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Lazareva TE, Barbitoff YA, Nasykhova YA, Glotov AS. Major Causes of Conflicting Interpretations of Variant Pathogenicity in Rare Disease: A Systematic Analysis. J Pers Med 2024; 14:864. [PMID: 39202055 PMCID: PMC11355203 DOI: 10.3390/jpm14080864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 07/31/2024] [Accepted: 08/12/2024] [Indexed: 09/03/2024] Open
Abstract
The identification of the genetic causes of inherited disorders from next-generation sequencing (NGS) data remains a complicated process, in particular due to challenges in interpretation of the vast amount of generated data and hundreds of candidate variants identified. Inconsistencies in variant classification, where genetic centers classify the same variant differently, can hinder accurate diagnoses for rare diseases. Publicly available databases that collect data on human genetic variations and their association with diseases provide ample opportunities to discover conflicts in variant interpretation worldwide. In this study, we explored patterns of variant classification discrepancies using data from ClinVar, a public archive of variant interpretations. We found that 5.7% of variants have conflicting interpretations (COIs) reported, and the vast majority of interpretation conflicts arise for variants of uncertain significance (VUS). As many as 78% of clinically relevant genes harbor variants with COIs, and genes with high COI rates tended to have more exons and longer transcripts, with a greater proportion of genes linked to several distinct conditions. The enrichment analysis of COI-enriched genes revealed that the products of these genes are involved in cardiac disorders, muscle development, and function. To improve diagnoses, we believe that specific variant interpretation rules could be developed for such genes. Additionally, our findings underscore the need for the publication of variant pathogenicity evidence and the importance of considering every variant as VUS unless proven otherwise.
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Affiliation(s)
- Tatyana E. Lazareva
- Department of Genomic Medicine, D.O. Ott Research Institute of Obstetrics, Gynaecology, and Reproductology, Mendeleevskaya Line 3, 199034 St. Petersburg, Russia
| | - Yury A. Barbitoff
- Department of Genomic Medicine, D.O. Ott Research Institute of Obstetrics, Gynaecology, and Reproductology, Mendeleevskaya Line 3, 199034 St. Petersburg, Russia
- Bioinformatics Institute, Kantemirovskaya St. 2A, 197342 St. Petersburg, Russia
| | - Yulia A. Nasykhova
- Department of Genomic Medicine, D.O. Ott Research Institute of Obstetrics, Gynaecology, and Reproductology, Mendeleevskaya Line 3, 199034 St. Petersburg, Russia
| | - Andrey S. Glotov
- Department of Genomic Medicine, D.O. Ott Research Institute of Obstetrics, Gynaecology, and Reproductology, Mendeleevskaya Line 3, 199034 St. Petersburg, Russia
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2
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Tarantino A, Ciconte G, Melgari D, Frosio A, Ghiroldi A, Piccoli M, Villa M, Creo P, Calamaio S, Castoldi V, Coviello S, Micaglio E, Cirillo F, Locati ET, Negro G, Boccellino A, Mastrocinque F, Ćalović Ž, Ricagno S, Leocani L, Vicedomini G, Santinelli V, Rivolta I, Anastasia L, Pappone C. NaV1.5 autoantibodies in Brugada syndrome: pathogenetic implications. Eur Heart J 2024:ehae480. [PMID: 39078224 DOI: 10.1093/eurheartj/ehae480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/22/2024] [Accepted: 07/15/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND AND AIMS Patients suffering from Brugada syndrome (BrS) are predisposed to life-threatening cardiac arrhythmias. Diagnosis is challenging due to the elusive electrocardiographic (ECG) signature that often requires unconventional ECG lead placement and drug challenges to be detected. Although NaV1.5 sodium channel dysfunction is a recognized pathophysiological mechanism in BrS, only 25% of patients have detectable SCN5A variants. Given the emerging role of autoimmunity in cardiac ion channel function, this study explores the presence and potential impact of anti-NaV1.5 autoantibodies in BrS patients. METHODS Using engineered HEK293A cells expressing recombinant NaV1.5 protein, plasma from 50 BrS patients and 50 controls was screened for anti-NaV1.5 autoantibodies via western blot, with specificity confirmed by immunoprecipitation and immunofluorescence. The impact of these autoantibodies on sodium current density and their pathophysiological effects were assessed in cellular models and through plasma injection in wild-type mice. RESULTS Anti-NaV1.5 autoantibodies were detected in 90% of BrS patients vs. 6% of controls, yielding a diagnostic area under the curve of .92, with 94% specificity and 90% sensitivity. These findings were consistent across varying patient demographics and independent of SCN5A mutation status. Electrophysiological studies demonstrated a significant reduction specifically in sodium current density. Notably, mice injected with BrS plasma showed Brugada-like ECG abnormalities, supporting the pathogenic role of these autoantibodies. CONCLUSIONS The study demonstrates the presence of anti-NaV1.5 autoantibodies in the majority of BrS patients, suggesting an immunopathogenic component of the syndrome beyond genetic predispositions. These autoantibodies, which could serve as additional diagnostic markers, also prompt reconsideration of the underlying mechanisms of BrS, as evidenced by their role in inducing the ECG signature of the syndrome in wild-type mice. These findings encourage a more comprehensive diagnostic approach and point to new avenues for therapeutic research.
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Affiliation(s)
- Adriana Tarantino
- Institute for Molecular and Translational Cardiology (IMTC), IRCCS Policlinico San Donato, Piazza Malan, 2, 20097 San Donato Milanese, Milan, Italy
- School of Medicine, University Vita-Salute San Raffaele, Via Olgettina, 58, 20132 Milan, Italy
| | - Giuseppe Ciconte
- Institute for Molecular and Translational Cardiology (IMTC), IRCCS Policlinico San Donato, Piazza Malan, 2, 20097 San Donato Milanese, Milan, Italy
- School of Medicine, University Vita-Salute San Raffaele, Via Olgettina, 58, 20132 Milan, Italy
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza Malan, 2, 20097 San Donato Milanese, Milan, Italy
| | - Dario Melgari
- Institute for Molecular and Translational Cardiology (IMTC), IRCCS Policlinico San Donato, Piazza Malan, 2, 20097 San Donato Milanese, Milan, Italy
| | - Anthony Frosio
- Institute for Molecular and Translational Cardiology (IMTC), IRCCS Policlinico San Donato, Piazza Malan, 2, 20097 San Donato Milanese, Milan, Italy
| | - Andrea Ghiroldi
- Institute for Molecular and Translational Cardiology (IMTC), IRCCS Policlinico San Donato, Piazza Malan, 2, 20097 San Donato Milanese, Milan, Italy
| | - Marco Piccoli
- Institute for Molecular and Translational Cardiology (IMTC), IRCCS Policlinico San Donato, Piazza Malan, 2, 20097 San Donato Milanese, Milan, Italy
| | - Marco Villa
- Institute for Molecular and Translational Cardiology (IMTC), IRCCS Policlinico San Donato, Piazza Malan, 2, 20097 San Donato Milanese, Milan, Italy
| | - Pasquale Creo
- Institute for Molecular and Translational Cardiology (IMTC), IRCCS Policlinico San Donato, Piazza Malan, 2, 20097 San Donato Milanese, Milan, Italy
| | - Serena Calamaio
- Institute for Molecular and Translational Cardiology (IMTC), IRCCS Policlinico San Donato, Piazza Malan, 2, 20097 San Donato Milanese, Milan, Italy
| | - Valerio Castoldi
- Experimental Neurophysiology Unit, Institute of Experimental Neurology-INSPE, IRCCS Ospedale San Raffaele, Via Olgettina, 58, 20132 Milan, Italy
| | - Simona Coviello
- Institute for Molecular and Translational Cardiology (IMTC), IRCCS Policlinico San Donato, Piazza Malan, 2, 20097 San Donato Milanese, Milan, Italy
| | - Emanuele Micaglio
- Institute for Molecular and Translational Cardiology (IMTC), IRCCS Policlinico San Donato, Piazza Malan, 2, 20097 San Donato Milanese, Milan, Italy
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza Malan, 2, 20097 San Donato Milanese, Milan, Italy
| | - Federica Cirillo
- Institute for Molecular and Translational Cardiology (IMTC), IRCCS Policlinico San Donato, Piazza Malan, 2, 20097 San Donato Milanese, Milan, Italy
| | - Emanuela Teresina Locati
- Institute for Molecular and Translational Cardiology (IMTC), IRCCS Policlinico San Donato, Piazza Malan, 2, 20097 San Donato Milanese, Milan, Italy
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza Malan, 2, 20097 San Donato Milanese, Milan, Italy
| | - Gabriele Negro
- Institute for Molecular and Translational Cardiology (IMTC), IRCCS Policlinico San Donato, Piazza Malan, 2, 20097 San Donato Milanese, Milan, Italy
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza Malan, 2, 20097 San Donato Milanese, Milan, Italy
| | - Antonio Boccellino
- Institute for Molecular and Translational Cardiology (IMTC), IRCCS Policlinico San Donato, Piazza Malan, 2, 20097 San Donato Milanese, Milan, Italy
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza Malan, 2, 20097 San Donato Milanese, Milan, Italy
| | - Flavio Mastrocinque
- Institute for Molecular and Translational Cardiology (IMTC), IRCCS Policlinico San Donato, Piazza Malan, 2, 20097 San Donato Milanese, Milan, Italy
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza Malan, 2, 20097 San Donato Milanese, Milan, Italy
| | - Žarko Ćalović
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza Malan, 2, 20097 San Donato Milanese, Milan, Italy
| | - Stefano Ricagno
- Institute for Molecular and Translational Cardiology (IMTC), IRCCS Policlinico San Donato, Piazza Malan, 2, 20097 San Donato Milanese, Milan, Italy
- Department of Biosciences, Università degli Studi di Milano, 20133 Milan, Italy
| | - Letizia Leocani
- School of Medicine, University Vita-Salute San Raffaele, Via Olgettina, 58, 20132 Milan, Italy
- Experimental Neurophysiology Unit, Institute of Experimental Neurology-INSPE, IRCCS Ospedale San Raffaele, Via Olgettina, 58, 20132 Milan, Italy
| | - Gabriele Vicedomini
- Institute for Molecular and Translational Cardiology (IMTC), IRCCS Policlinico San Donato, Piazza Malan, 2, 20097 San Donato Milanese, Milan, Italy
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza Malan, 2, 20097 San Donato Milanese, Milan, Italy
| | - Vincenzo Santinelli
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza Malan, 2, 20097 San Donato Milanese, Milan, Italy
| | - Ilaria Rivolta
- Institute for Molecular and Translational Cardiology (IMTC), IRCCS Policlinico San Donato, Piazza Malan, 2, 20097 San Donato Milanese, Milan, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Via Cadore, 48, 20900 Monza, Italy
| | - Luigi Anastasia
- Institute for Molecular and Translational Cardiology (IMTC), IRCCS Policlinico San Donato, Piazza Malan, 2, 20097 San Donato Milanese, Milan, Italy
- School of Medicine, University Vita-Salute San Raffaele, Via Olgettina, 58, 20132 Milan, Italy
| | - Carlo Pappone
- Institute for Molecular and Translational Cardiology (IMTC), IRCCS Policlinico San Donato, Piazza Malan, 2, 20097 San Donato Milanese, Milan, Italy
- School of Medicine, University Vita-Salute San Raffaele, Via Olgettina, 58, 20132 Milan, Italy
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza Malan, 2, 20097 San Donato Milanese, Milan, Italy
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3
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Renard E, Surget E, Walton RD, Michel C, Benoist D, Dubes V, Guillot B, Martinez ME, Hocini M, Haïssaguerre M, Bernus O. Distinct Electrogram Features and Ventricular Arrhythmia Induction Modes Between Repolarization and Conduction Heterogeneities. JACC Clin Electrophysiol 2024; 10:1424-1438. [PMID: 38661605 DOI: 10.1016/j.jacep.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Recent clinical studies have indicated the presence of localized electrical abnormalities in idiopathic ventricular fibrillation and J-wave syndrome patients. OBJECTIVES This study aims to characterize the specific electrical signatures of localized repolarization and conduction heterogeneities and their respective role in vulnerability to arrhythmias. METHODS Optical mapping was performed in porcine right ventricles with local: 1) repolarization shortening; 2) conduction slowing; or 3) structural heterogeneity induced by locally perfusing: 1) pinacidil (20 μmol/L, n = 13); or 2) flecainide (2 μmol/L, n = 13) via an epicardial catheter; or 3) by local epicardial tissue destruction (9 radiofrequency lesions n = 12). Electrograms were recorded (n = 5 in each group) and spontaneous and induced arrhythmias were quantified and optically mapped. RESULTS Electrograms were normal in (1) but showed local fragmentation in 40% of preparations in (2) with greater effects observed at high pacing frequencies dependent on the wavefront direction. In (3), the structural substrate alone increased the width and number of peaks in the electrograms, and addition of flecainide induced pronounced fragmentation (≥3 peaks and ≥70 ms) in all cases. Occurrence of spontaneous arrhythmias was significantly increased in (1) and (2) (P < 0.0001 and 0.05, respectively, vs baseline) and were triggered by ectopies. Vulnerability to arrhythmias at high pacing frequencies (≥2 Hz) was the lowest in (1) and greatest in (2). CONCLUSIONS Microstructural substrates have the most pronounced impact on electrograms, especially when combined with sodium channel blockers, whereas local action potential duration shortening does not lead to electrogram fragmentation even though it is associated with the highest prevalence of spontaneous arrhythmias.
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Affiliation(s)
- Estelle Renard
- IHU LIRYC, L'Institut des maladies du RYthme Cardiaque, Fondation Bordeaux Université, Bordeaux, France; University of Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France.
| | - Elodie Surget
- IHU LIRYC, L'Institut des maladies du RYthme Cardiaque, Fondation Bordeaux Université, Bordeaux, France; University of Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
| | - Richard D Walton
- IHU LIRYC, L'Institut des maladies du RYthme Cardiaque, Fondation Bordeaux Université, Bordeaux, France; University of Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
| | - Cindy Michel
- IHU LIRYC, L'Institut des maladies du RYthme Cardiaque, Fondation Bordeaux Université, Bordeaux, France; University of Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
| | - David Benoist
- IHU LIRYC, L'Institut des maladies du RYthme Cardiaque, Fondation Bordeaux Université, Bordeaux, France; University of Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
| | - Virginie Dubes
- IHU LIRYC, L'Institut des maladies du RYthme Cardiaque, Fondation Bordeaux Université, Bordeaux, France; University of Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
| | - Bastien Guillot
- IHU LIRYC, L'Institut des maladies du RYthme Cardiaque, Fondation Bordeaux Université, Bordeaux, France; University of Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
| | - Marine E Martinez
- IHU LIRYC, L'Institut des maladies du RYthme Cardiaque, Fondation Bordeaux Université, Bordeaux, France; University of Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
| | - Mélèze Hocini
- IHU LIRYC, L'Institut des maladies du RYthme Cardiaque, Fondation Bordeaux Université, Bordeaux, France; University of Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France; CHU de Bordeaux, Département d'électrophysiologie et de stimulation cardiaques, Hôpital Cardiologique du Haut-Lévêque, Pessac, France
| | - Michel Haïssaguerre
- IHU LIRYC, L'Institut des maladies du RYthme Cardiaque, Fondation Bordeaux Université, Bordeaux, France; University of Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France; CHU de Bordeaux, Département d'électrophysiologie et de stimulation cardiaques, Hôpital Cardiologique du Haut-Lévêque, Pessac, France
| | - Olivier Bernus
- IHU LIRYC, L'Institut des maladies du RYthme Cardiaque, Fondation Bordeaux Université, Bordeaux, France; University of Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux, Bordeaux, France
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Chimatapu SN, Schachter JL, Batra AS, Sirignano R, Okawa ER. A Pediatric Case of Refractory Torsades de Pointes in Autoimmune Hypothyroidism. JCEM CASE REPORTS 2024; 2:luae124. [PMID: 39011403 PMCID: PMC11247166 DOI: 10.1210/jcemcr/luae124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Indexed: 07/17/2024]
Abstract
Hypothyroidism can have a significant impact on cardiac contractility, vascular resistance, blood pressure, and cardiac rhythm. Ventricular arrhythmias induced by hypothyroidism are infrequently reported, especially in pediatric cases. A 15-year-old girl with autoimmune hypothyroidism experienced pulseless ventricular arrhythmias on 2 separate occasions because of nonadherence to levothyroxine medication. Subsequent investigations revealed an SCN5A mutation associated with Brugada syndrome. A loop recorder captured polymorphic ventricular tachycardia (PMVT), specifically Torsades de Pointes during her second event. Both arrhythmias were addressed only after stabilizing her thyroid hormone levels with replacement therapy. Although rare, patients with uncontrolled hypothyroidism may present with ventricular arrhythmias, particularly PMVT. The cornerstone of treatment for hypothyroidism-induced ventricular arrhythmia is thyroid replacement therapy. The identification of an SCN5A mutation unmasked by overt hypothyroidism emphasizes the need for a comprehensive cardiac evaluation in patients with hypothyroidism being assessed for PMVT.
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Affiliation(s)
- Sri Nikhita Chimatapu
- University of California, Los Angeles, Mattel Children's Hospital, Los Angeles, CA 90095, USA
| | - Jessica L Schachter
- Department of Cardiology, University of California Irvine Medical Center, Orange, CA 92868, USA
| | - Anjan S Batra
- Department of Cardiology, University of California Irvine Medical Center, Orange, CA 92868, USA
| | - Rachel Sirignano
- Children's Heart Institute, Memorial Care Miller Children's & Women's Hospital, Long Beach, CA 90806, USA
| | - Erin R Okawa
- University of California, Los Angeles, Mattel Children's Hospital, Los Angeles, CA 90095, USA
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5
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Rattanawong P, Shen WK. To the Editor - Revisiting the prognostic role of SCN5A in Brugada syndrome. Heart Rhythm 2024:S1547-5271(24)02735-8. [PMID: 38901522 DOI: 10.1016/j.hrthm.2024.05.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 05/14/2024] [Indexed: 06/22/2024]
Affiliation(s)
- Pattara Rattanawong
- Demoulas Center for Cardiac Arrhythmias, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona.
| | - Win-Kuang Shen
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, Arizona
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6
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Russo V, Caturano A, Migliore F, Guerra F, Francia P, Nesti M, Conte G, Perini AP, Mascia G, Albani S, Marchese P, Santobuono VE, Dendramis G, Rossi A, Attena E, Ghidini AO, Sciarra L, Palamà Z, Baldi E, Romeo E, D'Onofrio A, Nigro G. Long-term clinical outcomes of patients with drug-induced type 1 Brugada electrocardiographic pattern: A nationwide cohort registry study. Heart Rhythm 2024; 21:555-561. [PMID: 38242222 DOI: 10.1016/j.hrthm.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/08/2024] [Accepted: 01/11/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND There are limited real-world data on the extended prognosis of patients with drug-induced type 1 Brugada electrocardiogram (ECG). OBJECTIVE We assessed the clinical outcomes and predictors of life-threatening arrhythmias in patients with drug-induced type 1 Brugada ECG. METHODS This multicenter retrospective study, conducted at 21 Italian and Swiss hospitals from July 1997 to May 2021, included consecutive patients with drug-induced type 1 ECG. The primary outcome, a composite of appropriate ICD therapies and sudden cardiac death, was assessed along with the clinical predictors of these events. RESULTS A total of 606 patients (mean age 49.7 ± 14.7 years; 423 [69.8%] men) were followed for a median of 60.3 months (interquartile range 23.0-122.4 months). Nineteen patients (3.1%) experienced life-threatening arrhythmias, with a median annual event rate of 0.5% over 5 years and 0.25% over 10 years. The SCN5A mutation was the only predictor of the primary outcome (hazard ratio 4.54; P = .002), whereas a trend was observed for unexplained syncope (hazard ratio 3.85; P = .05). In patients who were asymptomatic at presentation, the median annual rate of life-threatening arrhythmias is 0.24% over 5 years and increases to 1.2% if they have inducible ventricular fibrillation during programmed ventricular stimulation. CONCLUSION In patients with drug-induced type 1 Brugada ECG, the annual risk of life-threatening arrhythmias is low, with the SCN5A mutation as the only independent predictor. Unexplained syncope correlated with worse clinical outcomes. Ventricular fibrillation inducibility at programmed ventricular stimulation significantly increases the median annual rate of life-threatening arrhythmias from 0.24% to 1.2% over 5 years.
