italy
| | - Luca F Pavarino
- Dipartimento di Matematica, Università degli Studi di Pavia, Via Ferrata 1, 27100, Pavia, Italy
| | - Vincenzo Gionti
- Istituto di cura Città di Pavia, via Parco Vecchio 27, 27100, Pavia, Italy
| | - Cesare Storti
- Istituto di cura Città di Pavia, via Parco Vecchio 27, 27100, Pavia, Italy
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3
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Zaytseva AK, Kiselev AM, Boitsov AS, Fomicheva YV, Pavlov GS, Zhorov BS, Kostareva AA. Characterization of the novel heterozygous SCN5A genetic variant Y739D associated with Brugada syndrome. Biochem Biophys Rep 2022; 30:101249. [PMID: 35300108 PMCID: PMC8920867 DOI: 10.1016/j.bbrep.2022.101249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/25/2022] [Accepted: 03/07/2022] [Indexed: 11/29/2022] Open
Abstract
Genetic variants in SCN5A gene were identified in patients with various arrhythmogenic conditions including Brugada syndrome. Despite significant progress of last decades in studying the molecular mechanism of arrhythmia-associated SCN5A mutations, the understanding of relationship between genetics, electrophysiological consequences and clinical phenotype is lacking. We have found a novel genetic variant Y739D in the SCN5A-encoded sodium channel Nav1.5 of a male patient with Brugada syndrome (BrS). The objective of the study was to characterize the biophysical properties of Nav1.5-Y739D and provide possible explanation of the phenotype observed in the patient. The WT and Y739D channels were heterologously expressed in the HEK-293T cells and the whole-cell sodium currents were recorded. Substitution Y739D reduced the sodium current density by 47 ± 2% at −20 mV, positively shifted voltage-dependent activation, accelerated both fast and slow inactivation, and decelerated recovery from the slow inactivation. The Y739D loss-of-function phenotype likely causes the BrS manifestation. In the hNav1.5 homology models, which are based on the cryo-EM structure of rat Nav1.5 channel, Y739 in the extracellular loop IIS1-S2 forms H-bonds with K1381 and E1435 and pi-cation contacts with K1397 (all in loop IIIS5-P1). In contrast, Y739D accepts H-bonds from K1397 and Y1434. Substantially different contacts of Y739 and Y739D with loop IIIS5-P1 would differently transmit allosteric signals from VSD-II to the fast-inactivation gate at the N-end of helix IIIS5 and slow-inactivation gate at the C-end of helix IIIP1. This may underlie the atomic mechanism of the Y739D channel dysfunction. A novel BrS-associated genetic variant Y739D in gene SCN5A is identified. Y739D caused Nav1.5 loss-of-function by enhancing slow and fast inactivation. Y739 in loop IIS1-S2 forms H-bonds and pi-cation contacts with loop IIIS5-P1. The contacts may mediate signal transfer from VSD-II to two inactivation gates. Altered contacts of Y739D would affect the allosteric signal transduction.
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Tsao CW, Aday AW, Almarzooq ZI, Alonso A, Beaton AZ, Bittencourt MS, Boehme AK, Buxton AE, Carson AP, Commodore-Mensah Y, Elkind MSV, Evenson KR, Eze-Nliam C, Ferguson JF, Generoso G, Ho JE, Kalani R, Khan SS, Kissela BM, Knutson KL, Levine DA, Lewis TT, Liu J, Loop MS, Ma J, Mussolino ME, Navaneethan SD, Perak AM, Poudel R, Rezk-Hanna M, Roth GA, Schroeder EB, Shah SH, Thacker EL, VanWagner LB, Virani SS, Voecks JH, Wang NY, Yaffe K, Martin SS. Heart Disease and Stroke Statistics-2022 Update: A Report From the American Heart Association. Circulation 2022; 145:e153-e639. [PMID: 35078371 DOI: 10.1161/cir.0000000000001052] [Citation(s) in RCA: 2304] [Impact Index Per Article: 1152.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Pinsach-Abuin M, del Olmo B, Pérez-Agustin A, Mates J, Allegue C, Iglesias A, Ma Q, Merkurjev D, Konovalov S, Zhang J, Sheikh F, Telenti A, Brugada J, Brugada R, Gymrek M, di Iulio J, Garcia-Bassets I, Pagans S. Analysis of Brugada syndrome loci reveals that fine-mapping clustered GWAS hits enhances the annotation of disease-relevant variants. Cell Rep Med 2021; 2:100250. [PMID: 33948580 PMCID: PMC8080235 DOI: 10.1016/j.xcrm.2021.100250] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 01/07/2021] [Accepted: 03/23/2021] [Indexed: 11/30/2022]
Abstract
Genome-wide association studies (GWASs) are instrumental in identifying loci harboring common single-nucleotide variants (SNVs) that affect human traits and diseases. GWAS hits emerge in clusters, but the focus is often on the most significant hit in each trait- or disease-associated locus. The remaining hits represent SNVs in linkage disequilibrium (LD) and are considered redundant and thus frequently marginally reported or exploited. Here, we interrogate the value of integrating the full set of GWAS hits in a locus repeatedly associated with cardiac conduction traits and arrhythmia, SCN5A-SCN10A. Our analysis reveals 5 common 7-SNV haplotypes (Hap1-5) with 2 combinations associated with life-threatening arrhythmia-Brugada syndrome (the risk Hap1/1 and protective Hap2/3 genotypes). Hap1 and Hap2 share 3 SNVs; thus, this analysis suggests that assuming redundancy among clustered GWAS hits can lead to confounding disease-risk associations and supports the need to deconstruct GWAS data in the context of haplotype composition.
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Affiliation(s)
- Mel·lina Pinsach-Abuin
- Department of Medical Sciences, School of Medicine, Universitat de Girona, Girona, Spain
- Visiting Scholar Program, Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, CA, USA
- Institut d’Investigació Biomèdica de Girona, Salt, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Bernat del Olmo
- Department of Medical Sciences, School of Medicine, Universitat de Girona, Girona, Spain
- Visiting Scholar Program, Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, CA, USA
- Institut d’Investigació Biomèdica de Girona, Salt, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Adrian Pérez-Agustin
- Department of Medical Sciences, School of Medicine, Universitat de Girona, Girona, Spain
- Institut d’Investigació Biomèdica de Girona, Salt, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Jesus Mates
- Department of Medical Sciences, School of Medicine, Universitat de Girona, Girona, Spain
- Institut d’Investigació Biomèdica de Girona, Salt, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Catarina Allegue
- Department of Medical Sciences, School of Medicine, Universitat de Girona, Girona, Spain
- Visiting Scholar Program, Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, CA, USA
- Institut d’Investigació Biomèdica de Girona, Salt, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Anna Iglesias
- Department of Medical Sciences, School of Medicine, Universitat de Girona, Girona, Spain
- Institut d’Investigació Biomèdica de Girona, Salt, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Qi Ma
- Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Daria Merkurjev
- Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, CA, USA
- Department of Statistics, University of California, Los Angeles, Los Angeles, CA, USA
| | - Sergiy Konovalov
- Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Jing Zhang
- Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Farah Sheikh
- Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Amalio Telenti
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, CA, USA
| | - Josep Brugada
- Arrhythmia Unit, Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Ramon Brugada
- Department of Medical Sciences, School of Medicine, Universitat de Girona, Girona, Spain
- Institut d’Investigació Biomèdica de Girona, Salt, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
- Cardiology Service, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - Melissa Gymrek
- Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, CA, USA
- Department of Computer Science and Engineering, University of California, San Diego, La Jolla, CA, USA
| | - Julia di Iulio
- Department of Integrative Structural and Computational Biology, The Scripps Research Institute, La Jolla, CA, USA
| | - Ivan Garcia-Bassets
- Department of Medicine, School of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Sara Pagans
- Department of Medical Sciences, School of Medicine, Universitat de Girona, Girona, Spain
- Institut d’Investigació Biomèdica de Girona, Salt, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
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Lopez-Blazquez M, Field E, Tollit J, Walsh H, Addis A, French N, Starling L, Kaski JP. Clinical significance of inferolateral early repolarisation and late potentials in children with Brugada Syndrome. J Electrocardiol 2021; 66:79-83. [PMID: 33831794 DOI: 10.1016/j.jelectrocard.2021.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/23/2021] [Accepted: 03/26/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The clinical utility of inferolateral early repolarisation (ER) and late potentials (LP) in children with Brugada Syndrome (BrS) has not been previously evaluated. The aim of this study was to determine the prevalence of electrocardiographic (ECG) abnormalities in children with BrS, and to investigate their relationship with clinical outcomes. METHODS 43 patients with BrS and 47 controls aged ≤18 undergoing systematic clinical and ECG evaluation, including signal-averaged ECG (SAECG) and pharmacological provocation testing, between 2003 and 2019 were included. RESULTS Four patients with BrS (9%) presented with a spontaneous type 1 Brugada pattern; the remaining 39 (91%) were diagnosed following ajmaline provocation testing. Twelve BrS patients (28%) had late potentials (LP) on SAECG compared to 1 (2%) in controls (p = 0.001). LP were more common in 5 patients with a high-risk phenotype (60% vs 24%) but this was not statistically significant. Twelve patients with BrS (28%) had inferolateral early repolarisation (ER) and 2 (5%) had fractionated QRS (f-QRS), but there were no statistically-significant differences with controls in these parameters. A significant arrhythmia (non-sustained ventricular tachycardia or atrial fibrillation) was seen in 4 patients (9%). CONCLUSIONS This study shows a high prevalence of SAECG abnormalities in children with BrS compared with controls, but this was not significantly associated with a high-risk phenotype.
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Affiliation(s)
- Maria Lopez-Blazquez
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom; Gregorio Marañon Children Hospital, Madrid, Spain
| | - Ella Field
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Jennifer Tollit
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Helen Walsh
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Amy Addis
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Nichola French
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Luke Starling
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Juan Pablo Kaski
- Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom; UCL Institute of Cardiovascular Science, London, United Kingdom.
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Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Cheng S, Delling FN, Elkind MSV, Evenson KR, Ferguson JF, Gupta DK, Khan SS, Kissela BM, Knutson KL, Lee CD, Lewis TT, Liu J, Loop MS, Lutsey PL, Ma J, Mackey J, Martin SS, Matchar DB, Mussolino ME, Navaneethan SD, Perak AM, Roth GA, Samad Z, Satou GM, Schroeder EB, Shah SH, Shay CM, Stokes A, VanWagner LB, Wang NY, Tsao CW. Heart Disease and Stroke Statistics-2021 Update: A Report From the American Heart Association. Circulation 2021; 143:e254-e743. [PMID: 33501848 DOI: 10.1161/cir.0000000000000950] [Citation(s) in RCA: 2972] [Impact Index Per Article: 990.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2021 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors related to cardiovascular disease. RESULTS Each of the 27 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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Alegria S, Ferreira F, Repolho D, Loureiro MJ. Chronic thromboembolic pulmonary hypertension secondary to implantable cardioverter defibrillator lead thrombus in a patient with Brugada syndrome: a rare complication requiring a multidisciplinary approach. BMJ Case Rep 2020; 13:13/5/e234549. [DOI: 10.1136/bcr-2020-234549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report the case of a 57-year-old male patient with prior syncope associated with sustained ventricular tachycardia in the setting of Brugada syndrome, who was submitted to implantation of a cardioverter defibrillator for secondary prevention. During follow-up, he presented a significant increase in lead impedance, and a transthoracic echocardiogram showed a mass attached to the lead. He was started on oral anticoagulation after infective endocarditis was excluded but nevertheless suffered repeated episodes of pulmonary embolism that led to severe chronic thromboembolic pulmonary hypertension. After heart team discussion, he was referred to pulmonary endarterectomy and replacement of the implantable cardioverter defibrillator with a subcutaneous device. This led to significant improvement of functional class and normalisation of pulmonary haemodynamics. More recently, he suffered syncope in the setting of ventricular fibrillation with appropriate shocks and was started on quinidine without further recurrence of arrhythmic episodes.
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Manzano-Cabada J, Reyes-Quintero ÁE, Chávez-Gutiérrez CA, Gómez-Flores J, Colín-Lizalde L, Morales JL, Nava S, Iturralde P, Márquez MF. Diagnostic challenges of Brugada Syndrome in pediatric patients. J Electrocardiol 2020; 60:72-76. [PMID: 32304903 DOI: 10.1016/j.jelectrocard.2020.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 03/29/2020] [Indexed: 11/25/2022]
Abstract
Although most cases of Brugada syndrome have been described in adults, pediatric patients with the disease have been reported since the original article from Josep and Pedro Brugada. Herein is presented the case series of Brugada syndrome in pediatric population of the National Institute of Cardiology Ignacio Chavez. One boy and two adolescent males had palpitations as clinical presentation of the disease. Atrial arrhythmias were documented in two, in the third case there was a high clinical suspicion and quinidine abolished symptoms. The aim of this report is to highlight the importance of performing a detailed clinical history as well as the usefulness of high precordial leads for the diagnosis of this entity.
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Affiliation(s)
- Janneth Manzano-Cabada
- Departamento de Electrofisiología, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, Mexico
| | - Álvaro E Reyes-Quintero
- Departamento de Electrofisiología, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, Mexico
| | - Carlos A Chávez-Gutiérrez
- Departamento de Electrofisiología, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, Mexico
| | - Jorge Gómez-Flores
- Departamento de Electrofisiología, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, Mexico
| | - Luis Colín-Lizalde
- Departamento de Electrofisiología, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, Mexico
| | - José L Morales
- Departamento de Electrofisiología, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, Mexico
| | - Santiago Nava
- Departamento de Electrofisiología, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, Mexico
| | - Pedro Iturralde
- Departamento de Electrofisiología, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, Mexico
| | - Manlio F Márquez
- Departamento de Electrofisiología, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, Mexico.