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Affiliation(s)
- Vincenzo Russo
- Division of Cardiology, Department of Medical Translational Sciences University of Campania "Luigi Vanvitelli", Naples, Italy.
| | - Alfredo Caturano
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy; Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Federico Guerra
- Azienda Ospedaliera Universitaria Ospedali Riuniti Ancona, Ancona, Italy
| | - Pietro Francia
- Azienda Ospedaliero-Universitaria Sant'Andrea, Rome, Italy
| | - Martina Nesti
- Cardiovascular and Neurological Department, Ospedale San Donato, Arezzo, Italy
| | - Giulio Conte
- Cardiocentro Ticino Foundation, Lugano, Switzerland
| | | | | | | | | | - Vincenzo Ezio Santobuono
- Cardiology Unit, Department of Interdisciplinary Medicine and Policlinico of Bari, University of Bari "Aldo Moro", Bari, Italy
| | - Gregory Dendramis
- Cardiology Unit, Clinical and Interventional Arrhythmology, ARNAS, Ospedale Civico Di Cristina Benfratelli, Palermo, Italy
| | | | | | | | | | | | | | - Emanuele Romeo
- Department of Cardiology, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples, Italy
| | - Antonio D'Onofrio
- Monaldi Hospital, Departmental Unit of Electrophysiology, Evaluation and Treatment of Arrhythmias, Naples, Italy
| | - Gerardo Nigro
- Division of Cardiology, Department of Medical Translational Sciences University of Campania "Luigi Vanvitelli", Naples, Italy
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7
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Gallego-Delgado M, Cámara-Checa A, Rubio-Alarcón M, Heredero-Jung D, de la Fuente-Blanco L, Rapún J, Plata-Izquierdo B, Pérez-Martín S, Cebrián J, Moreno de Redrojo L, García-Berrocal B, Delpón E, Sánchez PL, Villacorta E, Caballero R. Variable Penetrance and Expressivity of a Rare Pore Loss-of-Function Mutation (p.L889V) of Nav1.5 Channels in Three Spanish Families. Int J Mol Sci 2024; 25:4686. [PMID: 38731905 PMCID: PMC11083067 DOI: 10.3390/ijms25094686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/05/2024] [Accepted: 04/10/2024] [Indexed: 05/13/2024] Open
Abstract
A novel rare mutation in the pore region of Nav1.5 channels (p.L889V) has been found in three unrelated Spanish families that produces quite diverse phenotypic manifestations (Brugada syndrome, conduction disease, dilated cardiomyopathy, sinus node dysfunction, etc.) with variable penetrance among families. We clinically characterized the carriers and recorded the Na+ current (INa) generated by p.L889V and native (WT) Nav1.5 channels, alone or in combination, to obtain further insight into the genotypic-phenotypic relationships in patients carrying SCN5A mutations and in the molecular determinants of the Nav1.5 channel function. The variant produced a strong dominant negative effect (DNE) since the peak INa generated by p.L889V channels expressed in Chinese hamster ovary cells, either alone (-69.4 ± 9.0 pA/pF) or in combination with WT (-62.2 ± 14.6 pA/pF), was significantly (n ≥ 17, p < 0.05) reduced compared to that generated by WT channels alone (-199.1 ± 44.1 pA/pF). The mutation shifted the voltage dependence of channel activation and inactivation to depolarized potentials, did not modify the density of the late component of INa, slightly decreased the peak window current, accelerated the recovery from fast and slow inactivation, and slowed the induction kinetics of slow inactivation, decreasing the fraction of channels entering this inactivated state. The membrane expression of p.L889V channels was low, and in silico molecular experiments demonstrated profound alterations in the disposition of the pore region of the mutated channels. Despite the mutation producing a marked DNE and reduction in the INa and being located in a critical domain of the channel, its penetrance and expressivity are quite variable among the carriers. Our results reinforce the argument that the incomplete penetrance and phenotypic variability of SCN5A loss-of-function mutations are the result of a combination of multiple factors, making it difficult to predict their expressivity in the carriers despite the combination of clinical, genetic, and functional studies.
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Affiliation(s)
- María Gallego-Delgado
- Department of Cardiology, CSUR Cardiopatías Familiares, Institute of Biomedical Research of Salamanca (IBSAL), Complejo Asistencial Universitario de Salamanca, Gerencia Regional de Salud de Castilla y León (SACYL), 37007 Salamaca, Spain; (M.G.-D.)
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain (M.R.-A.); (J.R.); (J.C.); (R.C.)
| | - Anabel Cámara-Checa
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain (M.R.-A.); (J.R.); (J.C.); (R.C.)
- Department of Pharmacology, School of Medicine, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, 28040 Madrid, Spain
| | - Marcos Rubio-Alarcón
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain (M.R.-A.); (J.R.); (J.C.); (R.C.)
- Department of Pharmacology, School of Medicine, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, 28040 Madrid, Spain
| | - David Heredero-Jung
- Department of Biochemistry, CSUR Cardiopatías Familiares, Institute of Biomedical Research of Salamanca (IBSAL), Complejo Asistencial Universitario de Salamanca, Gerencia Regional de Salud de Castilla y León (SACYL), 37007 Salamaca, Spain
| | - Laura de la Fuente-Blanco
- Department of Cardiology, CSUR Cardiopatías Familiares, Institute of Biomedical Research of Salamanca (IBSAL), Complejo Asistencial Universitario de Salamanca, Gerencia Regional de Salud de Castilla y León (SACYL), 37007 Salamaca, Spain; (M.G.-D.)
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain (M.R.-A.); (J.R.); (J.C.); (R.C.)
| | - Josu Rapún
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain (M.R.-A.); (J.R.); (J.C.); (R.C.)
- Department of Pharmacology, School of Medicine, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, 28040 Madrid, Spain
| | - Beatriz Plata-Izquierdo
- Department of Pediatrics, Institute of Biomedical Research of Salamanca (IBSAL), Complejo Asistencial Universitario de Salamanca, Gerencia Regional de Salud de Castilla y Leon (SACYL), CIBERCV, 37007 Salamaca, Spain;
| | - Sara Pérez-Martín
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain (M.R.-A.); (J.R.); (J.C.); (R.C.)
- Department of Pharmacology, School of Medicine, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, 28040 Madrid, Spain
| | - Jorge Cebrián
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain (M.R.-A.); (J.R.); (J.C.); (R.C.)
- Department of Pharmacology, School of Medicine, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, 28040 Madrid, Spain
| | - Lucía Moreno de Redrojo
- Department of Cardiology, CSUR Cardiopatías Familiares, Institute of Biomedical Research of Salamanca (IBSAL), Complejo Asistencial Universitario de Salamanca, Gerencia Regional de Salud de Castilla y León (SACYL), 37007 Salamaca, Spain; (M.G.-D.)
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain (M.R.-A.); (J.R.); (J.C.); (R.C.)
| | - Belén García-Berrocal
- Department of Biochemistry, CSUR Cardiopatías Familiares, Institute of Biomedical Research of Salamanca (IBSAL), Complejo Asistencial Universitario de Salamanca, Gerencia Regional de Salud de Castilla y León (SACYL), 37007 Salamaca, Spain
| | - Eva Delpón
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain (M.R.-A.); (J.R.); (J.C.); (R.C.)
- Department of Pharmacology, School of Medicine, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, 28040 Madrid, Spain
| | - Pedro L. Sánchez
- Department of Cardiology, CSUR Cardiopatías Familiares, Institute of Biomedical Research of Salamanca (IBSAL), Complejo Asistencial Universitario de Salamanca, Gerencia Regional de Salud de Castilla y León (SACYL), 37007 Salamaca, Spain; (M.G.-D.)
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain (M.R.-A.); (J.R.); (J.C.); (R.C.)
| | - Eduardo Villacorta
- Department of Cardiology, CSUR Cardiopatías Familiares, Institute of Biomedical Research of Salamanca (IBSAL), Complejo Asistencial Universitario de Salamanca, Gerencia Regional de Salud de Castilla y León (SACYL), 37007 Salamaca, Spain; (M.G.-D.)
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain (M.R.-A.); (J.R.); (J.C.); (R.C.)
| | - Ricardo Caballero
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain (M.R.-A.); (J.R.); (J.C.); (R.C.)
- Department of Pharmacology, School of Medicine, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense, 28040 Madrid, Spain
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8
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Doundoulakis I, Pannone L, Chiotis S, Della Rocca DG, Sorgente A, Tsioufis P, Del Monte A, Vetta G, Piperis C, Overeinder I, Bala G, Almorad A, Ströker E, Sieira J, La Meir M, Brugada P, Tsiachris D, Sarkozy A, Chierchia GB, de Asmundis C. SCN5A gene variants and arrhythmic risk in Brugada syndrome: An updated systematic review and meta-analysis. Heart Rhythm 2024:S1547-5271(24)02374-9. [PMID: 38614189 DOI: 10.1016/j.hrthm.2024.04.047] [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: 02/20/2024] [Revised: 04/02/2024] [Accepted: 04/08/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND A rare gene variant in SCN5A can be found in approximately 20%-25% of patients with Brugada syndrome (BrS). OBJECTIVE The aim of this systematic review and meta-analysis was to evaluate the differences in clinical characteristics of BrS patients with and without SCN5A rare variants and the prognostic role of SCN5A for ventricular arrhythmias in BrS. METHODS PubMed and Cochrane Central Register of Controlled Trials (CENTRAL) were systematically searched from inception to January 2024 to identify all relevant studies. Studies were analyzed if they included patients diagnosed with BrS in whom genetic testing for SCN5A variants was performed and arrhythmic outcomes were reported. RESULTS A total of 17 studies with 3568 BrS patients, of whom 3030 underwent genetic testing for SCN5A variants, fulfilled the eligibility criteria and were included. Compared with SCN5A- patients, SCN5A+ BrS patients more frequently had spontaneous type 1 electrocardiogram, history of syncope, and documented arrhythmias. Furthermore, higher PQ and QRS intervals in SCN5A+ BrS patients compared with SCN5A- have been found. The pooled analysis demonstrated a significant association between the presence of SCN5A rare variants in BrS patients and the risk of major arrhythmic events, with a pooled odds ratio of 2.14 (95% confidence interval, 1.53-2.99; I2 = 29%). CONCLUSION SCN5A+ BrS patients showed a worse clinical phenotype compared with SCN5A-. The pooled analysis demonstrated a significant association between SCN5A+ mutation status and the risk of major arrhythmic events in BrS patients.
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Affiliation(s)
- Ioannis Doundoulakis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Luigi Pannone
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Sotirios Chiotis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Domenico Giovanni Della Rocca
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Antonio Sorgente
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Panagiotis Tsioufis
- First Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Alvise Del Monte
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Giampaolo Vetta
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Christos Piperis
- First Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Ingrid Overeinder
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Gezim Bala
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Alexandre Almorad
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Erwin Ströker
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Juan Sieira
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Mark La Meir
- Department of Cardiac Surgery, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Pedro Brugada
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Dimitrios Tsiachris
- First Department of Cardiology, "Hippokration" General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Andrea Sarkozy
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Gian Battista Chierchia
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium.
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9
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Pannone L, Bisignani A, Osei R, Gauthey A, Sorgente A, Monaco C, Della Rocca DG, Del Monte A, Strazdas A, Mojica J, Al Housari M, Miraglia V, Mouram S, Vetta G, Paparella G, Ramak R, Overeinder I, Bala G, Almorad A, Ströker E, Pappaert G, Sieira J, de Ravel T, La Meir M, Sarkozy A, Brugada P, Chierchia GB, Van Dooren S, de Asmundis C. Genetic Testing in Brugada Syndrome: A 30-Year Experience. Circ Arrhythm Electrophysiol 2024; 17:e012374. [PMID: 38426305 DOI: 10.1161/circep.123.012374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 01/29/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND A pathogenic/likely pathogenic variant can be found in 20% to 25% of patients with Brugada syndrome (BrS) and a pathogenic/likely pathogenic variant in SCN5A is associated with a worse prognosis. The aim of this study is to define the diagnostic yield of a large gene panel with American College of Medical Genetics and Genomics variant classification and to assess prognosis of SCN5A and non-SCN5A variants. METHODS All patients with BrS, were prospectively enrolled in the Universitair Ziekenhuis Brussel registry between 1992 and 2022. Inclusion criteria for the study were (1) BrS diagnosis; (2) genetic analysis performed with a large gene panel; (3) classification of variants following American College of Medical Genetics and Genomics guidelines. Patients with a pathogenic/likely pathogenic variant in SCN5A were defined as SCN5A+. Patients with a reported variant in a non-SCN5A gene or with no reported variants were defined as patients with SCN5A-. All variants were classified as missense or predicted loss of function. RESULTS A total of 500 BrS patients were analyzed. A total of 104 patients (20.8%) were SCN5A+ and 396 patients (79.2%) were SCN5A-. A non-SCN5A gene variant was found in 75 patients (15.0%), of whom, 58 patients (77.3%) had a missense variant and 17 patients (22.7%) had a predicted loss of function variant. At a follow-up of 84.0 months, 48 patients (9.6%) experienced a ventricular arrhythmia (VA). Patients without any variant had higher VA-free survival, compared with carriers of a predicted loss of function variant in SCN5A+ or non-SCN5A genes. There was no difference in VA-free survival between patients without any variant and missense variant carriers in SCN5A+ or non-SCN5A genes. At Cox analysis, SCN5A+ or non-SCN5A predicted loss of function variant was an independent predictor of VA. CONCLUSIONS In a large BrS cohort, the yield for SCN5A+ is 20.8%. A predicted loss of function variant carrier is an independent predictor of VA.
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Affiliation(s)
- Luigi Pannone
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology & Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart (L.P., A.B., A.G., A. Sorgente, C.M., D.G.D.R., A.D.M., A.S., J.M., M.A.H., V.M., S.M., G.V., G. Paparella, R.R., I.O., G.B., A.A., E.S., G. Pappaert, J.S., A. Sarkozy, P.B., G.B.C., C.d.A.)
| | - Antonio Bisignani
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology & Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart (L.P., A.B., A.G., A. Sorgente, C.M., D.G.D.R., A.D.M., A.S., J.M., M.A.H., V.M., S.M., G.V., G. Paparella, R.R., I.O., G.B., A.A., E.S., G. Pappaert, J.S., A. Sarkozy, P.B., G.B.C., C.d.A.)
| | - Randy Osei
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Clinical Sciences, Research Group Reproduction and Genetics, Centre for Medical Genetics (R.O., T.d.R., S.V.D.)
| | - Anaïs Gauthey
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology & Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart (L.P., A.B., A.G., A. Sorgente, C.M., D.G.D.R., A.D.M., A.S., J.M., M.A.H., V.M., S.M., G.V., G. Paparella, R.R., I.O., G.B., A.A., E.S., G. Pappaert, J.S., A. Sarkozy, P.B., G.B.C., C.d.A.)
| | - Antonio Sorgente
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology & Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart (L.P., A.B., A.G., A. Sorgente, C.M., D.G.D.R., A.D.M., A.S., J.M., M.A.H., V.M., S.M., G.V., G. Paparella, R.R., I.O., G.B., A.A., E.S., G. Pappaert, J.S., A. Sarkozy, P.B., G.B.C., C.d.A.)
| | - Cinzia Monaco
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology & Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart (L.P., A.B., A.G., A. Sorgente, C.M., D.G.D.R., A.D.M., A.S., J.M., M.A.H., V.M., S.M., G.V., G. Paparella, R.R., I.O., G.B., A.A., E.S., G. Pappaert, J.S., A. Sarkozy, P.B., G.B.C., C.d.A.)
| | - Domenico Giovanni Della Rocca
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology & Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart (L.P., A.B., A.G., A. Sorgente, C.M., D.G.D.R., A.D.M., A.S., J.M., M.A.H., V.M., S.M., G.V., G. Paparella, R.R., I.O., G.B., A.A., E.S., G. Pappaert, J.S., A. Sarkozy, P.B., G.B.C., C.d.A.)
| | - Alvise Del Monte
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology & Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart (L.P., A.B., A.G., A. Sorgente, C.M., D.G.D.R., A.D.M., A.S., J.M., M.A.H., V.M., S.M., G.V., G. Paparella, R.R., I.O., G.B., A.A., E.S., G. Pappaert, J.S., A. Sarkozy, P.B., G.B.C., C.d.A.)
| | - Antanas Strazdas
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology & Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart (L.P., A.B., A.G., A. Sorgente, C.M., D.G.D.R., A.D.M., A.S., J.M., M.A.H., V.M., S.M., G.V., G. Paparella, R.R., I.O., G.B., A.A., E.S., G. Pappaert, J.S., A. Sarkozy, P.B., G.B.C., C.d.A.)
| | - Joerelle Mojica
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology & Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart (L.P., A.B., A.G., A. Sorgente, C.M., D.G.D.R., A.D.M., A.S., J.M., M.A.H., V.M., S.M., G.V., G. Paparella, R.R., I.O., G.B., A.A., E.S., G. Pappaert, J.S., A. Sarkozy, P.B., G.B.C., C.d.A.)
| | - Maysam Al Housari
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology & Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart (L.P., A.B., A.G., A. Sorgente, C.M., D.G.D.R., A.D.M., A.S., J.M., M.A.H., V.M., S.M., G.V., G. Paparella, R.R., I.O., G.B., A.A., E.S., G. Pappaert, J.S., A. Sarkozy, P.B., G.B.C., C.d.A.)
| | - Vincenzo Miraglia
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology & Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart (L.P., A.B., A.G., A. Sorgente, C.M., D.G.D.R., A.D.M., A.S., J.M., M.A.H., V.M., S.M., G.V., G. Paparella, R.R., I.O., G.B., A.A., E.S., G. Pappaert, J.S., A. Sarkozy, P.B., G.B.C., C.d.A.)
| | - Sahar Mouram
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology & Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart (L.P., A.B., A.G., A. Sorgente, C.M., D.G.D.R., A.D.M., A.S., J.M., M.A.H., V.M., S.M., G.V., G. Paparella, R.R., I.O., G.B., A.A., E.S., G. Pappaert, J.S., A. Sarkozy, P.B., G.B.C., C.d.A.)
| | - Giampaolo Vetta
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology & Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart (L.P., A.B., A.G., A. Sorgente, C.M., D.G.D.R., A.D.M., A.S., J.M., M.A.H., V.M., S.M., G.V., G. Paparella, R.R., I.O., G.B., A.A., E.S., G. Pappaert, J.S., A. Sarkozy, P.B., G.B.C., C.d.A.)
| | - Gaetano Paparella
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology & Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart (L.P., A.B., A.G., A. Sorgente, C.M., D.G.D.R., A.D.M., A.S., J.M., M.A.H., V.M., S.M., G.V., G. Paparella, R.R., I.O., G.B., A.A., E.S., G. Pappaert, J.S., A. Sarkozy, P.B., G.B.C., C.d.A.)
| | - Robbert Ramak
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology & Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart (L.P., A.B., A.G., A. Sorgente, C.M., D.G.D.R., A.D.M., A.S., J.M., M.A.H., V.M., S.M., G.V., G. Paparella, R.R., I.O., G.B., A.A., E.S., G. Pappaert, J.S., A. Sarkozy, P.B., G.B.C., C.d.A.)
| | - Ingrid Overeinder
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology & Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart (L.P., A.B., A.G., A. Sorgente, C.M., D.G.D.R., A.D.M., A.S., J.M., M.A.H., V.M., S.M., G.V., G. Paparella, R.R., I.O., G.B., A.A., E.S., G. Pappaert, J.S., A. Sarkozy, P.B., G.B.C., C.d.A.)
| | - Gezim Bala
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology & Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart (L.P., A.B., A.G., A. Sorgente, C.M., D.G.D.R., A.D.M., A.S., J.M., M.A.H., V.M., S.M., G.V., G. Paparella, R.R., I.O., G.B., A.A., E.S., G. Pappaert, J.S., A. Sarkozy, P.B., G.B.C., C.d.A.)
| | - Alexandre Almorad
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology & Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart (L.P., A.B., A.G., A. Sorgente, C.M., D.G.D.R., A.D.M., A.S., J.M., M.A.H., V.M., S.M., G.V., G. Paparella, R.R., I.O., G.B., A.A., E.S., G. Pappaert, J.S., A. Sarkozy, P.B., G.B.C., C.d.A.)
| | - Erwin Ströker
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology & Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart (L.P., A.B., A.G., A. Sorgente, C.M., D.G.D.R., A.D.M., A.S., J.M., M.A.H., V.M., S.M., G.V., G. Paparella, R.R., I.O., G.B., A.A., E.S., G. Pappaert, J.S., A. Sarkozy, P.B., G.B.C., C.d.A.)
| | - Gudrun Pappaert
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology & Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart (L.P., A.B., A.G., A. Sorgente, C.M., D.G.D.R., A.D.M., A.S., J.M., M.A.H., V.M., S.M., G.V., G. Paparella, R.R., I.O., G.B., A.A., E.S., G. Pappaert, J.S., A. Sarkozy, P.B., G.B.C., C.d.A.)
| | - Juan Sieira
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology & Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart (L.P., A.B., A.G., A. Sorgente, C.M., D.G.D.R., A.D.M., A.S., J.M., M.A.H., V.M., S.M., G.V., G. Paparella, R.R., I.O., G.B., A.A., E.S., G. Pappaert, J.S., A. Sarkozy, P.B., G.B.C., C.d.A.)
| | - Thomy de Ravel
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Clinical Sciences, Research Group Reproduction and Genetics, Centre for Medical Genetics (R.O., T.d.R., S.V.D.)
| | - Mark La Meir
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel (M.L.M.)
| | - Andrea Sarkozy
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology & Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart (L.P., A.B., A.G., A. Sorgente, C.M., D.G.D.R., A.D.M., A.S., J.M., M.A.H., V.M., S.M., G.V., G. Paparella, R.R., I.O., G.B., A.A., E.S., G. Pappaert, J.S., A. Sarkozy, P.B., G.B.C., C.d.A.)
| | - Pedro Brugada
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology & Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart (L.P., A.B., A.G., A. Sorgente, C.M., D.G.D.R., A.D.M., A.S., J.M., M.A.H., V.M., S.M., G.V., G. Paparella, R.R., I.O., G.B., A.A., E.S., G. Pappaert, J.S., A. Sarkozy, P.B., G.B.C., C.d.A.)
| | - Gian Battista Chierchia
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology & Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart (L.P., A.B., A.G., A. Sorgente, C.M., D.G.D.R., A.D.M., A.S., J.M., M.A.H., V.M., S.M., G.V., G. Paparella, R.R., I.O., G.B., A.A., E.S., G. Pappaert, J.S., A. Sarkozy, P.B., G.B.C., C.d.A.)
| | - Sonia Van Dooren
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Clinical Sciences, Research Group Reproduction and Genetics, Centre for Medical Genetics (R.O., T.d.R., S.V.D.)
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Clinical Sciences, Research Group Reproduction and Genetics, Brussels Interuniversity Genomics High Throughput Core (BRIGHTcore), Belgium (S.V.D.)
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology & Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart (L.P., A.B., A.G., A. Sorgente, C.M., D.G.D.R., A.D.M., A.S., J.M., M.A.H., V.M., S.M., G.V., G. Paparella, R.R., I.O., G.B., A.A., E.S., G. Pappaert, J.S., A. Sarkozy, P.B., G.B.C., C.d.A.)
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10
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Bioletto F, Cuboni D, Varaldo E, Bona C, Berton AM, Maccario M, Prencipe N. Severe hypothyroidism as a trigger for Brugada-type ECG abnormalities: a case report and literature review. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2024; 68:e230027. [PMID: 38330292 PMCID: PMC10948039 DOI: 10.20945/2359-4292-2023-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/15/2023] [Indexed: 02/10/2024]
Abstract
Brugada syndrome (BrS) is an inherited disorder that can cause ventricular fibrillation and sudden cardiac death in individuals with otherwise structurally normal hearts. Several provoking factors are known to potentially unmask or exacerbate a typical Brugada ECG pattern in predisposed subjects. Hypothyroidism has been suggested as one of these triggers, but the exact mechanisms underlying this relationship remain poorly understood. Moreover, the severity of thyroid dysfunction beyond which a Brugada-type ECG alteration might be triggered is still unclear. We report the case of a 33-year-old male who displayed a Brugada type 1 ECG pattern and was diagnosed with severe hypothyroidism (TSH > 100 mU/L with undetectable levels of fT4 and fT3). Hormonal replacement therapy with levothyroxine was initiated at increasing doses; serial biochemical and ECG controls were performed, initially every 3 weeks up to 15 weeks and afterward every 3 months. The regression of typical Brugada ECG waveforms could be seen at an early stage, when the patient was still taking a low dose of levothyroxine (37.5 µg/day, i.e., one-fourth of his final requirements of 150 µg/day), and laboratory tests still showed a marked alteration of thyroid hormonal parameters. Hypothyroidism may act as a trigger for Brugada-type ECG abnormalities, but a very severe alteration of the hormonal parameters is necessary to prompt these alterations. In our case, the initiation of replacement therapy with levothyroxine rapidly reversed the ECG modifications, even at a low subtherapeutic dose.
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Affiliation(s)
- Fabio Bioletto
- Divisione di Endocrinologia, Diabetologia e Metabolismo, Dipartimento di Scienze Mediche, Università di Torino, Torino, Italia,
| | - Daniela Cuboni
- Divisione di Endocrinologia, Diabetologia e Metabolismo, Dipartimento di Scienze Mediche, Università di Torino, Torino, Italia
| | - Emanuele Varaldo
- Divisione di Endocrinologia, Diabetologia e Metabolismo, Dipartimento di Scienze Mediche, Università di Torino, Torino, Italia
| | - Chiara Bona
- Divisione di Endocrinologia, Diabetologia e Metabolismo, Dipartimento di Scienze Mediche, Università di Torino, Torino, Italia
| | - Alessandro Maria Berton
- Divisione di Endocrinologia, Diabetologia e Metabolismo, Dipartimento di Scienze Mediche, Università di Torino, Torino, Italia
| | - Mauro Maccario
- Divisione di Endocrinologia, Diabetologia e Metabolismo, Dipartimento di Scienze Mediche, Università di Torino, Torino, Italia
| | - Nunzia Prencipe
- Divisione di Endocrinologia, Diabetologia e Metabolismo, Dipartimento di Scienze Mediche, Università di Torino, Torino, Italia
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11
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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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12
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Santinelli V, Ciconte G, Manguso F, Anastasia L, Micaglio E, Calovic Z, Vicedomini G, Mazza B, Vecchi M, Mecarocci V, Locati ET, Boccellino A, Negro G, Napolano A, Giannelli L, Pappone C. High-risk Brugada syndrome: factors associated with arrhythmia recurrence and benefits of epicardial ablation in addition to implantable cardioverter defibrillator implantation. Europace 2023; 26:euae019. [PMID: 38252933 PMCID: PMC10824473 DOI: 10.1093/europace/euae019] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 11/30/2023] [Accepted: 12/28/2023] [Indexed: 01/24/2024] Open
Abstract
AIMS This study aims to evaluate the prognostic impact of the arrhythmogenic substrate size in symptomatic Brugada syndrome (BrS) as well as to validate the long-term safety and effectiveness of epicardial radiofrequency ablation (RFA) compared with no-RFA group. METHODS AND RESULTS In this prospective investigational long-term registry study, 257 selected symptomatic BrS patients with implantable cardioverter defibrillator (ICD) implantation were included. Among them, 206 patients underwent epicardial RFA and were monitored for over 5 years post-ablation (RFA group), while 51 patients received only ICD implantation declining RFA. Primary endpoints included risk factors for ventricular fibrillation (VF) events pre-ablation and freedom from VF events post-ablation. In the RFA group, BrS substrates were identified in the epicardial surface of the right ventricle. During the pre-RFA follow-up period (median 27 months), VF episodes and VF storms were experienced by 53 patients. Independent risk factors included substrate size [hazard ratio (HR), 1.13; 95% confidence interval (CI), 1.08-1.18; P < 0.001], aborted cardiac arrest (HR, 2.98; 95% CI, 1.68-5.28; P < 0.001), and SCN5A variants (HR, 2.22; 95% CI, 1.15-4.27; P = 0.017). In the post-RFA follow-up (median 40 months), the RFA group demonstrated superior outcomes compared with no-RFA (P < 0.001) without major procedure-related complications. CONCLUSION Our study underscores the role of BrS substrate extent as a crucial prognostic factor for recurrent VF and validates the safety and efficacy of RFA when compared with a no-RFA group. Our findings highlight the importance of ajmaline in guiding epicardial mapping/ablation in symptomatic BrS patients, laying the groundwork for further exploration of non-invasive methods to guide informed clinical decision-making.
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Affiliation(s)
- Vincenzo Santinelli
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E Malan, 20097 San Donato Milanese, Italy
| | - Giuseppe Ciconte
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E Malan, 20097 San Donato Milanese, Italy
| | - Francesco Manguso
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E Malan, 20097 San Donato Milanese, Italy
| | - Luigi Anastasia
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E Malan, 20097 San Donato Milanese, Italy
| | - Emanuele Micaglio
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E Malan, 20097 San Donato Milanese, Italy
| | - Zarko Calovic
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E Malan, 20097 San Donato Milanese, Italy
| | - Gabriele Vicedomini
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E Malan, 20097 San Donato Milanese, Italy
| | - Beniamino Mazza
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E Malan, 20097 San Donato Milanese, Italy
| | - Mattia Vecchi
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E Malan, 20097 San Donato Milanese, Italy
| | - Valerio Mecarocci
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E Malan, 20097 San Donato Milanese, Italy
| | - Emanuela T Locati
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E Malan, 20097 San Donato Milanese, Italy
| | - Antonio Boccellino
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E Malan, 20097 San Donato Milanese, Italy
| | - Gabriele Negro
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E Malan, 20097 San Donato Milanese, Italy
| | - Antonio Napolano
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E Malan, 20097 San Donato Milanese, Italy
| | - Luigi Giannelli
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E Malan, 20097 San Donato Milanese, Italy
| | - Carlo Pappone
- Arrhythmology Department, IRCCS Policlinico San Donato, Piazza E Malan, 20097 San Donato Milanese, Italy
- University Vita-Salute San Raffaele, Via Olgettina 58, 20132 Milan, Italy
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13
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Pappone C, Ciconte G, Vicedomini G, Anastasia L, Santinelli V. Epicardial arrhythmogenic substrate in long QT syndrome. Heart Rhythm 2023; 20:1782-1784. [PMID: 38040481 DOI: 10.1016/j.hrthm.2023.07.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/05/2023] [Accepted: 07/08/2023] [Indexed: 12/03/2023]
Affiliation(s)
- Carlo Pappone
- Arrhythmia and Electrophysiology Center, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy; Institute of Molecular and Translational Cardiology (IMTC), San Donato Milanese, Milan, Italy.
| | - Giuseppe Ciconte
- Arrhythmia and Electrophysiology Center, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy; Institute of Molecular and Translational Cardiology (IMTC), San Donato Milanese, Milan, Italy
| | - Gabriele Vicedomini
- Arrhythmia and Electrophysiology Center, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Luigi Anastasia
- Arrhythmia and Electrophysiology Center, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy; Institute of Molecular and Translational Cardiology (IMTC), San Donato Milanese, Milan, Italy
| | - Vincenzo Santinelli
- Arrhythmia and Electrophysiology Center, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
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14
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Nagyova E, Hoorntje ET, Te Rijdt WP, Bosman LP, Syrris P, Protonotarios A, Elliott PM, Tsatsopoulou A, Mestroni L, Taylor MRG, Sinagra G, Merlo M, Wada Y, Horie M, Mogensen J, Christensen AH, Gerull B, Song L, Yao Y, Fan S, Saguner AM, Duru F, Koskenvuo JW, Cruz Marino T, Tichnell C, Judge DP, Dooijes D, Lekanne Deprez RH, Basso C, Pilichou K, Bauce B, Wilde AAM, Charron P, Fressart V, van der Heijden JF, van den Berg MP, Asselbergs FW, James CA, Jongbloed JDH, Harakalova M, van Tintelen JP. A Systematic Analysis of the Clinical Outcome Associated with Multiple Reclassified Desmosomal Gene Variants in Arrhythmogenic Right Ventricular Cardiomyopathy Patients. J Cardiovasc Transl Res 2023; 16:1276-1286. [PMID: 37418234 PMCID: PMC10721666 DOI: 10.1007/s12265-023-10403-8] [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] [Received: 12/21/2022] [Accepted: 06/07/2023] [Indexed: 07/08/2023]
Abstract
The presence of multiple pathogenic variants in desmosomal genes (DSC2, DSG2, DSP, JUP, and PKP2) in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) has been linked to a severe phenotype. However, the pathogenicity of variants is reclassified frequently, which may result in a changed clinical risk prediction. Here, we present the collection, reclassification, and clinical outcome correlation for the largest series of ARVC patients carrying multiple desmosomal pathogenic variants to date (n = 331). After reclassification, only 29% of patients remained carriers of two (likely) pathogenic variants. They reached the composite endpoint (ventricular arrhythmias, heart failure, and death) significantly earlier than patients with one or no remaining reclassified variant (hazard ratios of 1.9 and 1.8, respectively). Periodic reclassification of variants contributes to more accurate risk stratification and subsequent clinical management strategy. Graphical Abstract.
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Affiliation(s)
- Emilia Nagyova
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
- Department of Molecular Biology, Faculty of Natural Sciences, Comenius University in Bratislava, Bratislava, Slovakia
| | - Edgar T Hoorntje
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
| | - Wouter P Te Rijdt
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
| | - Laurens P Bosman
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Petros Syrris
- Center for Heart Muscle Disease, Institute of Cardiovascular Science, University College London, London, UK
| | - Alexandros Protonotarios
- Center for Heart Muscle Disease, Institute of Cardiovascular Science, University College London, London, UK
- Nikos Protonotarios Medical Center, 84300, Naxos, Greece
| | - Perry M Elliott
- Center for Heart Muscle Disease, Institute of Cardiovascular Science, University College London, London, UK
| | | | - Luisa Mestroni
- Cardiovascular Institute, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Matthew R G Taylor
- Cardiovascular Institute, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, Azienda Sanitaria-Universitaria Giuliano Isontina (ASUGI), Trieste, Italy
| | - Marco Merlo
- Cardiothoracovascular Department, Azienda Sanitaria-Universitaria Giuliano Isontina (ASUGI), Trieste, Italy
| | - Yuko Wada
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Minoru Horie
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Japan
| | - Jens Mogensen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Alex H Christensen
- Department of Cardiology, Herlev-Gentofte and Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Brenda Gerull
- Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
- Comprehensive Heart Failure Center (CHFC) and Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Lei Song
- Arrhythmia Center and Clinical EP Laboratory, State Key Laboratory of Cardiovascular Diseases, National Center for Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College-Chinese Academy of Medical Sciences, Beijing, China
| | - Yan Yao
- Arrhythmia Center and Clinical EP Laboratory, State Key Laboratory of Cardiovascular Diseases, National Center for Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College-Chinese Academy of Medical Sciences, Beijing, China
| | - Siyang Fan
- Arrhythmia Center and Clinical EP Laboratory, State Key Laboratory of Cardiovascular Diseases, National Center for Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College-Chinese Academy of Medical Sciences, Beijing, China
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center, Zurich, Switzerland
| | - Firat Duru
- Department of Cardiology, University Heart Center, Zurich, Switzerland
| | | | - Tania Cruz Marino
- Department of Medical Biology, CIUSSS Saguenay Lac-St-Jean, Chicoutimi, QC, Canada
| | - Crystal Tichnell
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Daniel P Judge
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, USA
| | - Dennis Dooijes
- Department of Genetics, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
| | - Ronald H Lekanne Deprez
- Department of Human Genetics, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Cristina Basso
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Kalliopi Pilichou
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Barbara Bauce
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Arthur A M Wilde
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Philippe Charron
- APHP, Referral Center for Cardiac Hereditary Diseases, Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France
| | - Véronique Fressart
- APHP, Referral Center for Cardiac Hereditary Diseases, Sorbonne University, Pitié-Salpêtrière Hospital, Paris, France
| | - Jeroen F van der Heijden
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Maarten P van den Berg
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Folkert W Asselbergs
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
- Institute of Cardiovascular Science, Faculty of Population Health Science, University College London, London, UK
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
| | - Cynthia A James
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Jan D H Jongbloed
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Magdalena Harakalova
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
- Netherlands Heart Institute, Utrecht, The Netherlands.
- Regenerative Medicine Utrecht (RMU), University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands.
| | - J Peter van Tintelen
- Netherlands Heart Institute, Utrecht, The Netherlands
- Department of Human Genetics, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands
- Department of Genetics, University Medical Center Utrecht, University of Utrecht, Utrecht, the Netherlands
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15
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Locati ET, Van Dam PM, Ciconte G, Heilbron F, Boonstra M, Vicedomini G, Micaglio E, Ćalović Ž, Anastasia L, Santinelli V, Pappone C. Electrocardiographic temporo-spatial assessment of depolarization and repolarization changes after epicardial arrhythmogenic substrate ablation in Brugada syndrome. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2023; 4:473-487. [PMID: 38045442 PMCID: PMC10689926 DOI: 10.1093/ehjdh/ztad050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/16/2023] [Accepted: 08/25/2023] [Indexed: 12/05/2023]
Abstract
Aims In Brugada syndrome (BrS), with spontaneous or ajmaline-induced coved ST elevation, epicardial electro-anatomic potential duration maps (epi-PDMs) were detected on a right ventricle (RV) outflow tract (RVOT), an arrhythmogenic substrate area (AS area), abolished by epicardial-radiofrequency ablation (EPI-AS-RFA). Novel CineECG, projecting 12-lead electrocardiogram (ECG) waveforms on a 3D heart model, previously localized depolarization forces in RV/RVOT in BrS patients. We evaluate 12-lead ECG and CineECG depolarization/repolarization changes in spontaneous type-1 BrS patients before/after EPI-AS-RFA, compared with normal controls. Methods and results In 30 high-risk BrS patients (93% males, age 37 + 9 years), 12-lead ECGs and epi-PDMs were obtained at baseline, early after EPI-AS-RFA, and late follow-up (FU) (2.7-16.1 months). CineECG estimates temporo-spatial localization during depolarization (Early-QRS and Terminal-QRS) and repolarization (ST-Tpeak, Tpeak-Tend). Differences within BrS patients (baseline vs. early after EPI-AS-RFA vs. late FU) were analysed by Wilcoxon signed-rank test, while differences between BrS patients and 60 age-sex-matched normal controls were analysed by the Mann-Whitney test. In BrS patients, baseline QRS and QTc durations were longer and normalized after EPI-AS-ATC (151 ± 15 vs. 102 ± 13 ms, P < 0.001; 454 ± 40 vs. 421 ± 27 ms, P < 0.000). Baseline QRS amplitude was lower and increased at late FU (0.63 ± 0.26 vs. 0.84 ± 13 ms, P < 0.000), while Terminal-QRS amplitude decreased (0.24 ± 0.07 vs. 0.08 ± 0.03 ms, P < 0.000). At baseline, CineECG depolarization/repolarization wavefront prevalently localized in RV/RVOT (Terminal-QRS, 57%; ST-Tpeak, 100%; and Tpeak-Tend, 61%), congruent with the AS area on epi-PDM. Early after EPI-AS-RFA, RV/RVOT localization during depolarization disappeared, as Terminal-QRS prevalently localized in the left ventricle (LV, 76%), while repolarization still localized on RV/RVOT [ST-Tpeak (44%) and Tpeak-Tend (98%)]. At late FU, depolarization/repolarization forces prevalently localized in the LV (Terminal-QRS, 94%; ST-Tpeak, 63%; Tpeak-Tend, 86%), like normal controls. Conclusion CineECG and 12-lead ECG showed a complex temporo-spatial perturbation of both depolarization and repolarization in BrS patients, prevalently localized in RV/RVOT, progressively normalizing after epicardial ablation.