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10
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Virani SS, Alonso A, Benjamin EJ, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Shay CM, Spartano NL, Stokes A, Tirschwell DL, VanWagner LB, Tsao CW. Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association. Circulation 2020; 141:e139-e596. [PMID: 31992061 DOI: 10.1161/cir.0000000000000757] [Citation(s) in RCA: 4716] [Impact Index Per Article: 1179.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The American Heart Association, in conjunction with the National Institutes of Health, annually reports on the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2020 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population, metrics to assess and monitor healthy diets, an enhanced focus on social determinants of health, a focus on the global burden of cardiovascular disease, and further evidence-based approaches to changing behaviors, implementation strategies, and implications of the American Heart Association's 2020 Impact Goals. RESULTS Each of the 26 chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policy makers, media professionals, clinicians, healthcare administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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11
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Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Jordan LC, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, O'Flaherty M, Pandey A, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Spartano NL, Stokes A, Tirschwell DL, Tsao CW, Turakhia MP, VanWagner LB, Wilkins JT, Wong SS, Virani SS. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Circulation 2019; 139:e56-e528. [PMID: 30700139 DOI: 10.1161/cir.0000000000000659] [Citation(s) in RCA: 5219] [Impact Index Per Article: 1043.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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12
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Rodríguez -Constaín JS, López-Garzón NA, Navia-Amézquita CA, Mora-Obando DL, Dueñas-Cuellar RA. Síndrome de Brugada. Aspectos fisiopatológicos, clínicos y su asociación con enfermedades infecciosas. IATREIA 2019. [DOI: 10.17533/udea.iatreia.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
El síndrome de Brugada (SBr) es una enfermedad cardiaca no estructural que afecta los canales iónicos cardiacos, caracterizado por manifestaciones clínicas como arritmias, taquicardia, síncope y muerte súbita, entre otras. Su diagnóstico es netamente electrocardiográfico, con un patrón altamente sugestivo pero no patognomónico, por lo que existen diagnósticos diferenciales desde el punto de vista electrocardiográfico.Existen tres patrones electrocardiográficos en los pacientes con SBr, de los cuales el tipo I es el patrón más característico. Actualmente, múltiples genes se han relacionado con la presentación de este síndrome, entre los cuales se destaca el gen SCN5A, el más descrito en la literatura. Se conoce que este síndrome es más frecuente en el género masculino; sin embargo, no existen estudios epidemiológicos en Latinoamérica que lo confirmen. Pese a que la investigación alrededor de los mecanismos causales del síndrome ha avanzado, existen varias cuestiones sin resolver, como su desenmascaramiento por los signos que producen algunas enfermedades infecciosas causadas principalmente por virus. Por lo tanto, dada la relevancia clínica del tema para el médico general y para el especialista, el objetivo de esta revisión es describir no solo aspectos fisiopatológicos y clínicos de la enfermedad, sino también resaltar casos de pacientes con enfermedades infecciosas quienes posteriormente han sido diagnosticados con el síndrome de Brugada.
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13
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Espinosa Á, Ripollés-Melchor J, Brugada R, Campuzano Ó, Sarquella-Brugada G, Abad-Motos A, Zaballos-García M, Abad-Torrent A, Prieto-Gundin A, Brugada J. Brugada Syndrome: anesthetic considerations and management algorithm. Minerva Anestesiol 2018; 85:173-188. [PMID: 30394071 DOI: 10.23736/s0375-9393.18.13170-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Brugada Syndrome is characterized by arrhythmogenic risk that may be exacerbated by different metabolic and pharmacological factors. Since its first description, knowledge of this syndrome and its detection by physicians belonging to different specialties have gradually increased. The risk of arrhythmias is well known to increase in the postoperative period, and this risk is particularly accentuated in patients with Brugada Syndrome. The purpose of this review is to analyze the relationship between this syndrome and anesthesia; establish recommendations for the safe management of these patients in the surgical setting; and update the relevant concepts regarding the safety of drug administration in individuals with Brugada Syndrome.
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Affiliation(s)
- Ángel Espinosa
- Department of Cardiothoracic Anesthesia, Mohammed Bin Khalifa Bin Salman Al Khalifa Cardiac Center, Royal Medical Services, Awali, Bahrain.,Evidence Anesthesia Review Group (EAR), Department of Pharmacology, Faculty of Medicine of Complutense University of Madrid, Madrid, Spain
| | - Javier Ripollés-Melchor
- Evidence Anesthesia Review Group (EAR), Department of Pharmacology, Faculty of Medicine of Complutense University of Madrid, Madrid, Spain - .,Department of Anesthesiology and Critical Care, Infanta Leonor University Hospital, Madrid, Spain.,Madrid Complutense University, Madrid, Spain.,Spanish Perioperative Audit and Research Network (RedGERM), Zaragoza, Spain
| | - Ramón Brugada
- Cardiovascular Genetics Center, Girona Biomedical Research Institute (IDIBGI), University of Girona, Girona, Spain.,Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain.,Cardiovascular Diseases Network Biomedical Research Center (CIBERCV), Madrid, Spain.,Department of Cardiology, Josep Trueta Hospital, Girona, Spain
| | - Óscar Campuzano
- Cardiovascular Genetics Center, Girona Biomedical Research Institute (IDIBGI), University of Girona, Girona, Spain.,Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain.,Cardiovascular Diseases Network Biomedical Research Center (CIBERCV), Madrid, Spain
| | - Georgia Sarquella-Brugada
- Department of Medical Sciences, School of Medicine, University of Girona, Girona, Spain.,Unit of Pediatric Arrhythmia, Department of Cardiology, Sant Joan de Déu Hospital, Barcelona, Spain.,Section of Arrhythmia, Department of Cardiology, Clinic Hospital, University of Barcelona, Barcelona, Spain
| | - Ane Abad-Motos
- Department of Anesthesiology and Critical Care, Infanta Leonor University Hospital, Madrid, Spain.,Madrid Complutense University, Madrid, Spain.,Spanish Perioperative Audit and Research Network (RedGERM), Zaragoza, Spain
| | - Matilde Zaballos-García
- Department of Anesthesiology, Gregorio Marañón University General Hospital, Madrid, Spain.,Clinical Toxicology, Madrid Complutense University, Madrid, Spain
| | - Ana Abad-Torrent
- Department of Anesthesiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Alejandra Prieto-Gundin
- Department of Pediatric Anesthesiology, Sant Joan de Déu Hospital, Barcelona Children's Hospital, Barcelona, Spain
| | - Josep Brugada
- Unit of Pediatric Arrhythmia, Department of Cardiology, Sant Joan de Déu Hospital, Barcelona, Spain.,Section of Arrhythmia, Department of Cardiology, Clinic Hospital, University of Barcelona, Barcelona, Spain
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14
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Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, Chiuve SE, Cushman M, Delling FN, Deo R, de Ferranti SD, Ferguson JF, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Lutsey PL, Mackey JS, Matchar DB, Matsushita K, Mussolino ME, Nasir K, O'Flaherty M, Palaniappan LP, Pandey A, Pandey DK, Reeves MJ, Ritchey MD, Rodriguez CJ, Roth GA, Rosamond WD, Sampson UKA, Satou GM, Shah SH, Spartano NL, Tirschwell DL, Tsao CW, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P. Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association. Circulation 2018; 137:e67-e492. [PMID: 29386200 DOI: 10.1161/cir.0000000000000558] [Citation(s) in RCA: 4454] [Impact Index Per Article: 742.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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15
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Ion Channel Disorders and Sudden Cardiac Death. Int J Mol Sci 2018; 19:ijms19030692. [PMID: 29495624 PMCID: PMC5877553 DOI: 10.3390/ijms19030692] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 02/22/2018] [Accepted: 02/23/2018] [Indexed: 12/19/2022] Open
Abstract
Long QT syndrome, short QT syndrome, Brugada syndrome and catecholaminergic polymorphic ventricular tachycardia are inherited primary electrical disorders that predispose to sudden cardiac death in the absence of structural heart disease. Also known as cardiac channelopathies, primary electrical disorders respond to mutations in genes encoding cardiac ion channels and/or their regulatory proteins, which result in modifications in the cardiac action potential or in the intracellular calcium handling that lead to electrical instability and life-threatening ventricular arrhythmias. These disorders may have low penetrance and expressivity, making clinical diagnosis often challenging. However, because sudden cardiac death might be the first presenting symptom of the disease, early diagnosis becomes essential. Genetic testing might be helpful in this regard, providing a definite diagnosis in some patients. Yet important limitations still exist, with a significant proportion of patients remaining with no causative mutation identifiable after genetic testing. This review aims to provide the latest knowledge on the genetic basis of cardiac channelopathies and discuss the role of the affected proteins in the pathophysiology of each one of these diseases.