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Affiliation(s)
- Emanuela T Locati
- Arrhythmology-Electrophysiology Department, IRCCS Policlinico San Donato, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
| | - Peter M Van Dam
- Cardiology Department, Utrecht University Medical Center, Heidelberglaan 100, 3584 CX, Utrecht, Netherlands
- Center for Digital Medicine and Robotics, Jagiellonian University Medical College, Kopernika 7e, 31-034 Kraków, Poland
| | - Giuseppe Ciconte
- Arrhythmology-Electrophysiology Department, IRCCS Policlinico San Donato, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
| | - Francesca Heilbron
- Milano Bicocca University, Istituto Auxologico, Via Thomas Mann 8, 20162 Milan, Italy
| | - Machteld Boonstra
- Cardiology Department, Utrecht University Medical Center, Heidelberglaan 100, 3584 CX, Utrecht, Netherlands
| | - Gabriele Vicedomini
- Arrhythmology-Electrophysiology Department, IRCCS Policlinico San Donato, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
| | - Emanuele Micaglio
- Arrhythmology-Electrophysiology Department, IRCCS Policlinico San Donato, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
| | - Žarko Ćalović
- Arrhythmology-Electrophysiology Department, IRCCS Policlinico San Donato, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
| | - Luigi Anastasia
- Arrhythmology-Electrophysiology Department, IRCCS Policlinico San Donato, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
- Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy
| | - Vincenzo Santinelli
- Arrhythmology-Electrophysiology Department, IRCCS Policlinico San Donato, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
| | - Carlo Pappone
- Arrhythmology-Electrophysiology Department, IRCCS Policlinico San Donato, Piazza Malan 2, 20097 San Donato Milanese, Milan, Italy
- Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy
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16
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Melo L, Ciconte G, Christy A, Vicedomini G, Anastasia L, Pappone C, Grant E. Deep learning unmasks the ECG signature of Brugada syndrome. PNAS NEXUS 2023; 2:pgad327. [PMID: 37937270 PMCID: PMC10627411 DOI: 10.1093/pnasnexus/pgad327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/29/2023] [Indexed: 11/09/2023]
Abstract
One in 10 cases of sudden cardiac death strikes without warning as the result of an inherited arrhythmic cardiomyopathy, such as Brugada Syndrome (BrS). Normal physiological variations often obscure visible signs of this and related life-threatening channelopathies in conventional electrocardiograms (ECGs). Sodium channel blockers can reveal previously hidden diagnostic ECG features, however, their use carries the risk of life-threatening proarrhythmic side effects. The absence of a nonintrusive test places a grossly underestimated fraction of the population at risk of SCD. Here, we present a machine-learning algorithm that extracts, aligns, and classifies ECG waveforms for the presence of BrS. This protocol, which succeeds without the use of a sodium channel blocker (88.4% accuracy, 0.934 AUC in validation), can aid clinicians in identifying the presence of this potentially life-threatening heart disease.
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Affiliation(s)
- Luke Melo
- Department of Chemistry, University of British Columbia, Vancouver, BC V6T 1Z1, Canada
| | - Giuseppe Ciconte
- Arrhythmia and Electrophysiology Center, IRCCS Policlinico San Donato, Milan 20097, Italy
| | - Ashton Christy
- Department of Chemistry, University of British Columbia, Vancouver, BC V6T 1Z1, Canada
| | - Gabriele Vicedomini
- Arrhythmia and Electrophysiology Center, IRCCS Policlinico San Donato, Milan 20097, Italy
| | - Luigi Anastasia
- Stem Cell Laboratory for Tissue Engineering, Università Vita-Salute San Raffaele, Milan 20132, Italy
| | - Carlo Pappone
- Arrhythmia and Electrophysiology Center, IRCCS Policlinico San Donato, Milan 20097, Italy
- Department of Cardiology, Università Vita-Salute San Raffaele, Milan 20132, Italy
| | - Edward Grant
- Department of Chemistry, University of British Columbia, Vancouver, BC V6T 1Z1, Canada
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17
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Frosio A, Micaglio E, Polsinelli I, Calamaio S, Melgari D, Prevostini R, Ghiroldi A, Binda A, Carrera P, Villa M, Mastrocinque F, Presi S, Salerno R, Boccellino A, Anastasia L, Ciconte G, Ricagno S, Pappone C, Rivolta I. Unravelling Novel SCN5A Mutations Linked to Brugada Syndrome: Functional, Structural, and Genetic Insights. Int J Mol Sci 2023; 24:15089. [PMID: 37894777 PMCID: PMC10606416 DOI: 10.3390/ijms242015089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/08/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
Brugada Syndrome (BrS) is a rare inherited cardiac arrhythmia causing potentially fatal ventricular tachycardia or fibrillation, mainly occurring during rest or sleep in young individuals without heart structural issues. It increases the risk of sudden cardiac death, and its characteristic feature is an abnormal ST segment elevation on the ECG. While BrS has diverse genetic origins, a subset of cases can be conducted to mutations in the SCN5A gene, which encodes for the Nav1.5 sodium channel. Our study focused on three novel SCN5A mutations (p.A344S, p.N347K, and p.D349N) found in unrelated BrS families. Using patch clamp experiments, we found that these mutations disrupted sodium currents: p.A344S reduced current density, while p.N347K and p.D349N completely abolished it, leading to altered voltage dependence and inactivation kinetics when co-expressed with normal channels. We also explored the effects of mexiletine treatment, which can modulate ion channel function. Interestingly, the p.N347K and p.D349N mutations responded well to the treatment, rescuing the current density, while p.A344S showed a limited response. Structural analysis revealed these mutations were positioned in key regions of the channel, impacting its stability and function. This research deepens our understanding of BrS by uncovering the complex relationship between genetic mutations, ion channel behavior, and potential therapeutic interventions.
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Affiliation(s)
- Anthony Frosio
- Institute of Molecular and Translational Cardiology (IMTC), IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy; (A.F.); (E.M.); (I.P.); (S.C.); (D.M.); (R.P.); (A.G.); (M.V.); (L.A.); (G.C.); (S.R.); (C.P.)
| | - Emanuele Micaglio
- Institute of Molecular and Translational Cardiology (IMTC), IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy; (A.F.); (E.M.); (I.P.); (S.C.); (D.M.); (R.P.); (A.G.); (M.V.); (L.A.); (G.C.); (S.R.); (C.P.)
- Arrhythmia and Electrophysiology Department, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy; (F.M.); (A.B.)
| | - Ivan Polsinelli
- Institute of Molecular and Translational Cardiology (IMTC), IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy; (A.F.); (E.M.); (I.P.); (S.C.); (D.M.); (R.P.); (A.G.); (M.V.); (L.A.); (G.C.); (S.R.); (C.P.)
| | - Serena Calamaio
- Institute of Molecular and Translational Cardiology (IMTC), IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy; (A.F.); (E.M.); (I.P.); (S.C.); (D.M.); (R.P.); (A.G.); (M.V.); (L.A.); (G.C.); (S.R.); (C.P.)
| | - Dario Melgari
- Institute of Molecular and Translational Cardiology (IMTC), IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy; (A.F.); (E.M.); (I.P.); (S.C.); (D.M.); (R.P.); (A.G.); (M.V.); (L.A.); (G.C.); (S.R.); (C.P.)
| | - Rachele Prevostini
- Institute of Molecular and Translational Cardiology (IMTC), IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy; (A.F.); (E.M.); (I.P.); (S.C.); (D.M.); (R.P.); (A.G.); (M.V.); (L.A.); (G.C.); (S.R.); (C.P.)
| | - Andrea Ghiroldi
- Institute of Molecular and Translational Cardiology (IMTC), IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy; (A.F.); (E.M.); (I.P.); (S.C.); (D.M.); (R.P.); (A.G.); (M.V.); (L.A.); (G.C.); (S.R.); (C.P.)
- Laboratory of Stem Cells for Tissue Engineering, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy
| | - Anna Binda
- School of Medicine and Surgery, University of Milano-Bicocca, Via Cadore, 48, 20900 Monza, Italy;
| | - Paola Carrera
- Laboratory of Clinical Molecular Genetics and Cytogenetics, Unit of Genomics for Diagnosis of Human Diseases, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (P.C.); (S.P.)
| | - Marco Villa
- Institute of Molecular and Translational Cardiology (IMTC), IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy; (A.F.); (E.M.); (I.P.); (S.C.); (D.M.); (R.P.); (A.G.); (M.V.); (L.A.); (G.C.); (S.R.); (C.P.)
| | - Flavio Mastrocinque
- Arrhythmia and Electrophysiology Department, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy; (F.M.); (A.B.)
| | - Silvia Presi
- Laboratory of Clinical Molecular Genetics and Cytogenetics, Unit of Genomics for Diagnosis of Human Diseases, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (P.C.); (S.P.)
| | - Raffaele Salerno
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina, 58, 20132 Milan, Italy;
| | - Antonio Boccellino
- Arrhythmia and Electrophysiology Department, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy; (F.M.); (A.B.)
| | - Luigi Anastasia
- Institute of Molecular and Translational Cardiology (IMTC), IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy; (A.F.); (E.M.); (I.P.); (S.C.); (D.M.); (R.P.); (A.G.); (M.V.); (L.A.); (G.C.); (S.R.); (C.P.)
- Laboratory of Stem Cells for Tissue Engineering, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina, 58, 20132 Milan, Italy;
| | - Giuseppe Ciconte
- Institute of Molecular and Translational Cardiology (IMTC), IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy; (A.F.); (E.M.); (I.P.); (S.C.); (D.M.); (R.P.); (A.G.); (M.V.); (L.A.); (G.C.); (S.R.); (C.P.)
- Arrhythmia and Electrophysiology Department, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy; (F.M.); (A.B.)
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina, 58, 20132 Milan, Italy;
| | - Stefano Ricagno
- Institute of Molecular and Translational Cardiology (IMTC), IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy; (A.F.); (E.M.); (I.P.); (S.C.); (D.M.); (R.P.); (A.G.); (M.V.); (L.A.); (G.C.); (S.R.); (C.P.)
- Department of Biosciences, Università degli Studi di Milano, Via Celoria, 26, 20133 Milan, Italy
| | - Carlo Pappone
- Institute of Molecular and Translational Cardiology (IMTC), IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy; (A.F.); (E.M.); (I.P.); (S.C.); (D.M.); (R.P.); (A.G.); (M.V.); (L.A.); (G.C.); (S.R.); (C.P.)
- Arrhythmia and Electrophysiology Department, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy; (F.M.); (A.B.)
- Faculty of Medicine and Surgery, Vita-Salute San Raffaele University, Via Olgettina, 58, 20132 Milan, Italy;
| | - Ilaria Rivolta
- Institute of Molecular and Translational Cardiology (IMTC), IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy; (A.F.); (E.M.); (I.P.); (S.C.); (D.M.); (R.P.); (A.G.); (M.V.); (L.A.); (G.C.); (S.R.); (C.P.)
- School of Medicine and Surgery, University of Milano-Bicocca, Via Cadore, 48, 20900 Monza, Italy;
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18
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Theisen B, Holtz A, Rajagopalan V. Noncoding RNAs and Human Induced Pluripotent Stem Cell-Derived Cardiomyocytes in Cardiac Arrhythmic Brugada Syndrome. Cells 2023; 12:2398. [PMID: 37830612 PMCID: PMC10571919 DOI: 10.3390/cells12192398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/14/2023] Open
Abstract
Hundreds of thousands of people die each year as a result of sudden cardiac death, and many are due to heart rhythm disorders. One of the major causes of these arrhythmic events is Brugada syndrome, a cardiac channelopathy that results in abnormal cardiac conduction, severe life-threatening arrhythmias, and, on many occasions, death. This disorder has been associated with mutations and dysfunction of about two dozen genes; however, the majority of the patients do not have a definite cause for the diagnosis of Brugada Syndrome. The protein-coding genes represent only a very small fraction of the mammalian genome, and the majority of the noncoding regions of the genome are actively transcribed. Studies have shown that most of the loci associated with electrophysiological traits are located in noncoding regulatory regions and are expected to affect gene expression dosage and cardiac ion channel function. Noncoding RNAs serve an expanding number of regulatory and other functional roles within the cells, including but not limited to transcriptional, post-transcriptional, and epigenetic regulation. The major noncoding RNAs found in Brugada Syndrome include microRNAs; however, others such as long noncoding RNAs are also identified. They contribute to pathogenesis by interacting with ion channels and/or are detectable as clinical biomarkers. Stem cells have received significant attention in the recent past, and can be differentiated into many different cell types including those in the heart. In addition to contractile and relaxational properties, BrS-relevant electrophysiological phenotypes are also demonstrated in cardiomyocytes differentiated from stem cells induced from adult human cells. In this review, we discuss the current understanding of noncoding regions of the genome and their RNA biology in Brugada Syndrome. We also delve into the role of stem cells, especially human induced pluripotent stem cell-derived cardiac differentiated cells, in the investigation of Brugada syndrome in preclinical and clinical studies.
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Affiliation(s)
- Benjamin Theisen
- Department of Biomedical and Anatomical Sciences, New York Institute of Technology College of Osteopathic Medicine at Arkansas State University, Jonesboro, AR 72401, USA
| | - Austin Holtz
- Department of Biomedical and Anatomical Sciences, New York Institute of Technology College of Osteopathic Medicine at Arkansas State University, Jonesboro, AR 72401, USA
| | - Viswanathan Rajagopalan
- Department of Biomedical and Anatomical Sciences, New York Institute of Technology College of Osteopathic Medicine at Arkansas State University, Jonesboro, AR 72401, USA
- Arkansas Biosciences Institute, Jonesboro, AR 72401, USA
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19
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Cheniti G, Haissaguerre M, Dina C, Kamakura T, Duchateau J, Sacher F, Racine HP, Surget E, Simonet F, Gourraud JB, Sridi S, Cochet H, Andre C, Bouyer B, Chauvel R, Tixier R, Derval N, Pambrun T, Dubois R, Jais P, Nademanee K, Redon R, Schott JJ, Probst V, Hocini M, Barc J, Bernus O. Left Ventricular Abnormal Substrate in Brugada Syndrome. JACC Clin Electrophysiol 2023; 9:2041-2051. [PMID: 37480873 DOI: 10.1016/j.jacep.2023.05.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/26/2023] [Accepted: 05/31/2023] [Indexed: 07/24/2023]
Abstract
BACKGROUND Slow-conductive structural abnormalities located in the epicardium of the right ventricle (RV) underlie Brugada syndrome (BrS). The extent of such substrate in the left ventricle (LV) has not been investigated. OBJECTIVES This study sought to characterize the extent of epicardial substrate abnormalities in BrS. METHODS We evaluated 22 consecutive patients (mean age 46 ± 11 years, 21 male) referred for recurrent ventricular arrhythmias (mean 10 ± 13 episodes) in the setting of BrS. The patients underwent clinical investigations and wide genetic screening to identify SCN5A mutations and common risk variants. High-density biventricular epicardial mapping was performed to detect prolonged (>70 ms) fragmented electrograms, indicating abnormal substrate area. RESULTS All patients presented with abnormal substrate in the epicardial anterior RV (27 ± 11 cm2). Abnormal substrate was also identified on the LV epicardium in 10 patients (45%), 9 at baseline and 1 after ajmaline infusion, covering 15 ± 11 cm2. Of these, 4 had severe LV fascicular blocks. Patients with LV substrate had a longer history of arrhythmia (11.4 ± 6.7 years vs 4.3 ± 4.3 years; P = 0.003), longer PR (217 ± 24 ms vs 171 ± 14 ms; P < 0.001) and HV (60 ± 12 ms vs 46 ± 5 ms; P = 0.005) intervals, and abnormal substrate also extending into the inferior RV (100% vs 33%; P = 0.001). SCN5A mutation was present in 70% of patients with LV substrate (vs 25%; P = 0.035). SCN5A BrS patients with recurrent ventricular arrhythmias present a higher polygenic risk score compared with a nonselected BrS population (median of differences: -0.86; 95% CI: -1.48 to -0.27; P = 0.02). CONCLUSIONS A subset of patients with BrS present an abnormal substrate extending onto the LV epicardium and inferior RV that is associated with SCN5A mutations and multigenic variants.