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16
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Liu X, Zheng J, Fan Z, Rao L. Case report: an unusual case of Brugada syndrome combined with a ventricular septal defect: A case report. Medicine (Baltimore) 2017; 96:e8695. [PMID: 29381953 PMCID: PMC5708952 DOI: 10.1097/md.0000000000008695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Brugada syndrome (BrS) is a cardiac ion channel disease that is caused by an autosomal dominant genetic abnormality. A ventricular septal defect is a common congenital heart disease, in which genetic defects play a significant role. PATIENT CONCERNS We report an extremely rare case of a 42-year-old male with congenital heart disease, who suffered recurrent syncope and gastrointestinal bleeding. His electrocardiogram showed an unusual right bundle branch block-like pattern and ST-segment elevation in leads V1-V3. DIAGNOSES The patient was eventually diagnosed with Brugada Syndrome Combined with a Ventricular Septal Defect. INTERVENTIONS The patient was treated with ICD implants. OUTCOMES We extracted his blood and performed whole exome sequencing. Whole exome sequencing revealed mutations in genes, which encode ion channels and proteins important for embryonic heart development. However, a novel mutation in the SCN5A gene was also found. LESSONS To our knowledge, this is the first genetically proven case of BrS combined with a ventricular septal defect.
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Affiliation(s)
- Xing Liu
- Department of Cardiovascular Medicine, West China Hospital, Sichuan University, Chengdu
| | - Jianmei Zheng
- Department of Cardiovascular Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Zhongcai Fan
- Department of Cardiovascular Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan Province, China
| | - Li Rao
- Department of Cardiovascular Medicine, West China Hospital, Sichuan University, Chengdu
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17
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Asensio Lafuente E. Patrón de Brugada desenmascarado por propafenona en un hombre de 84 años. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2017; 87:359-362. [DOI: 10.1016/j.acmx.2017.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 06/09/2017] [Accepted: 06/12/2017] [Indexed: 10/19/2022] Open
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18
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Graceffa RF, Boezio AA, Able J, Altmann S, Berry LM, Boezio C, Butler JR, Chu-Moyer M, Cooke M, DiMauro EF, Dineen TA, Feric Bojic E, Foti RS, Fremeau RT, Guzman-Perez A, Gao H, Gunaydin H, Huang H, Huang L, Ilch C, Jarosh M, Kornecook T, Kreiman CR, La DS, Ligutti J, Milgram BC, Lin MHJ, Marx IE, Nguyen HN, Peterson EA, Rescourio G, Roberts J, Schenkel L, Shimanovich R, Sparling BA, Stellwagen J, Taborn K, Vaida KR, Wang J, Yeoman J, Yu V, Zhu D, Moyer BD, Weiss MM. Sulfonamides as Selective NaV1.7 Inhibitors: Optimizing Potency, Pharmacokinetics, and Metabolic Properties to Obtain Atropisomeric Quinolinone (AM-0466) that Affords Robust in Vivo Activity. J Med Chem 2017; 60:5990-6017. [DOI: 10.1021/acs.jmedchem.6b01850] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | | | - Jessica Able
- Department
of Neuroscience, Amgen Inc., One Amgen Center Drive, Thousand Oaks, California 91320, United States
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Thomas Kornecook
- Department
of Neuroscience, Amgen Inc., One Amgen Center Drive, Thousand Oaks, California 91320, United States
| | | | | | - Joseph Ligutti
- Department
of Neuroscience, Amgen Inc., One Amgen Center Drive, Thousand Oaks, California 91320, United States
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Bryan D. Moyer
- Department
of Neuroscience, Amgen Inc., One Amgen Center Drive, Thousand Oaks, California 91320, United States
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19
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Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, de Ferranti SD, Floyd J, Fornage M, Gillespie C, Isasi CR, Jiménez MC, Jordan LC, Judd SE, Lackland D, Lichtman JH, Lisabeth L, Liu S, Longenecker CT, Mackey RH, Matsushita K, Mozaffarian D, Mussolino ME, Nasir K, Neumar RW, Palaniappan L, Pandey DK, Thiagarajan RR, Reeves MJ, Ritchey M, Rodriguez CJ, Roth GA, Rosamond WD, Sasson C, Towfighi A, Tsao CW, Turner MB, Virani SS, Voeks JH, Willey JZ, Wilkins JT, Wu JH, Alger HM, Wong SS, Muntner P. Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation 2017; 135:e146-e603. [PMID: 28122885 PMCID: PMC5408160 DOI: 10.1161/cir.0000000000000485] [Citation(s) in RCA: 6023] [Impact Index Per Article: 860.4] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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20
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Anesthesia and Brugada syndrome: a 12-year case series. J Clin Anesth 2017; 36:168-173. [DOI: 10.1016/j.jclinane.2016.09.031] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 08/27/2016] [Accepted: 09/28/2016] [Indexed: 11/18/2022]
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21
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Urrea JK, Parra PF, Casanova ME. Reporte de un caso de fibrilación auricular como manifestación inicial de síndrome de Brugada. REVISTA COLOMBIANA DE CARDIOLOGÍA 2016. [DOI: 10.1016/j.rccar.2015.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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22
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Brugada tipo i asociado a celulitis: revisión y puesta al día. Semergen 2016; 42:e22-4. [DOI: 10.1016/j.semerg.2015.01.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Revised: 01/28/2015] [Accepted: 01/30/2015] [Indexed: 11/19/2022]
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23
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Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, Das SR, de Ferranti S, Després JP, Fullerton HJ, Howard VJ, Huffman MD, Isasi CR, Jiménez MC, Judd SE, Kissela BM, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Magid DJ, McGuire DK, Mohler ER, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Rosamond W, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Woo D, Yeh RW, Turner MB. Heart Disease and Stroke Statistics-2016 Update: A Report From the American Heart Association. Circulation 2015; 133:e38-360. [PMID: 26673558 DOI: 10.1161/cir.0000000000000350] [Citation(s) in RCA: 3724] [Impact Index Per Article: 413.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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24
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Epicardial mapping and ablation of the right ventricle substrate during flecainide testing in Brugada syndrome. HeartRhythm Case Rep 2015; 2:52-56. [PMID: 28491631 PMCID: PMC5412659 DOI: 10.1016/j.hrcr.2015.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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25
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Castro-Torres Y, Carmona-Puerta R, Katholi RE. Ventricular repolarization markers for predicting malignant arrhythmias in clinical practice. World J Clin Cases 2015; 3:705-720. [PMID: 26301231 PMCID: PMC4539410 DOI: 10.12998/wjcc.v3.i8.705] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 02/22/2015] [Accepted: 06/08/2015] [Indexed: 02/05/2023] Open
Abstract
Malignant cardiac arrhythmias which result in sudden cardiac death may be present in individuals apparently healthy or be associated with other medical conditions. The way to predict their appearance represents a challenge for the medical community due to the tragic outcomes in most cases. In the last two decades some ventricular repolarization (VR) markers have been found to be useful to predict malignant cardiac arrhythmias in several clinical conditions. The corrected QT, QT dispersion, Tpeak-Tend, Tpeak-Tend dispersion and Tp-e/QT have been studied and implemented in clinical practice for this purpose. These markers are obtained from 12 lead surface electrocardiogram. In this review we discuss how these markers have demonstrated to be effective to predict malignant arrhythmias in medical conditions such as long and short QT syndromes, Brugada syndrome, early repolarization syndrome, acute myocardial ischemia, heart failure, hypertension, diabetes mellitus, obesity and highly trained athletes. Also the main pathophysiological mechanisms that explain the arrhythmogenic predisposition in these diseases and the basis for the VR markers are discussed. However, the same results have not been found in all conditions. Further studies are needed to reach a global consensus in order to incorporate these VR parameters in risk stratification of these patients.