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Affiliation(s)
- Ghassen Cheniti
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France; Université de Bordeaux, CRCTB, INSERM, U1045, Pessac, France.
| | - Michel Haissaguerre
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France; Université de Bordeaux, CRCTB, INSERM, U1045, Pessac, France
| | - Christian Dina
- Nantes Université, CHU Nantes, CNRS, INSERM, l'Institut du Thorax, Nantes, France; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart)
| | - Tsukasa Kamakura
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France
| | - Josselin Duchateau
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France; Université de Bordeaux, CRCTB, INSERM, U1045, Pessac, France
| | - Frederic Sacher
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France; Université de Bordeaux, CRCTB, INSERM, U1045, Pessac, France
| | - Hugo-Pierre Racine
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France; Université de Bordeaux, CRCTB, INSERM, U1045, Pessac, France
| | - Elodie Surget
- Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France; Université de Bordeaux, CRCTB, INSERM, U1045, Pessac, France
| | - Floriane Simonet
- Nantes Université, CHU Nantes, CNRS, INSERM, l'Institut du Thorax, Nantes, France; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart)
| | - Jean-Baptiste Gourraud
- Nantes Université, CHU Nantes, CNRS, INSERM, l'Institut du Thorax, Nantes, France; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart)
| | - Soumaya Sridi
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France; Université de Bordeaux, CRCTB, INSERM, U1045, Pessac, France
| | - Hubert Cochet
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France; Université de Bordeaux, CRCTB, INSERM, U1045, Pessac, France
| | - Clementine Andre
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France; Université de Bordeaux, CRCTB, INSERM, U1045, Pessac, France
| | - Benjamin Bouyer
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France; Université de Bordeaux, CRCTB, INSERM, U1045, Pessac, France
| | - Remi Chauvel
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France; Université de Bordeaux, CRCTB, INSERM, U1045, Pessac, France
| | - Romain Tixier
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France; Université de Bordeaux, CRCTB, INSERM, U1045, Pessac, France
| | - Nicolas Derval
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France; Université de Bordeaux, CRCTB, INSERM, U1045, Pessac, France
| | - Thomas Pambrun
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France; Université de Bordeaux, CRCTB, INSERM, U1045, Pessac, France
| | - Remi Dubois
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France; Université de Bordeaux, CRCTB, INSERM, U1045, Pessac, France
| | - Pierre Jais
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France; Université de Bordeaux, CRCTB, INSERM, U1045, Pessac, France
| | | | - Richard Redon
- Nantes Université, CHU Nantes, CNRS, INSERM, l'Institut du Thorax, Nantes, France; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart)
| | - Jean-Jacques Schott
- Nantes Université, CHU Nantes, CNRS, INSERM, l'Institut du Thorax, Nantes, France; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart)
| | - Vincent Probst
- Nantes Université, CHU Nantes, CNRS, INSERM, l'Institut du Thorax, Nantes, France; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart)
| | - Meleze Hocini
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France; Université de Bordeaux, CRCTB, INSERM, U1045, Pessac, France
| | - Julien Barc
- Nantes Université, CHU Nantes, CNRS, INSERM, l'Institut du Thorax, Nantes, France; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart)
| | - Olivier Bernus
- Department of Electrophysiology and Cardiac Stimulation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France; Institut Hospitalo-Universitaire Liryc, Electrophysiology and Heart Modeling Institute, Pessac, France; Université de Bordeaux, CRCTB, INSERM, U1045, Pessac, France
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20
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Crotti L, Brugada P, Calkins H, Chevalier P, Conte G, Finocchiaro G, Postema PG, Probst V, Schwartz PJ, Behr ER. From gene-discovery to gene-tailored clinical management: 25 years of research in channelopathies and cardiomyopathies. Europace 2023; 25:euad180. [PMID: 37622577 PMCID: PMC10450790 DOI: 10.1093/europace/euad180] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/03/2023] [Indexed: 08/26/2023] Open
Abstract
In the early nineties, few years before the birth of Europace, the clinical and scientific world of familial arrhythmogenic conditions was revolutionized by the identification of the first disease-causing genes. The explosion of genetic studies over a 15-year period led to the discovery of major disease-causing genes in practically all channelopathies and cardiomyopathies, bringing insight into the pathophysiological mechanisms of these conditions. The birth of next generation sequencing allowed a further step forward and other significant genes, as CALM1-3 in channelopathies and FLN C and TTN in cardiomyopathies were identified. Genotype-phenotype studies allowed the implementation of the genetic results in diagnosis, risk stratification, and therapeutic management with a different level of evidence in different arrhythmogenic conditions. The influence of common genetic variants, i.e. SNPs, on disease manifestation was proved in mid-twenties, and in the last 10 years with the advent of genome-wide association studies performed in familial arrhythmogenic diseases, the concept of polygenic risk score has been consolidated. Now, we are at the start of another amazing phase, i.e. the initiation of first gene therapy clinical trials.
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Affiliation(s)
- Lia Crotti
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Piazza dell'Ateneo Nuovo, 1 - 20126, Italy
- IRCCS Istituto Auxologico Italiano, Department of Cardiology, Cardiomyopathy Unit, Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, Piazzale Brescia, 20, 20149 Milan, Italy
| | - Pedro Brugada
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, Brussels 1090, Belgium
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Philippe Chevalier
- Neuromyogene Institute, Claude Bernard University, Lyon 1, Lyon, France
- Service de Rythmologie, Hospices Civils de Lyon, Lyon, France
| | - Giulio Conte
- Division of Cardiology, Istituto Cardiocentro Ticino, Ente Cantonale Ospedaliero, Lugano, Switzerland
| | - Gherardo Finocchiaro
- Cardiovascular Sciences Research Centre, St. George’s, University of London, London, UK
| | - Pieter G Postema
- Department of Cardiology, Amsterdam University Medical Centers, location University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, the Netherlands
| | - Vincent Probst
- Centre Hospitalier Universitaire Nantes, Nantes Université, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Peter J Schwartz
- IRCCS Istituto Auxologico Italiano, Center for Cardiac Arrhythmias of Genetic Origin, Milan, Italy
| | - Elijah R Behr
- Cardiology Section, Institute of Molecular and Clinical Sciences, St. George's, University of London, London SW17 0RE, UK
- Department of Cardiology, Mayo Clinic Healthcare, 15 Portland Pl, London W1B 1PT, UK
- Department of Cardiology, St. George's University Hospitals NHS Foundation Trust, London SW17 0QT
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21
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Negro G, Boccellino A, Napolano A, Micaglio E, Calovic Z, Anastasia L, Ciconte G. Arrhythmogenic substrate elimination for safe testosterone therapy in symptomatic Brugada syndrome patients. Europace 2023; 25:euad254. [PMID: 37655650 PMCID: PMC10472325 DOI: 10.1093/europace/euad254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/09/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Brugada Syndrome (BrS) is a cardiogenetic disease known for its association with sudden cardiac death (SCD) in individuals with structurally normal hearts. The prevalence of BrS is higher in males, who also face a greater risk of SCD. Its higher prevalence and worse outcome in male subjects may be due to testosterone effects on ion channels expression and function. The influence of testosterone on cardiac action potentials, both genomically and non-genomically, underscores its potential role in unmasking the syndrome and triggering life-threatening arrhythmias. Notably, testosterone replacement therapy (TRT), used for hypogonadism and gender reassignment, has been linked to BrS unmasking. The role of epicardial ablation in symptomatic BrS patients where hormonal therapy cannot be discontinued is unknown. METHODS AND RESULTS In this study we describe the first two cases of substrate mapping and ablation in BrS patients experiencing arrhythmic events while on TRT. In both cases, high-density epicardial mapping revealed abnormal areas of prolonged and fragmented electrograms in the right ventricular (RV) outflow tract and anterior wall. These abnormalities were completely abolished by radiofrequency ablation (RFA). After ablation, both patients showed a persistent normalization of the ECG and were free from ventricular arrhythmias at follow-up, despite ongoing TRT. CONCLUSION RFA can be considered as a therapeutic option in symptomatic BrS patients with a high-risk profile who cannot discontinue TRT, being essential for restoring their normal physiology or preserving their sexual identity. As testosterone use is increasing, further studies are warranted to define a standardized diagnostic and therapeutic strategy in this specific subset of BrS patients.
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Affiliation(s)
- Gabriele Negro
- Arrhythmia and Electrophysiology Center, IRCCS Policlinico San Donato, Piazza Malan 2, San Donato Milanese, 20097 Milan, Italy
| | - Antonio Boccellino
- Arrhythmia and Electrophysiology Center, IRCCS Policlinico San Donato, Piazza Malan 2, San Donato Milanese, 20097 Milan, Italy
| | - Antonio Napolano
- Arrhythmia and Electrophysiology Center, IRCCS Policlinico San Donato, Piazza Malan 2, San Donato Milanese, 20097 Milan, Italy
| | - Emanuele Micaglio
- Arrhythmia and Electrophysiology Center, IRCCS Policlinico San Donato, Piazza Malan 2, San Donato Milanese, 20097 Milan, Italy
| | - Zarko Calovic
- Arrhythmia and Electrophysiology Center, IRCCS Policlinico San Donato, Piazza Malan 2, San Donato Milanese, 20097 Milan, Italy
| | - Luigi Anastasia
- Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy
- Institute of Molecular and Translational Cardiology (IMTC), Piazza Malan 2, San Donato Milanese, 20097 Milan, Italy
| | - Giuseppe Ciconte
- Arrhythmia and Electrophysiology Center, IRCCS Policlinico San Donato, Piazza Malan 2, San Donato Milanese, 20097 Milan, Italy
- Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy
- Institute of Molecular and Translational Cardiology (IMTC), Piazza Malan 2, San Donato Milanese, 20097 Milan, Italy
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22
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Renard E, Walton RD, Benoist D, Brette F, Bru-Mercier G, Chaigne S, Charron S, Constantin M, Douard M, Dubes V, Guillot B, Hof T, Magat J, Martinez ME, Michel C, Pallares-Lupon N, Pasdois P, Récalde A, Vaillant F, Sacher F, Labrousse L, Rogier J, Kyndt F, Baudic M, Schott JJ, Barc J, Probst V, Sarlandie M, Marionneau C, Ashton JL, Hocini M, Haïssaguerre M, Bernus O. Functional Epicardial Conduction Disturbances Due to a SCN5A Variant Associated With Brugada Syndrome. JACC Clin Electrophysiol 2023; 9:1248-1261. [PMID: 37227351 PMCID: PMC10406612 DOI: 10.1016/j.jacep.2023.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/06/2023] [Accepted: 03/10/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Brugada syndrome is a significant cause of sudden cardiac death (SCD), but the underlying mechanisms remain hypothetical. OBJECTIVES This study aimed to elucidate this knowledge gap through detailed ex vivo human heart studies. METHODS A heart was obtained from a 15-year-old adolescent boy with normal electrocardiogram who experienced SCD. Postmortem genotyping was performed, and clinical examinations were done on first-degree relatives. The right ventricle was optically mapped, followed by high-field magnetic resonance imaging and histology. Connexin-43 and NaV1.5 were localized by immunofluorescence, and RNA and protein expression levels were studied. HEK-293 cell surface biotinylation assays were performed to examine NaV1.5 trafficking. RESULTS A Brugada-related SCD diagnosis was established for the donor because of a SCN5A Brugada-related variant (p.D356N) inherited from his mother, together with a concomitant NKX2.5 variant of unknown significance. Optical mapping demonstrated a localized epicardial region of impaired conduction near the outflow tract, in the absence of repolarization alterations and microstructural defects, leading to conduction blocks and figure-of-8 patterns. NaV1.5 and connexin-43 localizations were normal in this region, consistent with the finding that the p.D356N variant does not affect the trafficking, nor the expression of NaV1.5. Trends of decreased NaV1.5, connexin-43, and desmoglein-2 protein levels were noted; however, the RT-qPCR results suggested that the NKX2-5 variant was unlikely to be involved. CONCLUSIONS This study demonstrates for the first time that SCD associated with a Brugada-SCN5A variant can be caused by localized functionally, not structurally, impaired conduction.
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Affiliation(s)
- Estelle Renard
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France.
| | - Richard D Walton
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - David Benoist
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - Fabien Brette
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - Gilles Bru-Mercier
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - Sébastien Chaigne
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - Sabine Charron
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - Marion Constantin
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - Matthieu Douard
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - Virginie Dubes
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - Bastien Guillot
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - Thomas Hof
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - Julie Magat
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - Marine E Martinez
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - Cindy Michel
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - Néstor Pallares-Lupon
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - Philippe Pasdois
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - Alice Récalde
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - Fanny Vaillant
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
| | - Frédéric Sacher
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France; Centre Hospitalier Universitaire de Bordeaux, Département d'électrophysiologie et de stimulation cardiaques, Hôpital Cardiologique du Haut-Lévêque, Pessac, France
| | - Louis Labrousse
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Centre Hospitalier Universitaire de Bordeaux, Département de chirurgie cardiovasculaire, Hôpital Cardiologique du Haut-Lévêque, Pessac, France
| | - Julien Rogier
- Centre Hospitalier Universitaire de Bordeaux, Coordination des prélèvements d'organes et de tissus, Bordeaux, France
| | - Florence Kyndt
- Nantes Université, Centre Hospitalier Universitaire Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France; Centre Hospitalier Universitaire Nantes, Service de génétique médicale, Nantes, France
| | - Manon Baudic
- L'Institut du thorax, INSERM, CNRS, Université Nantes, Nantes, France
| | - Jean-Jacques Schott
- Nantes Université, Centre Hospitalier Universitaire Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Julien Barc
- Nantes Université, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Vincent Probst
- Nantes Université, Centre Hospitalier Universitaire Nantes, CNRS, INSERM, l'institut du thorax, Nantes, France
| | - Marine Sarlandie
- L'Institut du thorax, INSERM, CNRS, Université Nantes, Nantes, France
| | - Céline Marionneau
- L'Institut du thorax, INSERM, CNRS, Université Nantes, Nantes, France
| | - Jesse L Ashton
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Mélèze Hocini
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France; Centre Hospitalier Universitaire de Bordeaux, Département d'électrophysiologie et de stimulation cardiaques, Hôpital Cardiologique du Haut-Lévêque, Pessac, France
| | - Michel Haïssaguerre
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France; Centre Hospitalier Universitaire de Bordeaux, Département d'électrophysiologie et de stimulation cardiaques, Hôpital Cardiologique du Haut-Lévêque, Pessac, France
| | - Olivier Bernus
- IHU LIRYC, L'Institut de Rythmologie et Modélisation Cardiaque, Fondation Bordeaux Université, Bordeaux, France; Université Bordeaux, Inserm, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, Bordeaux, France
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23
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Pannone L, Bisignani A, Osei R, Gauthey A, Sorgente A, Vergara P, Monaco C, Della Rocca DG, Del Monte A, Strazdas A, Mojica J, Al Housari M, Miraglia V, Mouram S, Paparella G, Ramak R, Overeinder I, Bala G, Almorad A, Ströker E, Pappaert G, Sieira J, de Ravel T, La Meir M, Brugada P, Chierchia GB, Van Dooren S, de Asmundis C. Genetic testing in children with Brugada syndrome: results from a large prospective registry. Europace 2023; 25:euad079. [PMID: 37061847 PMCID: PMC10227762 DOI: 10.1093/europace/euad079] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/07/2023] [Indexed: 04/17/2023] Open
Abstract
AIMS A pathogenic/likely pathogenic (P/LP) variant in SCN5A is found in 20-25% of patients with Brugada syndrome (BrS). However, the diagnostic yield and prognosis of gene panel testing in paediatric BrS is unclear. The aim of this study is to define the diagnostic yield and outcomes of SCN5A gene testing with ACMG variant classification in paediatric BrS patients compared with adults. METHODS AND RESULTS All consecutive patients diagnosed with BrS, between 1992 and 2022, were prospectively enrolled in the UZ Brussel BrS registry. Inclusion criteria were: (i) BrS diagnosis; (ii) genetic analysis performed with a large gene panel; and (iii) classification of gene variants following ACMG guidelines. Paediatric patients were defined as ≤16 years of age. The primary endpoint was ventricular arrhythmias (VAs). A total of 500 BrS patients were included, with 63 paediatric patients and 437 adult patients. Among children with BrS, 29 patients (46%) had a P/LP variant (P+) in SCN5A and no variants were found in 34 (54%) patients (P-). After a mean follow-up of 125.9 months, 8 children (12.7%) experienced a VA, treated with implanted cardioverter defibrillator shock. At survival analysis, P- paediatric patients had higher VA-free survival during the follow-up, compared with P+ paediatric patients. P+ status was an independent predictor of VA. There was no difference in VA-free survival between paediatric and adult BrS patients for both P- and P+. CONCLUSION In a large BrS cohort, the diagnostic yield for P/LP variants in the paediatric population is 46%. P+ children with BrS have a worse arrhythmic prognosis.
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Affiliation(s)
- Luigi Pannone
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan, 101 1090 Brussels, Belgium
| | - Antonio Bisignani
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan, 101 1090 Brussels, Belgium
| | - Randy Osei
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Clinical Sciences, Research Group Reproduction and Genetics, Centre for Medical Genetics, Brussels, Belgium
| | - Anaïs Gauthey
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan, 101 1090 Brussels, Belgium
| | - Antonio Sorgente
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan, 101 1090 Brussels, Belgium
| | - Pasquale Vergara
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan, 101 1090 Brussels, Belgium
| | - Cinzia Monaco
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan, 101 1090 Brussels, Belgium
| | - Domenico Giovanni Della Rocca
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan, 101 1090 Brussels, Belgium
| | - Alvise Del Monte
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan, 101 1090 Brussels, Belgium
| | - Antanas Strazdas
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan, 101 1090 Brussels, Belgium
| | - Joerelle Mojica
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan, 101 1090 Brussels, Belgium
| | - Maysam Al Housari
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan, 101 1090 Brussels, Belgium
| | - Vincenzo Miraglia
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan, 101 1090 Brussels, Belgium
| | - Sahar Mouram
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan, 101 1090 Brussels, Belgium
| | - Gaetano Paparella
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan, 101 1090 Brussels, Belgium
| | - Robbert Ramak
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan, 101 1090 Brussels, Belgium
| | - Ingrid Overeinder
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan, 101 1090 Brussels, Belgium
| | - Gezim Bala
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan, 101 1090 Brussels, Belgium
| | - Alexandre Almorad
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan, 101 1090 Brussels, Belgium
| | - Erwin Ströker
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan, 101 1090 Brussels, Belgium
| | - Gudrun Pappaert
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan, 101 1090 Brussels, Belgium
| | - Juan Sieira
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan, 101 1090 Brussels, Belgium
| | - Thomy de Ravel
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Clinical Sciences, Research Group Reproduction and Genetics, Centre for Medical Genetics, Brussels, Belgium
| | - Mark La Meir
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, Brussels, Belgium
| | - Pedro Brugada
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan, 101 1090 Brussels, Belgium
| | - Gian Battista Chierchia
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan, 101 1090 Brussels, Belgium
| | - Sonia Van Dooren
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Clinical Sciences, Research Group Reproduction and Genetics, Centre for Medical Genetics, Brussels, Belgium
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Clinical Sciences, Research Group Reproduction and Genetics, Brussels Interuniversity Genomics High Throughput Core (BRIGHTcore), Brussels, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan, 101 1090 Brussels, Belgium
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De Raffele M, Di Domenico A, Balla C, Vitali F, Boccadoro A, Pavasini R, Micillo M, Cocco M, Campo G, Bertini M, Tonet E. Structural Abnormalities in Brugada Syndrome and Non-Invasive Cardiac Imaging: A Systematic Review. BIOLOGY 2023; 12:biology12040606. [PMID: 37106806 PMCID: PMC10136319 DOI: 10.3390/biology12040606] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/30/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023]
Abstract
The aim of this review is to identify possible structural abnormalities of BrS and their potential association with symptoms, risk stratification, and prognosis. (1) Background: BrS has always been considered a purely electrical disease and imaging techniques do not currently play a specific role in the diagnosis of this arrhythmic syndrome. Some authors have recently hypothesized the presence of structural and functional abnormalities. Therefore, several studies investigated the presence of pathological features in echocardiography and cardiac magnetic resonance imaging (MRI) in patients with BrS, but results were controversial. (2) Methods: We performed a systematic review of the literature on the spectrum of features detected by echocardiography and cardiac MRI. Articles were searched in Pubmed, Cochrane Library, and Biomed Central. Only papers published in English and in peer-reviewed journals up to November 2021 were selected. After an initial evaluation, 596 records were screened; the literature search identified 19 relevant articles. (3) Results: The imaging findings associated with BrS were as follows: right ventricular dilation, right ventricular wall motion abnormalities, delayed right ventricular contraction, speckle and feature tracking abnormalities, late gadolinium enhancement, and fat infiltration in the right ventricle. Furthermore, these features emerged more frequently in patients carrying the genetic mutation on the sodium voltage-gated channel α-subunit 5 (SCN5A) gene. (4) Conclusions: Specific imaging features detected by echocardiography and cardiac magnetic resonance are associated with BrS. However, this population appears to be heterogeneous and imaging anomalies emerged to be more frequent in patients carrying genetic mutations of SCN5A. Future studies with an evaluation of BrS patients are needed to identify the specific association linking the Brugada pattern, imaging abnormalities and their possible correlation with prognosis.