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26
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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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27
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Eftekhari H. Case study of Brugada syndrome presenting initially as acute myocardial infarction. Int Emerg Nurs 2015; 23:329-33. [PMID: 25956667 DOI: 10.1016/j.ienj.2015.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 02/01/2015] [Indexed: 11/16/2022]
Affiliation(s)
- Helen Eftekhari
- Arrhythmia Nurse Specialist, University Hospitals Coventry & Warwickshire, UK.
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28
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León Ariza HH, Valenzuela Faccini N, Rojas Ortega AC, Botero Rosas DA. Nav1.5 cardiac sodium channels, regulation and clinical implications. REVISTA DE LA FACULTAD DE MEDICINA 2015. [DOI: 10.15446/revfacmed.v62n4.44015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
<p>Voltage-gated sodium channels constitute a group of membrane<br />proteins widely distributed thought the body. In the heart, there<br />are at least six different isoforms, being the Nav1.5 the most<br />abundant. The channel is composed of an α subunit that is formed<br />by four domains of six segments each, and four much smaller β<br />subunits that provide stability and integrate other channels into<br />the α subunit. The function of the Nav1.5 channel is modulated<br />by intracellular cytoskeleton proteins, extracellular proteins,<br />calcium concentration, free radicals, and medications, among<br />other things. The study of the channel and its alterations has<br />grown thanks to its association with pathogenic conditions such<br />as Long QT syndrome, Brugada syndrome, atrial fibrillation,<br />arrhythmogenic ventricular dysplasia and complications during<br />ischemic processes.</p>
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29
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Saber S, Amarouch MY, Fazelifar AF, Haghjoo M, Emkanjoo Z, Alizadeh A, Houshmand M, Gavrilenko AV, Abriel H, Zaklyazminskaya EV. Complex genetic background in a large family with Brugada syndrome. Physiol Rep 2015; 3:3/1/e12256. [PMID: 25626866 PMCID: PMC4387754 DOI: 10.14814/phy2.12256] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The Brugada syndrome (BrS) is an inherited arrhythmia characterized by ST-segment elevation in V1-V3 leads and negative T wave on standard ECG. BrS patients are at risk of sudden cardiac death (SCD) due to ventricular tachyarrhythmia. At least 17 genes have been proposed to be linked to BrS, although recent findings suggested a polygenic background. Mutations in SCN5A, the gene coding for the cardiac sodium channel Nav1.5, have been found in 15-30% of index cases. Here, we present the results of clinical, genetic, and expression studies of a large Iranian family with BrS carrying a novel genetic variant (p.P1506S) in SCN5A. By performing whole-cell patch-clamp experiments using HEK293 cells expressing wild-type (WT) or p.P1506S Nav1.5 channels, hyperpolarizing shift of the availability curve, depolarizing shift of the activation curve, and hastening of the fast inactivation process were observed. These mutant-induced alterations lead to a loss of function of Nav1.5 and thus suggest that the p.P1506S variant is pathogenic. In addition, cascade familial screening found a family member with BrS who did not carry the p.P1506S mutation. Additional next generation sequencing analyses revealed the p.R25W mutation in KCNH2 gene in SCN5A-negative BrS patients. These findings illustrate the complex genetic background of BrS found in this family and the possible pathogenic role of a new SCN5A genetic variant.
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Affiliation(s)
- Siamak Saber
- I. M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Mohamed-Yassine Amarouch
- Environment & Natural Substances Team, University of Sidi Mohamed Ben Abdellah-Fes, Multidisciplinary Faculty of Taza, Taza, Morocco
| | - Amir-Farjam Fazelifar
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Majid Haghjoo
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Emkanjoo
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Abolfath Alizadeh
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Massoud Houshmand
- Medical Genetics Department, National Institute for Genetic Engineering & Biotechnology, Tehran, Iran
| | - Alexander V Gavrilenko
- I. M. Sechenov First Moscow State Medical University, Moscow, Russia Petrovsky Russian Research Center of Surgery, RAMS, Moscow, Russia
| | - Hugues Abriel
- Department of Clinical Research, Ion Channels and Channelopathies, University of Bern, Bern, Switzerland
| | - Elena V Zaklyazminskaya
- I. M. Sechenov First Moscow State Medical University, Moscow, Russia Petrovsky Russian Research Center of Surgery, RAMS, Moscow, Russia
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Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, de Ferranti S, Després JP, Fullerton HJ, Howard VJ, Huffman MD, Judd SE, Kissela BM, Lackland DT, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Matchar DB, McGuire DK, Mohler ER, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Willey JZ, Woo D, Yeh RW, Turner MB. Heart disease and stroke statistics--2015 update: a report from the American Heart Association. Circulation 2014; 131:e29-322. [PMID: 25520374 DOI: 10.1161/cir.0000000000000152] [Citation(s) in RCA: 4448] [Impact Index Per Article: 444.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Domínguez-Lenogue S, Amoros-García R, Sierra-Bergua B, Valiente-Martínez C, Sáenz-Abad D. Fiebre que desenmascara: a propósito de 2 casos de síndrome de Brugada. Semergen 2014; 40:347-9. [DOI: 10.1016/j.semerg.2013.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 11/22/2013] [Accepted: 12/03/2013] [Indexed: 10/25/2022]
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González-Melchor L, Villarreal-Molina T, Iturralde-Torres P, Medeiros-Domingo A. [Sudden cardiac death in individuals with normal hearts: an update]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2014; 84:293-304. [PMID: 25128006 DOI: 10.1016/j.acmx.2014.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 03/27/2014] [Accepted: 04/01/2014] [Indexed: 11/19/2022] Open
Abstract
Sudden death (SD) is a tragic event and a world-wide health problem. Every year, near 4-5 million people experience SD. SD is defined as the death occurred in 1h after the onset of symptoms in a person without previous signs of fatality. It can be named "recovered SD" when the case received medical attention, cardiac reanimation effective defibrillation or both, surviving the fatal arrhythmia. Cardiac channelopathies are a group of diseases characterized by abnormal ion channel function due to genetic mutations in ion channel genes, providing increased susceptibility to develop cardiac arrhythmias and SD. Usually the death occurs before 40 years of age and in the autopsy the heart is normal. In this review we discuss the main cardiac channelopathies involved in sudden cardiac death along with current management of cases and family members that have experienced such tragic event.