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Affiliation(s)
- Martina De Raffele
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, FE, Italy
| | - Assunta Di Domenico
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, FE, Italy
| | - Cristina Balla
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, FE, Italy
| | - Francesco Vitali
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, FE, Italy
| | - Alberto Boccadoro
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, FE, Italy
| | - Rita Pavasini
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, FE, Italy
| | - Marco Micillo
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, FE, Italy
| | - Marta Cocco
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, FE, Italy
| | - Gianluca Campo
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, FE, Italy
| | - Matteo Bertini
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, FE, Italy
| | - Elisabetta Tonet
- Cardiovascular Institute, Azienda Ospedaliero-Universitaria di Ferrara, 44124 Cona, FE, Italy
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Li Y, Dinkel H, Pakalniskyte D, Busley AV, Cyganek L, Zhong R, Zhang F, Xu Q, Maywald L, Aweimer A, Huang M, Liao Z, Meng Z, Yan C, Prädel T, Rose L, Moscu‐Gregor A, Hohn A, Yang Z, Qiao L, Mügge A, Zhou X, Akin I, El‐Battrawy I. Novel insights in the pathomechanism of Brugada syndrome and fever-related type 1 ECG changes in a preclinical study using human-induced pluripotent stem cell-derived cardiomyocytes. Clin Transl Med 2023; 13:e1130. [PMID: 36881552 PMCID: PMC9990896 DOI: 10.1002/ctm2.1130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 11/13/2022] [Accepted: 11/17/2022] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Brugada syndrome (BrS) is causing sudden cardiac death (SCD) mainly at young age. Studying the underlying mechanisms associated with BrS type I electrocardiogram (ECG) changes in the presence of fever and roles of autophagy for BrS remains lacking. OBJECTIVES We sought to study the pathogenic role of an SCN5A gene variant for BrS with fever-induced type 1 ECG phenotype. In addition, we studied the role of inflammation and autophagy in the pathomechanism of BrS. METHODS Human-induced pluripotent stem cell (hiPSC) lines from a BrS patient harboring a pathogenic variant (c.3148G>A/p. Ala1050Thr) in SCN5A and two healthy donors (non-BrS) and a CRISPR/Cas9 site-corrected cell line (BrS-corr) were differentiated into cardiomyocytes (hiPSC-CMs) for the study. RESULTS Reductions of Nav 1.5 expression, peak sodium channel current (INa ) and upstroke velocity (Vmax ) of action potentials with an increase in arrhythmic events were detected in BrS compared to non-BrS and BrS-corr cells. Increasing the cell culture temperature from 37 to 40°C (fever-like state) exacerbated the phenotypic changes in BrS cells. The fever-effects were enhanced by protein kinase A (PKA) inhibitor but reversed by PKA activator. Lipopolysaccharides (LPS) but not increased temperature up to 40°C enhanced the autophagy level in BrS-hiPSC-CMs by increasing reactive oxidative species and inhibiting PI3K/AKT signalling, and hence exacerbated the phenotypic changes. LPS enhanced high temperature-related effect on peak INa shown in BrS hiPSC-CMs. Effects of LPS and high temperature were not detected in non-BrS cells. CONCLUSIONS The study demonstrated that the SCN5A variant (c.3148G>A/p.Ala1050Thr) caused loss-of-function of sodium channels and increased the channel sensitivity to high temperature and LPS challenge in hiPSC-CMs from a BrS cell line with this variant but not in two non-BrS hiPSC-CM lines. The results suggest that LPS may exacerbate BrS phenotype via enhancing autophagy, whereas fever may exacerbate BrS phenotype via inhibiting PKA-signalling in BrS cardiomyocytes with but probably not limited to this variant.
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Affiliation(s)
- Yingrui Li
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM)Heidelberg UniversityMannheimGermany
- DZHK (German Center for Cardiovascular Research)Partner SiteHeidelberg‐Mannheim and GöttingenMannheimGermany
| | - Hendrik Dinkel
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM)Heidelberg UniversityMannheimGermany
- DZHK (German Center for Cardiovascular Research)Partner SiteHeidelberg‐Mannheim and GöttingenMannheimGermany
| | - Dalia Pakalniskyte
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM)Heidelberg UniversityMannheimGermany
- DZHK (German Center for Cardiovascular Research)Partner SiteHeidelberg‐Mannheim and GöttingenMannheimGermany
| | - Alexandra Viktoria Busley
- DZHK (German Center for Cardiovascular Research)Partner SiteHeidelberg‐Mannheim and GöttingenMannheimGermany
- Stem Cell UnitClinic for Cardiology and PneumologyUniversity Medical Center GöttingenGöttingenGermany
| | - Lukas Cyganek
- DZHK (German Center for Cardiovascular Research)Partner SiteHeidelberg‐Mannheim and GöttingenMannheimGermany
- Stem Cell UnitClinic for Cardiology and PneumologyUniversity Medical Center GöttingenGöttingenGermany
| | - Rujia Zhong
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM)Heidelberg UniversityMannheimGermany
| | - Feng Zhang
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM)Heidelberg UniversityMannheimGermany
| | - Qiang Xu
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM)Heidelberg UniversityMannheimGermany
- Key Laboratory of Medical Electrophysiology of Ministry of Education and Medical Electrophysiological Key Laboratory of Sichuan ProvinceInstitute of Cardiovascular ResearchSouthwest Medical UniversityLuzhouChina
| | - Lasse Maywald
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM)Heidelberg UniversityMannheimGermany
- DZHK (German Center for Cardiovascular Research)Partner SiteHeidelberg‐Mannheim and GöttingenMannheimGermany
| | - Assem Aweimer
- Department of Cardiology and AngiologyBergmannsheil University HospitalsRuhr University of BochumBochumGermany
| | - Mengying Huang
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM)Heidelberg UniversityMannheimGermany
| | - Zhenxing Liao
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM)Heidelberg UniversityMannheimGermany
| | - Zenghui Meng
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM)Heidelberg UniversityMannheimGermany
| | - Chen Yan
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM)Heidelberg UniversityMannheimGermany
| | - Timo Prädel
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM)Heidelberg UniversityMannheimGermany
- DZHK (German Center for Cardiovascular Research)Partner SiteHeidelberg‐Mannheim and GöttingenMannheimGermany
| | - Lena Rose
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM)Heidelberg UniversityMannheimGermany
| | | | - Alyssa Hohn
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM)Heidelberg UniversityMannheimGermany
| | - Zhen Yang
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM)Heidelberg UniversityMannheimGermany
| | - Lin Qiao
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM)Heidelberg UniversityMannheimGermany
| | - Andreas Mügge
- Department of Cardiology and AngiologyBergmannsheil University HospitalsRuhr University of BochumBochumGermany
| | - Xiaobo Zhou
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM)Heidelberg UniversityMannheimGermany
- DZHK (German Center for Cardiovascular Research)Partner SiteHeidelberg‐Mannheim and GöttingenMannheimGermany
- Key Laboratory of Medical Electrophysiology of Ministry of Education and Medical Electrophysiological Key Laboratory of Sichuan ProvinceInstitute of Cardiovascular ResearchSouthwest Medical UniversityLuzhouChina
| | - Ibrahim Akin
- First Department of MedicineFaculty of MedicineUniversity Medical Centre Mannheim (UMM)Heidelberg UniversityMannheimGermany
- DZHK (German Center for Cardiovascular Research)Partner SiteHeidelberg‐Mannheim and GöttingenMannheimGermany
| | - Ibrahim El‐Battrawy
- Department of Cardiology and AngiologyBergmannsheil University HospitalsRuhr University of BochumBochumGermany
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Popa IP, Șerban DN, Mărănducă MA, Șerban IL, Tamba BI, Tudorancea I. Brugada Syndrome: From Molecular Mechanisms and Genetics to Risk Stratification. Int J Mol Sci 2023; 24:ijms24043328. [PMID: 36834739 PMCID: PMC9967917 DOI: 10.3390/ijms24043328] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/13/2023] [Accepted: 02/06/2023] [Indexed: 02/11/2023] Open
Abstract
Brugada syndrome (BrS) is a rare hereditary arrhythmia disorder, with a distinctive ECG pattern, correlated with an increased risk of ventricular arrhythmias and sudden cardiac death (SCD) in young adults. BrS is a complex entity in terms of mechanisms, genetics, diagnosis, arrhythmia risk stratification, and management. The main electrophysiological mechanism of BrS requires further research, with prevailing theories centered on aberrant repolarization, depolarization, and current-load match. Computational modelling, pre-clinical, and clinical research show that BrS molecular anomalies result in excitation wavelength (k) modifications, which eventually increase the risk of arrhythmia. Although a mutation in the SCN5A (Sodium Voltage-Gated Channel Alpha Subunit 5) gene was first reported almost two decades ago, BrS is still currently regarded as a Mendelian condition inherited in an autosomal dominant manner with incomplete penetrance, despite the recent developments in the field of genetics and the latest hypothesis of additional inheritance pathways proposing a more complex mode of inheritance. In spite of the extensive use of the next-generation sequencing (NGS) technique with high coverage, genetics remains unexplained in a number of clinically confirmed cases. Except for the SCN5A which encodes the cardiac sodium channel NaV1.5, susceptibility genes remain mostly unidentified. The predominance of cardiac transcription factor loci suggests that transcriptional regulation is essential to the Brugada syndrome's pathogenesis. It appears that BrS is a multifactorial disease, which is influenced by several loci, each of which is affected by the environment. The primary challenge in individuals with a BrS type 1 ECG is to identify those who are at risk for sudden death, researchers propose the use of a multiparametric clinical and instrumental strategy for risk stratification. The aim of this review is to summarize the latest findings addressing the genetic architecture of BrS and to provide novel perspectives into its molecular underpinnings and novel models of risk stratification.
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Affiliation(s)
- Irene Paula Popa
- Cardiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
| | - Dragomir N. Șerban
- Department of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Minela Aida Mărănducă
- Department of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Ionela Lăcrămioara Șerban
- Department of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
| | - Bogdan Ionel Tamba
- Department of Pharmacology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
- Correspondence:
| | - Ionuț Tudorancea
- Cardiology Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
- Department of Physiology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania
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Asatryan B, Barth AS. Sex-related differences in incidence, phenotype and risk of sudden cardiac death in inherited arrhythmia syndromes. Front Cardiovasc Med 2023; 9:1010748. [PMID: 36684594 PMCID: PMC9845907 DOI: 10.3389/fcvm.2022.1010748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 12/08/2022] [Indexed: 01/06/2023] Open
Abstract
Inherited Arrhythmia Syndromes (IAS) including long QT and Brugada Syndrome, are characterized by life-threatening arrhythmias in the absence of apparent structural heart disease and are caused by pathogenic variants in genes encoding cardiac ion channels or associated proteins. Studies of large pedigrees of families affected by IAS have demonstrated incomplete penetrance and variable expressivity. Biological sex is one of several factors that have been recognized to modulate disease severity in IAS. There is a growing body of evidence linking sex hormones to the susceptibility to arrhythmias, yet, many sex-specific disease aspects remain underrecognized as female sex and women with IAS are underinvestigated and findings from male-predominant cohorts are often generalized to both sexes with minimal to no consideration of relevant sex-associated differences in prevalence, disease manifestations and outcome. In this review, we highlight current knowledge of sex-related biological differences in normal cardiac electrophysiology and sex-associated factors that influence IAS phenotypes.
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Affiliation(s)
- Babken Asatryan
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas S. Barth
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States,*Correspondence: Andreas S. Barth ✉
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28
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Chen GX, Barajas-Martínez H, Ciconte G, Wu CI, Monasky MM, Xia H, Li B, Capra JA, Guo K, Zhang ZH, Chen X, Yang B, Jiang H, Tse G, Mak CM, Aizawa Y, Gollob MH, Antzelevitch C, Wilde AAM, Pappone C, Hu D. Clinical characteristics and electrophysiologic properties of SCN5A variants in fever-induced Brugada syndrome. EBioMedicine 2023; 87:104388. [PMID: 36516610 PMCID: PMC9768239 DOI: 10.1016/j.ebiom.2022.104388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 10/12/2022] [Accepted: 11/15/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Brugada syndrome (BrS) is a severe inherited arrhythmia syndrome that can be unmasked by fever. METHODS A multicentre clinical analysis was performed in 261 patients diagnosed with fever-induced BrS, including 198 (75.9%) and 27 (10.3%) patients who received next-generation genetic sequencing and epicardial arrhythmogenic substrate (AS) mapping, respectively. FINDINGS In fever-induced BrS patients, pathogenic or likely pathogenic (P/LP) SCN5A variant carriers developed fever-induced BrS at a younger age, and more often in females and those of Caucasian descent. They exhibited significant electrophysical abnormalities, including a larger epicardial AS area, and more prolonged abnormal epicardial electrograms. During a median follow-up of 50.5 months (quartiles 32.5-81.5 months) after the diagnosis, major cardiac events (MCE) occurred in 27 (14.4%) patients. Patients with P/LP SCN5A variants had a higher ratio of MCE compared with the rest. Additionally, history of syncope, QRS duration, and Tpe interval could also predict an increased risk for future MCE according to univariate analysis. Multivariate analysis indicated that only P/LP SCN5A variants were independent significant predictors of MCE. Computational structural modelling showed that most variants are destabilizing, suggesting that Nav1.5 structure destabilization caused by SCN5A missense variants may contribute to fever-induced BrS. INTERPRETATION In our cohort, P/LP SCN5A variant carriers with fever-induced BrS are more prevalent among patients of Caucasian descent, females, and younger patients. These patients exhibit aggressive electrophysiological abnormalities and worse outcome, which warrants closer monitoring and more urgent management of fever. FUNDING The current work was supported by the National Natural Science Foundation Project of China (Nos. 82270332 & 81670304), The Fundamental Research Funds for the Central Universities of China - Independent Research Project of Wuhan University (No. 2042022kf1217) from China; the National Institutes of Health of USA [NIH R56 (HL47678), NIH R01 (HL138103), and NIH R01 (HL152201)], the W. W. Smith Charitable Trust and the Wistar and Martha Morris Fund, Sharpe-Strumia Research Foundation, the American Heart Association Postdoctoral Fellowship (20POST35220002) from United States; the Netherlands CardioVascular Research Initiative: the Dutch Heart Foundation, Dutch Federation of University Medical Centers, the Netherlands Organization for Health Research and Development, and the Royal Netherlands Academy of Sciences (PREDICT2) from the Netherlands.
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Affiliation(s)
- Gan-Xiao Chen
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, Hubei, China; Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Hector Barajas-Martínez
- Lankenau Institute for Medical Research and Lankenau Heart Institute, Wynnwood, PA, USA; Jefferson Medical College, Philadelphia, PA, USA
| | - Giuseppe Ciconte
- Arrhythmia and Electrophysiology Center, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy; Vita-Salute San Raffaele University, Milan, Italy; Institute of Molecular and Translational Cardiology (IMTC), San Donato Milanese, Milan, Italy
| | - Cheng-I Wu
- Amsterdam UMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands; Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Michelle M Monasky
- Arrhythmia and Electrophysiology Center, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Hao Xia
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, Hubei, China; Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Bian Li
- Department of Biological Sciences and Center for Structural Biology, Vanderbilt University, Nashville, TN, USA
| | - John A Capra
- Bakar Computational Health Sciences Institute and Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Kai Guo
- Department of Cardiology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhong-He Zhang
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, Hubei, China; Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Xiu Chen
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, Hubei, China; Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Bo Yang
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, Hubei, China; Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Hong Jiang
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, Hubei, China; Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin, China; Kent and Medway Medical School, Canterbury, Kent, United Kingdom; School of Nursing and Health Studies, Metropolitan University, Hong Kong, China
| | - Chloe Miu Mak
- Department of Pathology, Hong Kong Children's Hospital, Hong Kong, China
| | - Yoshiyasu Aizawa
- Department of Cardiovascular Medicine, International University of Health and Welfare, School of Medicine, 4-3, Kozunomori, Narita, Chiba, Japan
| | - Michael H Gollob
- Department of Physiology and Division of Cardiology, University of Toronto, Toronto, ON, Canada
| | - Charles Antzelevitch
- Lankenau Institute for Medical Research and Lankenau Heart Institute, Wynnwood, PA, USA; Jefferson Medical College, Philadelphia, PA, USA
| | - Arthur A M Wilde
- Amsterdam UMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Carlo Pappone
- Arrhythmia and Electrophysiology Center, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy; Vita-Salute San Raffaele University, Milan, Italy; Institute of Molecular and Translational Cardiology (IMTC), San Donato Milanese, Milan, Italy
| | - Dan Hu
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, Hubei, China; Hubei Key Laboratory of Cardiology, Wuhan, Hubei, China.
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Chattopadhyay A, Shih CY, Hsu YC, Juang JMJ, Chuang EY, Lu TP. CLIN_SKAT: an R package to conduct association analysis using functionally relevant variants. BMC Bioinformatics 2022; 23:441. [PMID: 36274122 PMCID: PMC9590128 DOI: 10.1186/s12859-022-04987-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 10/16/2022] [Indexed: 12/03/2022] Open
Abstract
Background Availability of next generation sequencing data, allows low-frequency and rare variants to be studied through strategies other than the commonly used genome-wide association studies (GWAS). Rare variants are important keys towards explaining the heritability for complex diseases that remains to be explained by common variants due to their low effect sizes. However, analysis strategies struggle to keep up with the huge amount of data at disposal therefore creating a bottleneck. This study describes CLIN_SKAT, an R package, that provides users with an easily implemented analysis pipeline with the goal of (i) extracting clinically relevant variants (both rare and common), followed by (ii) gene-based association analysis by grouping the selected variants.
Results CLIN_SKAT offers four simple functions that can be used to obtain clinically relevant variants, map them to genes or gene sets, calculate weights from global healthy populations and conduct weighted case–control analysis. CLIN_SKAT introduces improvements by adding certain pre-analysis steps and customizable features to make the SKAT results clinically more meaningful. Moreover, it offers several plot functions that can be availed towards obtaining visualizations for interpretation of the analyses results. CLIN_SKAT is available on Windows/Linux/MacOS and is operative for R version 4.0.4 or later. It can be freely downloaded from https://github.com/ShihChingYu/CLIN_SKAT, installed through devtools::install_github("ShihChingYu/CLIN_SKAT", force=T) and executed by loading the package into R using library(CLIN_SKAT). All outputs (tabular and graphical) can be downloaded in simple, publishable formats.
Conclusions Statistical association analysis is often underpowered due to low sample sizes and high numbers of variants to be tested, limiting detection of causal ones. Therefore, retaining a subset of variants that are biologically meaningful seems to be a more effective strategy for identifying explainable associations while reducing the degrees of freedom. CLIN_SKAT offers users a one-stop R package that identifies disease risk variants with improved power via a series of tailor-made procedures that allows dimension reduction, by retaining functionally relevant variants, and incorporating ethnicity based priors. Furthermore, it also eliminates the requirement for high computational resources and bioinformatics expertise. Supplementary Information The online version contains supplementary material available at 10.1186/s12859-022-04987-2.
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Marx M, Gass M, Michel-Behnke I. Generationenübergreifende Betreuung von Patienten mit tachykarden Rhythmusstörungen. Monatsschr Kinderheilkd 2022; 170:870-882. [PMID: 36105264 PMCID: PMC9461413 DOI: 10.1007/s00112-022-01591-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2022] [Indexed: 11/26/2022]
Abstract
Die Versorgung von Patienten mit Rhythmusstörungen hat sich in den letzten Jahrzehnten von einer rein konservativ medikamentösen Therapie zu einer echten kurativen Therapie mit Beseitigung des arryhthmogenen Substrats durch technisch immer ausgereiftere Möglichkeiten im Sinn der elektrophysiologische Untersuchung (EPU) und Ablation entwickelt. Parallel dazu haben sich in pädiatrisch-kardiologischen Zentren rhythmologische Spezialambulanzen zur Betreuung von Patienten mit Ionenkanalerkrankungen etabliert. Deren Aufgabe besteht in der generationenübergreifenden Betreuung von ganzen Familien, mit dem Ziel, präventiv, durch entsprechende Beratung und Führung, maligne Rhythmusstörungen primär zu verhindern.