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Affiliation(s)
- Laila González-Melchor
- Servicio de Arritmias, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | | | - Pedro Iturralde-Torres
- Servicio de Arritmias, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
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Treatment of anxiety and depression in a patient with brugada syndrome. Case Rep Psychiatry 2014; 2014:478397. [PMID: 25114827 PMCID: PMC4120482 DOI: 10.1155/2014/478397] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 06/26/2014] [Indexed: 12/01/2022] Open
Abstract
Background. Brugada syndrome is rare and has been a clinically diagnosable entity since 1992. Its clinical manifestations are highly variable, and while some patients remain asymptomatic, others endure sudden cardiac death. Initial presenting symptoms may include palpitations, seizures, syncope, and nocturnal agonal respiration. The diagnosis of Brugada syndrome relies on both clinical findings and characteristic ECG patterns that occur spontaneously or are induced by usage of sodium-channel blocking agents. Aims of Case Report. Many psychiatrists may be unaware of the possibility of medical cocontributing etiologies to physical symptoms of anxiety and depression. We present a case of a patient who was treated psychiatrically for anxiety and panic attacks and who was subsequently diagnosed with Brugada syndrome and treated medically with an implantable cardioverter defibrillator (ICD), the only treatment option demonstrated to be effective. Her psychiatric symptoms predated her diagnosis of Brugada syndrome by at least fifteen years. Conclusion. The patient's eventual diagnosis of Brugada syndrome altered the course of her psychopharmacologic medication management and illustrates the utility of a psychosomatic approach to psychiatric symptom management.
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Brugada syndrome and pregnancy: highlights on antenatal and prenatal management. Case Rep Obstet Gynecol 2014; 2014:531648. [PMID: 24963427 PMCID: PMC4055041 DOI: 10.1155/2014/531648] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 02/12/2014] [Indexed: 11/17/2022] Open
Abstract
Introduction. Brugada syndrome is characterized by a disruption of heart's normal rhythm. It is an autosomal dominant disease due to a mutation of SNC5A gene. Its prevalence is low all over the world, but it is a lethal disease. Sudden cardiac death is the result of phenotypic manifestation of Brugada syndrome. Among asymptomatic Brugada patients, arrhythmia could be provoked by physical activity, fever, or pregnancy. About obstetrical management, very few data or reports have been published since this syndrome has been diagnosed in late 1992. Case Presentation. A 20-year-old pregnant woman at 13 weeks of gestation was referred to our department because of her familial history of sudden cardiac deaths. Brothers and sisters of her mother died of Brugada syndrome in childhood or older and live components of this family were carrier of mutation in Brugada gene. The pregnancy was uneventful. The patient gave birth vaginally without any arrhythmia. Strictly cardiological monitoring was performed during labour, delivery, and 12 hours of the postpartum. Conclusion. Even though patient at low risk may never have arrhythmia, some conditions could represent a Brugada trigger. The management could be very easy and uneventful. Otherwise it could be very difficult with need of ECMO or antiarrhythmics drugs or intracardiac device. Obstetrical management of Brugada pregnant women should be very strict and multidisciplinary in cooperation with cardiologist and anaesthesiologist and should provide an informed consent to the couple.
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Rodríguez-Mañero M, Casado-Arroyo R, Sarkozy A, Leysen E, Sieira JA, Namdar M, Conte G, Levinstein M, Chierchia GB, de Asmundis C, Brugada P. Trascendencia clínica del embarazo en el síndrome de Brugada. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2013.06.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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¿Es el dolor torácico una rara manifestación de síndrome de Brugada? Semergen 2014; 40:110-3. [DOI: 10.1016/j.semerg.2013.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 06/23/2013] [Accepted: 06/28/2013] [Indexed: 11/23/2022]
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Benito B, Berruezo A. Síndrome de Brugada y embarazo: indagando en el papel de las hormonas sexuales en las canalopatías iónicas. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2013.09.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hoshi M, Du XX, Shinlapawittayatorn K, Liu H, Chai S, Wan X, Ficker E, Deschênes I. Brugada syndrome disease phenotype explained in apparently benign sodium channel mutations. ACTA ACUST UNITED AC 2014; 7:123-31. [PMID: 24573164 DOI: 10.1161/circgenetics.113.000292] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Brugada syndrome (BrS) is an arrhythmogenic disorder that has been linked to mutations in SCN5A, the gene encoding for the pore-forming α-subunit of the cardiac sodium channel. Typically, BrS mutations in SCN5A result in a reduction of sodium current with some mutations even exhibiting a dominant-negative effect on wild-type (WT) channels, thus leading to an even more prominent decrease in current amplitudes. However, there is also a category of apparently benign (atypical) BrS SCN5A mutations that in vitro demonstrates only minor biophysical defects. It is therefore not clear how these mutations produce a BrS phenotype. We hypothesized that similar to dominant-negative mutations, atypical mutations could lead to a reduction in sodium currents when coexpressed with WT to mimic the heterozygous patient genotype. METHODS AND RESULTS WT and atypical BrS mutations were coexpressed in Human Embryonic Kidney-293 cells, showing a reduction in sodium current densities similar to typical BrS mutations. Importantly, this reduction in sodium current was also seen when the atypical mutations were expressed in rat or human cardiomyocytes. This decrease in current density was the result of reduced surface expression of both mutant and WT channels. CONCLUSIONS Taken together, we have shown how apparently benign SCN5A BrS mutations can lead to the ECG abnormalities seen in patients with BrS through an induced defect that is only present when the mutations are coexpressed with WT channels. Our work has implications for risk management and stratification for some SCN5A-implicated BrS patients.
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Affiliation(s)
- Malcolm Hoshi
- Department of Medicine, Heart and Vascular Research Center, MetroHealth Campus and Department of Physiology and Biophysics, Case Western Reserve University, Cleveland, OH; and Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Dubner S, Azocar D, Gallino S, Cerantonio AR, Muryan S, Medrano J, Bruno C. Single oral flecainide dose to unmask type 1 Brugada syndrome electrocardiographic pattern. Ann Noninvasive Electrocardiol 2014; 18:256-61. [PMID: 23714084 DOI: 10.1111/anec.12052] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Brugada syndrome (BrS) includes a group of patients with a typical pattern of ST segment elevation in right precordial leads who are at risk for sudden cardiac death. The electrocardiogram pattern may be intermittent and unmasked by sodium channel blockers. The main objective of this study is to describe a serie of consecutive patients in whom oral administration of flecainide was used to unmask BrS type I electrocardiographic pattern. METHODS We prospectively studied 14 symptomatic (palpitations/syncope) patients referred to our laboratory presenting a suggestive but not diagnostic Brugada ECG or family history of sudden death. Single oral dose of flecainide 400 mg was administered. Resting 12-lead ECG with upper and standard right precordial leads were performed after flecainide administration at 15, 30, 60 and 90 min and hourly until ECG became normal. RESULTS Median age was 37.5 years (range = 22-50). None of them had structural heart disease. In 7 patients (50%) the typical coved-type ECG pattern of BrS was unmasked. PR interval, QRS duration and QTc median difference after-before test was 20 msec (min-max = -17-+57), 21 ms (min-max = 0 to +59) and 20 ms (min-max = -11-+77), respectively. There were no episodes of AV block, atrial or ventricular tachyarrhythmia. CONCLUSIONS In our experience we found that oral administration of flecainide in a single dose of 400 mg is useful to unmask type 1 Brugada electrocardiographic pattern.