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Affiliation(s)
- Manfred Marx
- Klinische Abteilung für Pädiatrische Kardiologie, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Währinger Gürtel 18–20, 1090 Wien, Österreich
| | - Matthias Gass
- Klinische Abteilung für Pädiatrische Kardiologie, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Währinger Gürtel 18–20, 1090 Wien, Österreich
- Pädiatrische Kardiologie, Universitäts-Kinderklinik Zürich, Zürich, Schweiz
| | - Ina Michel-Behnke
- Klinische Abteilung für Pädiatrische Kardiologie, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Währinger Gürtel 18–20, 1090 Wien, Österreich
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Comparing the performance of published risk scores in Brugada syndrome: a multi-center cohort study. Curr Probl Cardiol 2022; 47:101381. [PMID: 36058344 DOI: 10.1016/j.cpcardiol.2022.101381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 08/26/2022] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The management of Brugada Syndrome (BrS) patients at intermediate risk of arrhythmic events remains controversial. The present study evaluated the predictive performance of different risk scores in an Asian BrS population and its intermediate risk subgroup. METHODS This retrospective cohort study included consecutive patients diagnosed with BrS from January 1st, 1997 to June 20th, 2020 from Hong Kong. The primary outcome is sustained ventricular tachyarrhythmias. Two novel risk risk scores and seven machine learning-based models (random survival forest, Ada boost classifier, Gaussian naïve Bayes, light gradient boosting machine, random forest classifier, gradient boosting classifier and decision tree classifier) were developed. The area under the receiver operator characteristic (ROC) curve (AUC) [95% confidence intervals] was compared between the different models. RESULTS This study included 548 consecutive BrS patients (7% female, age at diagnosis: 50±16 years, follow-up: 84±55 months). For the whole cohort, the score developed by Sieira et al. showed the best performance (AUC: 0.806 [0.747-0.865]). A novel risk score was developed using the Sieira score and additional variables significant on univariable Cox regression (AUC: 0.855 [0.808-0.901]). A simpler score based on non-invasive results only showed a statistically comparable AUC (0.784 [0.724-0.845]), improved using random survival forests (AUC: 0.942 [0.913-0.964]). For the intermediate risk subgroup (N=274), a gradient boosting classifier model showed the best performance (AUC: 0.814 [0.791-0.832]). CONCLUSION A simple risk score based on clinical and electrocardiographic variables showed a good performance for predicting VT/VF, improved using machine learning. Abstract: The management of Brugada Syndrome (BrS) patients at intermediate risk of arrhythmic events remains controversial. This study evaluated the predictive performance of published risk scores in a cohort of BrS patients from Hong Kong (N=548) and its intermediate risk subgroup (N=274). A novel risk score developed by modifying the best performing existing score (by. Sieira et al.) showed an area under the curve of 0.855 and 0.760 for the whole BrS cohort and the intermediate risk subgroup, respectively. The performance of the different scores was significantly improved machine learning-based methods, such as random survival forests and gradient boosting classifier.
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Wilde AAM, Semsarian C, Márquez MF, Shamloo AS, Ackerman MJ, Ashley EA, Sternick EB, Barajas-Martinez H, Behr ER, Bezzina CR, Breckpot J, Charron P, Chockalingam P, Crotti L, Gollob MH, Lubitz S, Makita N, Ohno S, Ortiz-Genga M, Sacilotto L, Schulze-Bahr E, Shimizu W, Sotoodehnia N, Tadros R, Ware JS, Winlaw DS, Kaufman ES. European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) Expert Consensus Statement on the state of genetic testing for cardiac diseases. Europace 2022; 24:1307-1367. [PMID: 35373836 PMCID: PMC9435643 DOI: 10.1093/europace/euac030] [Citation(s) in RCA: 123] [Impact Index Per Article: 61.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Arthur A M Wilde
- Heart Centre, Department of Cardiology, Amsterdam Universitair Medische
Centra, Amsterdam, location AMC, The Netherlands
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute,
University of Sydney, Sydney, Australia
| | - Manlio F Márquez
- Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de
México, Mexico
- Member of the Latin American Heart Rhythm Society (LAHRS)
| | | | - Michael J Ackerman
- Departments of Cardiovascular Medicine, Pediatric and Adolescent Medicine,
and Molecular Pharmacology & Experimental Therapeutics; Divisions of Heart Rhythm
Services and Pediatric Cardiology; Windland Smith Rice Genetic Heart Rhythm Clinic and
Windland Smith Rice Sudden Death Genomics Laboratory, Mayo
Clinic, Rochester, MN, USA
| | - Euan A Ashley
- Department of Cardiovascular Medicine, Stanford University,
Stanford, California, USA
| | - Eduardo Back Sternick
- Arrhythmia and Electrophysiology Unit, Biocor Institute,
Minas Gerais, Brazil; and
Member of the Latin American Heart Rhythm Society (LAHRS)
| | - Héctor Barajas-Martinez
- Cardiovascular Research, Lankenau Institute of Medical
Research, Wynnewood, PA, USA; and Member of the Latin American Heart Rhythm Society (LAHRS)
| | - Elijah R Behr
- Cardiovascular Clinical Academic Group, Institute of Molecular and Clinical
Sciences, St. George’s, University of London; St. George’s University Hospitals NHS
Foundation Trust, London, UK; Mayo Clinic Healthcare, London
| | - Connie R Bezzina
- Amsterdam UMC Heart Center, Department of Experimental
Cardiology, Amsterdam, The
Netherlands
| | - Jeroen Breckpot
- Center for Human Genetics, University Hospitals Leuven,
Leuven, Belgium
| | - Philippe Charron
- Sorbonne Université, APHP, Centre de Référence des Maladies Cardiaques
Héréditaires, ICAN, Inserm UMR1166, Hôpital
Pitié-Salpêtrière, Paris, France
| | | | - Lia Crotti
- Center for Cardiac Arrhythmias of Genetic Origin,
Istituto Auxologico Italiano, IRCCS, Milan, Italy
- Cardiomyopathy Unit and Cardiac Rehabilitation Unit, San Luca Hospital,
Istituto Auxologico Italiano, IRCCS, Milan,
Italy
- Department of Medicine and Surgery, University of
Milano-Bicocca, Milan, Italy
| | - Michael H Gollob
- Inherited Arrhythmia and Cardiomyopathy Program, Division of Cardiology,
University of Toronto, Toronto, ON, Canada
| | - Steven Lubitz
- Cardiac Arrhythmia Service, Massachusetts General Hospital and Harvard
Medical School, Boston, MA, USA
| | - Naomasa Makita
- National Cerebral and Cardiovascular Center, Research
Institute, Suita, Japan
| | - Seiko Ohno
- Department of Bioscience and Genetics, National Cerebral and Cardiovascular
Center, Suita, Japan
| | - Martín Ortiz-Genga
- Clinical Department, Health in Code, A
Coruña, Spain; and Member of the Latin
American Heart Rhythm Society (LAHRS)
| | - Luciana Sacilotto
- Arrhythmia Unit, Instituto do Coracao, Hospital das Clinicas HCFMUSP,
Faculdade de Medicina, Universidade de Sao Paulo, Sao
Paulo, Brazil; and Member of the Latin
American Heart Rhythm Society (LAHRS)
| | - Eric Schulze-Bahr
- Institute for Genetics of Heart Diseases, University Hospital
Münster, Münster, Germany
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon
Medical School, Bunkyo-ku, Tokyo, Japan
| | - Nona Sotoodehnia
- Cardiovascular Health Research Unit, Division of Cardiology, Department of
Medicine, University of Washington, Seattle, WA,
USA
| | - Rafik Tadros
- Cardiovascular Genetics Center, Department of Medicine, Montreal Heart
Institute, Université de Montréal, Montreal,
Canada
| | - James S Ware
- National Heart and Lung Institute and MRC London Institute of Medical
Sciences, Imperial College London, London,
UK
- Royal Brompton & Harefield Hospitals, Guy’s
and St. Thomas’ NHS Foundation Trust, London, UK
| | - David S Winlaw
- Cincinnati Children's Hospital Medical Centre, University of
Cincinnati, Cincinnati, OH, USA
| | - Elizabeth S Kaufman
- Metrohealth Medical Center, Case Western Reserve University,
Cleveland, OH, USA
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Migliore F, Martini N, Calo' L, Martino A, Winnicki G, Vio R, Condello C, Rizzo A, Zorzi A, Pannone L, Miraglia V, Sieira J, Chierchia GB, Curcio A, Allocca G, Mantovan R, Salghetti F, Curnis A, Bertaglia E, De Lazzari M, de Asmundis C, Corrado D. Predictors of late arrhythmic events after generator replacement in Brugada syndrome treated with prophylactic ICD. Front Cardiovasc Med 2022; 9:964694. [PMID: 35935654 PMCID: PMC9355272 DOI: 10.3389/fcvm.2022.964694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Predictors of late life-threatening arrhythmic events in Brugada syndrome (BrS) patients who received a prophylactic ICD implantation remain to be evaluated. The aim of the present long-term multicenter study was to assess the incidence and clinical-electrocardiographic predictors of late life-threatening arrhythmic events in BrS patients with a prophylactic implantable cardioverter defibrillator (ICD) and undergoing generator replacement (GR). Methods The study population included 105 patients (75% males; mean age 45 ± 14years) who received a prophylactic ICD and had no arrhythmic event up to first GR. Results The median period from first ICD implantation to last follow-up was 155 (128-181) months and from first ICD Implantation to the GR was 84 (61-102) months. During a median follow-up of 57 (38-102) months after GR, 10 patients (9%) received successful appropriate ICD intervention (1.6%/year). ICD interventions included shock on ventricular fibrillation (n = 8 patients), shock on ventricular tachycardia (n = 1 patient), and antitachycardia pacing on ventricular tachycardia (n = 1 patient). At survival analysis, history of atrial fibrillation (log-rank test; P = 0.02), conduction disturbances (log-rank test; P < 0.01), S wave in lead I (log-rank test; P = 0.01) and first-degree atrioventricular block (log-rank test; P = 0.04) were significantly associated with the occurrence of late appropriate ICD intervention. At Cox-regression multivariate analysis, S-wave in lead I was the only independent predictor of late appropriate ICD intervention (HR: 9.17; 95%CI: 1.15-73.07; P = 0.03). Conclusions The present study indicates that BrS patient receiving a prophylactic ICD may experience late appropriate intervention after GR in a clinically relevant proportion of cases. S-wave in lead I at the time of first clinical evaluation was the only independent predictor of persistent risk of life-threatening arrhythmic events. These findings support the need for GR at the end of service regardless of previous appropriate intervention, mostly in BrS patients with conduction abnormalities.
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Affiliation(s)
- Federico Migliore
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Nicolò Martini
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Leonardo Calo'
- Department of Cardiology, Policlinico Casilino, Rome, Italy
| | | | - Giulia Winnicki
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Riccardo Vio
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Chiara Condello
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Alessandro Rizzo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Luigi Pannone
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Vincenzo Miraglia
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Juan Sieira
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Antonio Curcio
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Giuseppe Allocca
- Department of Cardiology, S.Maria dei Battuti Hospital, Conegliano, Italy
| | - Roberto Mantovan
- Department of Cardiology, S.Maria dei Battuti Hospital, Conegliano, Italy
| | | | - Antonio Curnis
- Spedali Civili Hospital, University of Brescia, Brescia, Italy
| | - Emanuele Bertaglia
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Manuel De Lazzari
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Domenico Corrado
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
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Nakano Y, Shimizu W. Brugada Syndrome as a Major Cause of Sudden Cardiac Death in Asians. JACC. ASIA 2022; 2:412-421. [PMID: 36339362 PMCID: PMC9627855 DOI: 10.1016/j.jacasi.2022.03.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/28/2022] [Accepted: 03/30/2022] [Indexed: 06/16/2023]
Abstract
Brugada syndrome (BrS) is one of the main inherited arrhythmia syndromes causing ventricular fibrillation (VF) and sudden cardiac death in young to middle-aged men, especially in Asians. The diagnosis of BrS is based on spontaneous or drug-provoked type 1 Brugada electrocardiogram. The current reliable therapy for BrS patients with VF history is the implantation of an implantable cardioverter-defibrillator. As for BrS patients without VF history, how asymptomatic BrS patients should effectively be treated is still uncertain because risk stratification of the BrS is still inadequate. Various parameters and combinations of several parameters have been reported for risk stratification of BrS. The SCN5A gene is believed to be the only gene that is responsible for BrS, and it has been reported to be useful for risk stratification. This review focuses on risk stratification of BrS patients, and focuses specifically on BrS patients of Asian descent.
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Affiliation(s)
- Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
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35
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Wilde AAM, Semsarian C, Márquez MF, Sepehri Shamloo A, Ackerman MJ, Ashley EA, Sternick Eduardo B, Barajas‐Martinez H, Behr ER, Bezzina CR, Breckpot J, Charron P, Chockalingam P, Crotti L, Gollob MH, Lubitz S, Makita N, Ohno S, Ortiz‐Genga M, Sacilotto L, Schulze‐Bahr E, Shimizu W, Sotoodehnia N, Tadros R, Ware JS, Winlaw DS, Kaufman ES, Aiba T, Bollmann A, Choi J, Dalal A, Darrieux F, Giudicessi J, Guerchicoff M, Hong K, Krahn AD, Mac Intyre C, Mackall JA, Mont L, Napolitano C, Ochoa Juan P, Peichl P, Pereira AC, Schwartz PJ, Skinner J, Stellbrink C, Tfelt‐Hansen J, Deneke T. European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) Expert Consensus Statement on the state of genetic testing for cardiac diseases. J Arrhythm 2022; 38:491-553. [PMID: 35936045 PMCID: PMC9347209 DOI: 10.1002/joa3.12717] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Arthur A. M. Wilde
- Heart Centre, Department of Cardiology, Amsterdam Universitair Medische CentraAmsterdamThe Netherlands
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary InstituteUniversity of SydneySydneyAustralia
| | - Manlio F. Márquez
- Instituto Nacional de Cardiología Ignacio ChávezCiudad de MéxicoMexico
| | | | - Michael J. Ackerman
- Departments of Cardiovascular Medicine, Pediatric and Adolescent Medicine, and Molecular Pharmacology & Experimental Therapeutics; Divisions of Heart Rhythm Services and Pediatric Cardiology; Windland Smith Rice Genetic Heart Rhythm Clinic and Windland Smith Rice Sudden Death Genomics Laboratory, Mayo ClinicRochesterMNUSA
| | - Euan A. Ashley
- Department of Cardiovascular MedicineStanford UniversityStanfordCAUSA
| | | | | | - Elijah R. Behr
- Cardiovascular Clinical Academic Group, Institute of Molecular and Clinical Sciences, St. George’sUniversity of London; St. George’s University Hospitals NHS Foundation TrustLondonUKMayo Clinic HealthcareLondon
| | - Connie R. Bezzina
- Amsterdam UMC Heart Center, Department of Experimental CardiologyAmsterdamThe Netherlands
| | - Jeroen Breckpot
- Center for Human GeneticsUniversity Hospitals LeuvenLeuvenBelgium
| | | | | | - Lia Crotti
- Center for Cardiac Arrhythmias of Genetic Origin, Istituto Auxologico Italiano, IRCCSMilanItaly
- Cardiomyopathy Unit and Cardiac Rehabilitation Unit, San Luca Hospital, Istituto Auxologico Italiano, IRCCSMilanItaly
- Department of Medicine and SurgeryUniversity of Milano‐BicoccaMilanItaly
| | - Michael H. Gollob
- Inherited Arrhythmia and Cardiomyopathy Program, Division of CardiologyUniversity of TorontoTorontoONCanada
| | - Steven Lubitz
- Cardiac Arrhythmia ServiceMassachusetts General Hospital and Harvard Medical SchoolBostonMAUSA
| | - Naomasa Makita
- National Cerebral and Cardiovascular CenterResearch InstituteSuitaJapan
| | - Seiko Ohno
- Department of Bioscience and Genetics, National Cerebral and Cardiovascular CenterSuitaJapan
| | | | - Luciana Sacilotto
- Arrhythmia Unit, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao PauloBrazil
| | - Eric Schulze‐Bahr
- Institute for Genetics of Heart DiseasesUniversity Hospital MünsterMünsterGermany
| | - Wataru Shimizu
- Department of Cardiovascular MedicineGraduate School of MedicineTokyoJapan
| | - Nona Sotoodehnia
- Cardiovascular Health Research Unit, Division of Cardiology, Department of MedicineUniversity of WashingtonSeattleWAUSA
| | - Rafik Tadros
- Cardiovascular Genetics Center, Department of Medicine, Montreal Heart InstituteUniversité de MontréalMontrealCanada
| | - James S. Ware
- National Heart and Lung Institute and MRC London Institute of Medical SciencesImperial College LondonLondonUK
- Royal Brompton & Harefield Hospitals, Guy’s and St. Thomas’ NHS Foundation TrustLondonUK
| | - David S. Winlaw
- Cincinnati Children's Hospital Medical CentreUniversity of CincinnatiCincinnatiOHUSA
| | | | - Takeshi Aiba
- Department of Clinical Laboratory Medicine and Genetics, National Cerebral and Cardiovascular Center, SuitaOsakaJapan
| | - Andreas Bollmann
- Department of ElectrophysiologyHeart Center Leipzig at University of LeipzigLeipzigGermany
- Leipzig Heart InstituteLeipzigGermany
| | - Jong‐Il Choi
- Division of Cardiology, Department of Internal Medicine, Korea University Anam HospitalKorea University College of MedicineSeoulRepublic of Korea
| | - Aarti Dalal
- Department of Pediatrics, Division of CardiologyVanderbilt University School of MedicineNashvilleTNUSA
| | - Francisco Darrieux
- Arrhythmia Unit, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São PauloSão PauloBrazil
| | - John Giudicessi
- Department of Cardiovascular Medicine (Divisions of Heart Rhythm Services and Circulatory Failure and the Windland Smith Rice Genetic Heart Rhythm Clinic), Mayo ClinicRochesterMNUSA
| | - Mariana Guerchicoff
- Division of Pediatric Arrhythmia and Electrophysiology, Italian Hospital of Buenos AiresBuenos AiresArgentina
| | - Kui Hong
- Department of Cardiovascular MedicineThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Andrew D. Krahn
- Division of CardiologyUniversity of British ColumbiaVancouverCanada
| | - Ciorsti Mac Intyre
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Windland Smith Rice Genetic Heart Rhythm Clinic, Mayo ClinicRochesterMNUSA
| | - Judith A. Mackall
- Center for Cardiac Electrophysiology and Pacing, University Hospitals Cleveland Medical CenterCase Western Reserve University School of MedicineClevelandOHUSA
| | - Lluís Mont
- Institut d’Investigacions Biomèdiques August Pi Sunyer (IDIBAPS). Barcelona, Spain; Centro de Investigacion Biomedica en Red en Enfermedades Cardiovasculares (CIBERCV), MadridSpain
| | - Carlo Napolitano
- Molecular Cardiology, Istituti Clinici Scientifici Maugeri, IRCCSPaviaItaly
- Department of Molecular MedicineUniversity of PaviaPaviaItaly
| | - Pablo Ochoa Juan
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), MadridSpain
- Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de HierroMadridSpain
- Centro de Investigacion Biomedica en Red en Enfermedades Cariovasculares (CIBERCV), MadridSpain
| | - Petr Peichl
- Department of CardiologyInstitute for Clinical and Experimental MedicinePragueCzech Republic
| | - Alexandre C. Pereira
- Laboratory of Genetics and Molecular Cardiology, Heart InstituteUniversity of São Paulo Medical SchoolSão PauloBrazil
- Hipercol Brasil ProgramSão PauloBrazil
| | - Peter J. Schwartz
- Center for Cardiac Arrhythmias of Genetic Origin, Istituto Auxologico Italiano, IRCCSMilanItaly
| | - Jon Skinner
- Sydney Childrens Hospital NetworkUniversity of SydneySydneyAustralia
| | - Christoph Stellbrink
- Department of Cardiology and Intensive Care MedicineUniversity Hospital Campus Klinikum BielefeldBielefeldGermany
| | - Jacob Tfelt‐Hansen
- The Department of Cardiology, the Heart Centre, Copenhagen University Hospital, Rigshopitalet, Copenhagen, Denmark; Section of genetics, Department of Forensic Medicine, Faculty of Medical SciencesUniversity of CopenhagenDenmark
| | - Thomas Deneke
- Heart Center Bad NeustadtBad Neustadt a.d. SaaleGermany
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Leung J, Lee S, Zhou J, Jeevaratnam K, Lakhani I, Radford D, Coakley-Youngs E, Pay L, Çinier G, Altinsoy M, Behnoush AH, Mahmoudi E, Matusik PT, Bazoukis G, Garcia-Zamora S, Zeng S, Chen Z, Xia Y, Liu T, Tse G. Clinical Characteristics, Genetic Findings and Arrhythmic Outcomes of Patients with Catecholaminergic Polymorphic Ventricular Tachycardia from China: A Systematic Review. Life (Basel) 2022; 12:1104. [PMID: 35892906 PMCID: PMC9330865 DOI: 10.3390/life12081104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/12/2022] [Accepted: 07/19/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare inherited cardiac ion channelopathy. The present study aims to examine the clinical characteristics, genetic basis, and arrhythmic outcomes of CPVT patients from China to elucidate the difference between CPVT patients in Asia and Western countries. METHODS PubMed and Embase were systematically searched for case reports or series reporting on CPVT patients from China until 19 February 2022 using the keyword: "Catecholaminergic Polymorphic Ventricular Tachycardia" or "CPVT", with the location limited to: "China" or "Hong Kong" or "Macau" in Embase, with no language or publication-type restriction. Articles that did not state a definite diagnosis of CPVT and articles with duplicate cases found in larger cohorts were excluded. All the included publications in this review were critically appraised based on the Joanna Briggs Institute Critical Appraisal Checklist. Clinical characteristics, genetic findings, and the primary outcome of spontaneous ventricular tachycardia/ventricular fibrillation (VT/VF) were analyzed. RESULTS A total of 58 unique cases from 15 studies (median presentation age: 8 (5.0-11.8) years old) were included. All patients, except one, presented at or before 19 years of age. There were 56 patients (96.6%) who were initially symptomatic. Premature ventricular complexes (PVCs) were present in 44 out of 51 patients (86.3%) and VT in 52 out of 58 patients (89.7%). Genetic tests were performed on 54 patients (93.1%) with a yield of 87%. RyR2, CASQ2, TERCL, and SCN10A mutations were found in 35 (71.4%), 12 (24.5%), 1 (0.02%) patient, and 1 patient (0.02%), respectively. There were 54 patients who were treated with beta-blockers, 8 received flecainide, 5 received amiodarone, 2 received verapamil and 2 received propafenone. Sympathectomy (n = 10), implantable cardioverter-defibrillator implantation (n = 8) and ablation (n = 1) were performed. On follow-up, 13 patients developed VT/VF. CONCLUSION This was the first systematic review of CPVT patients from China. Most patients had symptoms on initial presentation, with syncope as the presenting complaint. RyR2 mutation accounts for more than half of the CPVT cases, followed by CASQ2, TERCL and SCN10A mutations.