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Affiliation(s)
- Sergio Dubner
- Clínica y Maternidad Suizo Argentina and Sanatorio de los Arcos, Buenos Aires, Argentina.
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40
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Benito B, Berruezo A. Brugada syndrome and pregnancy: delving into the role of sex hormones in ion channelopathies. ACTA ACUST UNITED AC 2014; 67:165-7. [PMID: 24774388 DOI: 10.1016/j.rec.2013.09.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 09/15/2013] [Indexed: 11/19/2022]
Affiliation(s)
- Begoña Benito
- Unidad de Arritmias, Servicio de Cardiología, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Parc de Salut Mar, Barcelona, Spain.
| | - Antonio Berruezo
- Unidad de Arritmias, Servicio de Cardiología, Hospital Clínic, Universidad de Barcelona, Barcelona, Spain
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41
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Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, Dai S, Ford ES, Fox CS, Franco S, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Huffman MD, Judd SE, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Mackey RH, Magid DJ, Marcus GM, Marelli A, Matchar DB, McGuire DK, Mohler ER, Moy CS, Mussolino ME, Neumar RW, Nichol G, Pandey DK, Paynter NP, Reeves MJ, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Wong ND, Woo D, Turner MB. Heart disease and stroke statistics--2014 update: a report from the American Heart Association. Circulation 2014; 129:e28-e292. [PMID: 24352519 PMCID: PMC5408159 DOI: 10.1161/01.cir.0000441139.02102.80] [Citation(s) in RCA: 3513] [Impact Index Per Article: 351.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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42
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Rodríguez-Serrano D, Chicot-Llano M, Méndez-Fernández I. Fiebre y síndrome de Brugada. Rev Clin Esp 2014; 214:e11. [DOI: 10.1016/j.rce.2013.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 07/30/2013] [Indexed: 11/25/2022]
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Wolpert C, Herrera-Siklody C, Parade U, Strotmann C, Rüb N. [Brugada syndrome]. Herzschrittmacherther Elektrophysiol 2013; 24:209-216. [PMID: 24100621 DOI: 10.1007/s00399-013-0294-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Brugada syndrome is an ion channel disease which is associated with an increased risk of sudden cardiac death. Most probably the pathogenesis of ventricular fibrillation in these patients is a combination of both genetically determined repolarisation abnormalities and conduction delay in the right ventricular epicardium. The highest risk of sudden cardiac death is present in patients who have experienced syncope before, who reveal the pathognomic electrocardiographic changes already at rest and who have inducible ventricular fibrillation. Asymptomatic patients who have the J point elevations only after administration of a sodium channel blocker seem to be at lower risk. Most recently the latest joint consensus recommendations of the largest societies for diagnostic criteria, indications for genetic testing and therapy have been published.
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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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Tomašić T, Hartzoulakis B, Zidar N, Chan F, Kirby RW, Madge DJ, Peigneur S, Tytgat J, Kikelj D. Ligand- and Structure-Based Virtual Screening for Clathrodin-Derived Human Voltage-Gated Sodium Channel Modulators. J Chem Inf Model 2013; 53:3223-32. [DOI: 10.1021/ci400505e] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Tihomir Tomašić
- University of Ljubljana, Faculty of Pharmacy, Aškerčeva 7, 1000 Ljubljana, Slovenia
| | - Basil Hartzoulakis
- Xention Limited, Iconix Park, London
Road, Pampisford, Cambridge CB22 3EG, United Kingdom
| | - Nace Zidar
- University of Ljubljana, Faculty of Pharmacy, Aškerčeva 7, 1000 Ljubljana, Slovenia
| | - Fiona Chan
- Xention Limited, Iconix Park, London
Road, Pampisford, Cambridge CB22 3EG, United Kingdom
| | - Robert W. Kirby
- Xention Limited, Iconix Park, London
Road, Pampisford, Cambridge CB22 3EG, United Kingdom
| | - David J. Madge
- Xention Limited, Iconix Park, London
Road, Pampisford, Cambridge CB22 3EG, United Kingdom
| | - Steve Peigneur
- University of Leuven (K. U. Leuven), Toxicology and Pharmacology, Campus Gasthuisberg O&N2, Herestraat 49, P.O. Box 922, 3000 Leuven, Belgium
| | - Jan Tytgat
- University of Leuven (K. U. Leuven), Toxicology and Pharmacology, Campus Gasthuisberg O&N2, Herestraat 49, P.O. Box 922, 3000 Leuven, Belgium
| | - Danijel Kikelj
- University of Ljubljana, Faculty of Pharmacy, Aškerčeva 7, 1000 Ljubljana, Slovenia
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Rodríguez-Mañero M, Casado-Arroyo R, Sarkozy A, Leysen E, Sieira JA, Namdar M, Conte G, Levinstein M, Chierchia GB, de Asmundis C, Brugada P. The clinical significance of pregnancy in Brugada syndrome. ACTA ACUST UNITED AC 2013; 67:176-80. [PMID: 24774391 DOI: 10.1016/j.rec.2013.06.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 06/17/2013] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND OBJECTIVES Little is known about the risks and outcomes of pregnancy in women with Brugada syndrome. We therefore evaluated pregnancy outcomes and the influence of pregnancy in patients with Brugada syndrome. METHODS A retrospective analysis was performed in all pregnant women with Brugada syndrome. We included 104 women with a total of 219 deliveries. RESULTS There were 15 spontaneous abortions. One infant died suddenly during the night 3 months after birth. Six pregnant women reported they had experienced at least 1 syncope during the pregnancy. Of the 3 women who received an implantable cardioverter-defibrillator before the pregnancy, none received arrhythmia episodes. There were no events during the pregnancy in 4 patients with a previously aborted sudden cardiac death. Of 24 patients with syncope when not pregnant, 18 were asymptomatic and 6 experienced a recurrent syncope during the pregnancy. During the follow-up (mean follow-up 298.9 days; 95% confidence interval, 289.6-308.2), 2 women received appropriate shocks. CONCLUSIONS In this retrospective, single-center study, serious events were not more frequent during pregnancy and the peripartum period in women with Brugada syndrome. The occurrence of syncope during pregnancy was not associated with a worst outcome in the peri- and postpartum periods or during follow-up. The reported rate of miscarriage and sudden infant death will require further studies to confirm or rule out its association with Brugada syndrome.
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Affiliation(s)
| | - Rubén Casado-Arroyo
- Heart Rhythm Management Center, University Hospital Brussels-UZB, Brussels, Belgium
| | - Andrea Sarkozy
- Heart Rhythm Management Center, University Hospital Brussels-UZB, Brussels, Belgium
| | - Eva Leysen
- Heart Rhythm Management Center, University Hospital Brussels-UZB, Brussels, Belgium
| | - Juan Antonio Sieira
- Heart Rhythm Management Center, University Hospital Brussels-UZB, Brussels, Belgium
| | - Mehdi Namdar
- Heart Rhythm Management Center, University Hospital Brussels-UZB, Brussels, Belgium
| | - Gulio Conte
- Heart Rhythm Management Center, University Hospital Brussels-UZB, Brussels, Belgium
| | - Moisés Levinstein
- Heart Rhythm Management Center, University Hospital Brussels-UZB, Brussels, Belgium
| | | | - Carlo de Asmundis
- Heart Rhythm Management Center, University Hospital Brussels-UZB, Brussels, Belgium
| | - Pedro Brugada
- Heart Rhythm Management Center, University Hospital Brussels-UZB, Brussels, Belgium
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Raposeiras-Roubín S, Barreiro-Pardal C, Virgós-Lamela A, Rigueiro-Veloso P, González-Juanatey JR. [Electrocardiographic changes during stress test in a patient with a type 1 Brugada electrocardiogram pattern: a curiosity with a clinical implication]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2013; 60:352-353. [PMID: 22877759 DOI: 10.1016/j.redar.2012.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Accepted: 05/22/2012] [Indexed: 06/01/2023]
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Noris M, Carrillo A, Campuzano O, Santaella A, Brugada R, García-Niebla J, Fiol M. Syncope and polymorphic ventricular tachycardia in the setting of a febrile illness. J Electrocardiol 2013; 46:666-9. [PMID: 23522323 DOI: 10.1016/j.jelectrocard.2013.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Indexed: 10/27/2022]
Abstract
An asymptomatic woman with no clinical history consulted for pneumonia-induced fever; she then presented episodes of syncope due to polymorphic ventricular tachycardia and ECG alterations compatible with Brugada syndrome. Genetic studies showed no alterations in the SCN5A gene but other polymorphisms were observed. Further genetic studies are required to elucidate the pathophysiological mechanisms of fever and the function of sodium channels.
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Affiliation(s)
- Marta Noris
- Hospital Universitario Son Espases. Unidad Coronaria. Palma de Mallorca, España
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48
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Cardiomyocyte calcium cycling in a naturally occurring German shepherd dog model of inherited ventricular arrhythmia and sudden cardiac death. J Vet Cardiol 2013; 15:5-14. [PMID: 23434243 DOI: 10.1016/j.jvc.2012.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 03/30/2012] [Accepted: 07/16/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To further characterize arrhythmic mechanisms in German shepherd dogs (GSDs) affected with inherited ventricular arrhythmias by evaluating intracellular calcium cycling and expression of calcium handling genes. ANIMALS Twenty five GSDs, 9 backcross dogs, and 6 normal mongrel dogs (controls) were studied. The GSDs and backcross dogs were from a research colony of inherited ventricular arrhythmias. The control research dogs were purchased. METHODS Action potentials (APs) and pseudo-electrocardiograms (ECG) were recorded from left ventricular (LV) wedge preparations of GSDs and normal dogs. Midmyocardial (Mid) LV cells from GSDs and normal mongrels were isolated by enzymatic digestion. Cells were either field stimulated or voltage clamped and calcium transients were measured by confocal microscopy using the indicator Fluo-3AM. Expression of calcium handling genes was measured by quantitative RT-PCR. RESULTS Mean calcium transient decay (tau) was not different between affected GSDs and control dogs, but striking cell-to-cell variability for tau was observed within affected GSDs and between affected GSDs and controls (P < 0.0001 each); within-dog variability accounted for 75% of total variability. Calcium sparks and afterdepolarizations occurred in GSD but not control cells. ATP2A2/SERCA2a expression was significantly reduced (P = 0.0063) in affected GSDs and inversely correlated (P = 0.0006) with severity of ventricular arrhythmias. CONCLUSIONS German shepherd dogs with inherited ventricular arrhythmias have electrophysiologic abnormalities in calcium cycling associated with reduced ATP2A2/SERCA2a expression. These animals provide a unique opportunity to study calcium remodeling at the genetic and molecular level in familial ventricular arrhythmias.
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Kwong JSW, Leithäuser B, Park JW, Yu CM. Diagnostic value of magnetocardiography in coronary artery disease and cardiac arrhythmias: a review of clinical data. Int J Cardiol 2013; 167:1835-42. [PMID: 23336954 DOI: 10.1016/j.ijcard.2012.12.056] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 11/27/2012] [Accepted: 12/25/2012] [Indexed: 10/27/2022]
Abstract
Despite the availability of several advanced non-invasive diagnostic tests such as echocardiography and magnetic resonance imaging, electrocardiography (ECG) remains as the most widely used diagnostic technique in clinical cardiology. ECG detects electrical potentials that are generated by cardiac electrical activity. In addition to electrical potentials, the same electrical activity of the heart also induces magnetic fields. These extremely weak cardiac magnetic signals are detected by a non-invasive, contactless technique called magnetocardiography (MCG), which has been evaluated in a number of clinical studies for its usefulness in diagnosing heart diseases. We reviewed the basic principles, history and clinical data on the diagnostic role of MCG in coronary artery disease and cardiac arrhythmias.
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Affiliation(s)
- Joey S W Kwong
- Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong SAR
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50
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Genetics can contribute to the prognosis of Brugada syndrome: a pilot model for risk stratification. Eur J Hum Genet 2013; 21:911-7. [PMID: 23321620 DOI: 10.1038/ejhg.2012.289] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 11/22/2012] [Accepted: 11/28/2012] [Indexed: 12/19/2022] Open
Abstract
Brugada syndrome is an inherited arrhythmogenic disorder leading to sudden death predominantly in the 3-4 decade. To date the only reliable treatment is the implantation of a cardioverter defibrillator; however, better criteria for risk stratification are needed, especially for asymptomatic subjects. Brugada syndrome genetic bases have been only partially understood, accounting for <30% of patients, and have been poorly correlated with prognosis, preventing inclusion of genetic data in current guidelines. We designed an observational study to identify genetic markers for risk stratification of Brugada patients by exploratory statistical analysis. The presence of genetic variants, identified by SCN5A gene analysis and genotyping of 73 candidate polymorphisms, was correlated with the occurrence of major arrhythmic events in a cohort of 92 Brugada patients by allelic association and survival analysis. In all, 18 mutations were identified in the SCN5A gene, including 5 novel, and statistical analysis indicated that mutation carriers had a significantly increased risk of major arrhythmic events (P=0.024). In addition, we established association of five polymorphisms with major arrhythmic events occurrence and consequently elaborated a pilot risk stratification algorithm by calculating a weighted genetic risk score, including the associated polymorphisms and the presence of SCN5A mutation as function of their odds ratio. This study correlates for the first time the presence of genetic variants with increased arrhythmic risk in Brugada patients, representing a first step towards the design of a new risk stratification model.
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