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Affiliation(s)
- Justin Leung
- Cardiac Electrophysiology Unit, Cardiovascular Analytics Group, China-UK Collaboration, Hong Kong, China; (J.L.); (S.L.); (I.L.)
| | - Sharen Lee
- Cardiac Electrophysiology Unit, Cardiovascular Analytics Group, China-UK Collaboration, Hong Kong, China; (J.L.); (S.L.); (I.L.)
| | - Jiandong Zhou
- School of Data Science, City University of Hong Kong, Hong Kong, China;
| | - Kamalan Jeevaratnam
- Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK;
| | - Ishan Lakhani
- Cardiac Electrophysiology Unit, Cardiovascular Analytics Group, China-UK Collaboration, Hong Kong, China; (J.L.); (S.L.); (I.L.)
| | - Danny Radford
- Kent and Medway Medical School, Canterbury CT2 7FS, UK; (D.R.); (E.C.-Y.)
| | | | - Levent Pay
- Department of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul 34147, Turkey; (L.P.); (G.Ç.)
| | - Göksel Çinier
- Department of Cardiology, Dr Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul 34147, Turkey; (L.P.); (G.Ç.)
| | - Meltem Altinsoy
- Department of Cardiology, University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara 06145, Turkey;
| | - Amir Hossein Behnoush
- Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences, Tehran 1416643931, Iran; (A.H.B.); (E.M.)
| | - Elham Mahmoudi
- Universal Scientific Education and Research Network (USERN), Tehran University of Medical Sciences, Tehran 1416643931, Iran; (A.H.B.); (E.M.)
| | - Paweł T. Matusik
- Department of Electrocardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, 31-202 Kraków, Poland;
| | - George Bazoukis
- Department of Cardiology, Larnaca General Hospital, Larnaca 6301, Cyprus;
- Medical School, University of Nicosia, Nicosia 2408, Cyprus
| | - Sebastian Garcia-Zamora
- Cardiac Intensive Care Unit, Department of Cardiology, Delta Clinic, Rosario S2000, Argentina;
| | - Shaoying Zeng
- Department of Pediatric Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China;
| | - Ziliang Chen
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China;
| | - Yunlong Xia
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian 116014, China;
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China;
| | - Gary Tse
- Cardiac Electrophysiology Unit, Cardiovascular Analytics Group, China-UK Collaboration, Hong Kong, China; (J.L.); (S.L.); (I.L.)
- Faculty of Health and Medical Sciences, University of Surrey, Guildford GU2 7XH, UK;
- Kent and Medway Medical School, Canterbury CT2 7FS, UK; (D.R.); (E.C.-Y.)
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China;
- Department of Cardiology, First Affiliated Hospital of Dalian Medical University, Dalian 116014, China;
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Wilde AAM, Semsarian C, Márquez MF, Sepehri Shamloo A, Ackerman MJ, Ashley EA, Sternick EB, Barajas-Martinez H, Behr ER, Bezzina CR, Breckpot J, Charron P, Chockalingam P, Crotti L, Gollob MH, Lubitz S, Makita N, Ohno S, Ortiz-Genga M, Sacilotto L, Schulze-Bahr E, Shimizu W, Sotoodehnia N, Tadros R, Ware JS, Winlaw DS, Kaufman ES, Aiba T, Bollmann A, Choi JI, Dalal A, Darrieux F, Giudicessi J, Guerchicoff M, Hong K, Krahn AD, MacIntyre C, Mackall JA, Mont L, Napolitano C, Ochoa JP, Peichl P, Pereira AC, Schwartz PJ, Skinner J, Stellbrink C, Tfelt-Hansen J, Deneke T. European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) Expert Consensus Statement on the State of Genetic Testing for Cardiac Diseases. Heart Rhythm 2022; 19:e1-e60. [PMID: 35390533 DOI: 10.1016/j.hrthm.2022.03.1225] [Citation(s) in RCA: 72] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 03/25/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Arthur A M Wilde
- Heart Centre, Department of Cardiology, Amsterdam Universitair Medische Centra, Amsterdam, location AMC, The Netherlands.
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, University of Sydney, Sydney, Australia.
| | - Manlio F Márquez
- Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, Mexico; and Member of the Latin American Heart Rhythm Society (LAHRS).
| | | | - Michael J Ackerman
- Departments of Cardiovascular Medicine, Pediatric and Adolescent Medicine, and Molecular Pharmacology & Experimental Therapeutics; Divisions of Heart Rhythm Services and Pediatric Cardiology; Windland Smith Rice Genetic Heart Rhythm Clinic and Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Euan A Ashley
- Department of Cardiovascular Medicine, Stanford University, Stanford, CA, USA
| | - Eduardo Back Sternick
- Arrhythmia and Electrophysiology Unit, Biocor Institute, Minas Gerais, Brazil; and Member of the Latin American Heart Rhythm Society (LAHRS)
| | | | - Elijah R Behr
- Cardiovascular Clinical Academic Group, Institute of Molecular and Clinical Sciences, St. George's, University of London; St. George's University Hospitals NHS Foundation Trust, London, UK; Mayo Clinic Healthcare, London
| | - Connie R Bezzina
- Amsterdam UMC Heart Center, Department of Experimental Cardiology, Amsterdam, The Netherlands
| | - Jeroen Breckpot
- Center for Human Genetics, University Hospitals Leuven, Leuven, Belgium
| | - Philippe Charron
- Sorbonne Université, APHP, Centre de Référence des Maladies Cardiaques Héréditaires, ICAN, Inserm UMR1166, Hôpital Pitié-Salpêtrière, Paris, France
| | | | - Lia Crotti
- Center for Cardiac Arrhythmias of Genetic Origin, Istituto Auxologico Italiano, IRCCS, Milan, Italy; Cardiomyopathy Unit and Cardiac Rehabilitation Unit, San Luca Hospital, Istituto Auxologico Italiano, IRCCS, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Michael H Gollob
- Inherited Arrhythmia and Cardiomyopathy Program, Division of Cardiology, University of Toronto, Toronto, ON, Canada
| | - Steven Lubitz
- Cardiac Arrhythmia Service, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Naomasa Makita
- National Cerebral and Cardiovascular Center, Research Institute, Suita, Japan
| | - Seiko Ohno
- Department of Bioscience and Genetics, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Martín Ortiz-Genga
- Clinical Department, Health in Code, A Coruña, Spain; and Member of the Latin American Heart Rhythm Society (LAHRS)
| | - Luciana Sacilotto
- Arrhythmia Unit, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil; and Member of the Latin American Heart Rhythm Society (LAHRS)
| | - Eric Schulze-Bahr
- Institute for Genetics of Heart Diseases, University Hospital Münster, Münster, Germany
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School, Bunkyo-ku, Tokyo, Japan
| | - Nona Sotoodehnia
- Cardiovascular Health Research Unit, Division of Cardiology, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Rafik Tadros
- Cardiovascular Genetics Center, Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, Canada
| | - James S Ware
- National Heart and Lung Institute and MRC London Institute of Medical Sciences, Imperial College London, London, UK; Royal Brompton & Harefield Hospitals, Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - David S Winlaw
- Cincinnati Children's Hospital Medical Centre, University of Cincinnati, Cincinnati, OH, USA
| | - Elizabeth S Kaufman
- Metrohealth Medical Center, Case Western Reserve University, Cleveland, OH, USA.
| | - Takeshi Aiba
- Department of Clinical Laboratory Medicine and Genetics, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany; Leipzig Heart Institute, Leipzig Heart Digital, Leipzig, Germany
| | - Jong-Il Choi
- Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Aarti Dalal
- Department of Pediatrics, Division of Cardiology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Francisco Darrieux
- Arrhythmia Unit, Instituto do Coração, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - John Giudicessi
- Department of Cardiovascular Medicine (Divisions of Heart Rhythm Services and Circulatory Failure and the Windland Smith Rice Genetic Heart Rhythm Clinic), Mayo Clinic, Rochester, MN, USA
| | - Mariana Guerchicoff
- Division of Pediatric Arrhythmia and Electrophysiology, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Kui Hong
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Andrew D Krahn
- Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Ciorsti MacIntyre
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Windland Smith Rice Genetic Heart Rhythm Clinic, Mayo Clinic, Rochester, MN, USA
| | - Judith A Mackall
- Center for Cardiac Electrophysiology and Pacing, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Lluís Mont
- Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigacion Biomedica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Carlo Napolitano
- Molecular Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Juan Pablo Ochoa
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Heart Failure and Inherited Cardiac Diseases Unit, Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain; Centro de Investigacion Biomedica en Red en Enfermedades Cariovasculares (CIBERCV), Madrid, Spain
| | - Petr Peichl
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Alexandre C Pereira
- Laboratory of Genetics and Molecular Cardiology, Heart Institute, University of São Paulo Medical School, São Paulo 05403-000, Brazil; Hipercol Brasil Program, São Paulo, Brazil
| | - Peter J Schwartz
- Center for Cardiac Arrhythmias of Genetic Origin, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Jon Skinner
- Sydney Childrens Hospital Network, University of Sydney, Sydney, Australia
| | - Christoph Stellbrink
- Department of Cardiology and Intensive Care Medicine, University Hospital Campus Klinikum Bielefeld, Bielefeld, Germany
| | - Jacob Tfelt-Hansen
- The Department of Cardiology, the Heart Centre, Copenhagen University Hospital, Rigshopitalet, Copenhagen, Denmark; Section of Genetics, Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Denmark
| | - Thomas Deneke
- Heart Center Bad Neustadt, Bad Neustadt a.d. Saale, Germany
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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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Martínez-Barrios E, Arbelo E, Cesar S, Cruzalegui J, Fiol V, Díez-Escuté N, Hernández C, Brugada R, Brugada J, Campuzano O, Sarquella-Brugada G. Brugada Syndrome in Women: What Do We Know After 30 Years? Front Cardiovasc Med 2022; 9:874992. [PMID: 35479286 PMCID: PMC9035527 DOI: 10.3389/fcvm.2022.874992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 03/17/2022] [Indexed: 11/17/2022] Open
Abstract
Brugada syndrome (BrS) was initially described in 1992 by Josep and Pedro Brugada as an arrhythmogenic disease characterized by ST segment elevation in the right precordial leads and increased risk of sudden cardiac death (SCD). Alterations in the SCN5A gene are responsible for approximately 30% of cases of BrS, following an autosomal dominant pattern of inheritance. However, despite its autosomal transmission, sex-related differences are widely accepted. BrS is more prevalent in males than in females (8–10 times), with males having a 5.5-fold higher risk of SCD. There are also differences in clinical presentation, with females being more frequently asymptomatic and older than males at the time of diagnosis. Some factors have been identified that could explain these differences, among which testosterone seems to play an important role. However, only 30% of the available publications on the syndrome include sex-related information. Therefore, current findings on BrS are based on studies conducted mainly in male population, despite the wide acceptance of gender differences. The inclusion of complete clinical and demographic information in future publications would allow a better understanding of the phenotypic variability of BrS in different age and sex groups helping to improve the diagnosis, management and risk management of SCD.
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Affiliation(s)
- Estefanía Martínez-Barrios
- Arrhythmia, Inherited Cardiac Diseases and Sudden Death Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Elena Arbelo
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Institut d’Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Sergi Cesar
- Arrhythmia, Inherited Cardiac Diseases and Sudden Death Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - José Cruzalegui
- Arrhythmia, Inherited Cardiac Diseases and Sudden Death Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Victoria Fiol
- Arrhythmia, Inherited Cardiac Diseases and Sudden Death Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Nuria Díez-Escuté
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Clara Hernández
- Arrhythmia, Inherited Cardiac Diseases and Sudden Death Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
| | - Ramon Brugada
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Medical Science Department, School of Medicine, University of Girona, Girona, Spain
- Cardiovascular Genetics Center, University of Girona-Institut d’Investigacions Biomèdiques de Girona (IDIBGI), Girona, Spain
- Cardiology Service, Hospital Josep Trueta, University of Girona, Girona, Spain
| | - Josep Brugada
- Arrhythmia, Inherited Cardiac Diseases and Sudden Death Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Institut d’Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Oscar Campuzano
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Medical Science Department, School of Medicine, University of Girona, Girona, Spain
- Cardiovascular Genetics Center, University of Girona-Institut d’Investigacions Biomèdiques de Girona (IDIBGI), Girona, Spain
- Oscar Campuzano,
| | - Georgia Sarquella-Brugada
- Arrhythmia, Inherited Cardiac Diseases and Sudden Death Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain
- Medical Science Department, School of Medicine, University of Girona, Girona, Spain
- *Correspondence: Georgia Sarquella-Brugada,
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Crijns HJ, Sanders P, Albert CM, Lambiase PD. The year in cardiovascular medicine 2021: arrhythmias. Eur Heart J 2022; 43:1191-1197. [PMID: 35137041 PMCID: PMC9313516 DOI: 10.1093/eurheartj/ehac007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 12/22/2021] [Accepted: 01/06/2022] [Indexed: 11/14/2022] Open
Affiliation(s)
- Harry J.G.M. Crijns
- Department of Cardiology and Cardiovascular Research Centre Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Prashantan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Christine M. Albert
- Department of Cardiology, Smidt Heart Institute, Cedars Sinai Medical Center (CMA), Los Angeles, CA, USA
| | - Pier D. Lambiase
- Department of Cardiology, University College London and Barts Heart Centre, London, UK
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Chung CT, Bazoukis G, Radford D, Coakley-Youngs E, Rajan R, Matusik PT, Liu T, Letsas K, Lee S, Tse G. Predictive risk models for forecasting arrhythmic outcomes in Brugada syndrome: A focused review. J Electrocardiol 2022; 72:28-34. [PMID: 35287003 DOI: 10.1016/j.jelectrocard.2022.02.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/19/2022] [Accepted: 02/20/2022] [Indexed: 12/20/2022]
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SCN5A mutation in Brugada syndrome is associated with substrate severity detected by ECG imaging and high density electroanatomical mapping. Heart Rhythm 2022; 19:945-951. [DOI: 10.1016/j.hrthm.2022.01.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/25/2022] [Accepted: 01/28/2022] [Indexed: 11/16/2022]
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Monasky MM, Micaglio E, D'Imperio S, Pappone C. The Mechanism of Ajmaline and Thus Brugada Syndrome: Not Only the Sodium Channel! Front Cardiovasc Med 2022; 8:782596. [PMID: 35004896 PMCID: PMC8733296 DOI: 10.3389/fcvm.2021.782596] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/29/2021] [Indexed: 12/12/2022] Open
Abstract
Ajmaline is an anti-arrhythmic drug that is used to unmask the type-1 Brugada syndrome (BrS) electrocardiogram pattern to diagnose the syndrome. Thus, the disease is defined at its core as a particular response to this or other drugs. Ajmaline is usually described as a sodium-channel blocker, and most research into the mechanism of BrS has centered around this idea that the sodium channel is somehow impaired in BrS, and thus the genetics research has placed much emphasis on sodium channel gene mutations, especially the gene SCN5A, to the point that it has even been suggested that only the SCN5A gene should be screened in BrS patients. However, pathogenic rare variants in SCN5A are identified in only 20–30% of cases, and recent data indicates that SCN5A variants are actually, in many cases, prognostic rather than diagnostic, resulting in a more severe phenotype. Furthermore, the misconception by some that ajmaline only influences the sodium current is flawed, in that ajmaline actually acts additionally on potassium and calcium currents, as well as mitochondria and metabolic pathways. Clinical studies have implicated several candidate genes in BrS, encoding not only for sodium, potassium, and calcium channel proteins, but also for signaling-related, scaffolding-related, sarcomeric, and mitochondrial proteins. Thus, these proteins, as well as any proteins that act upon them, could prove absolutely relevant in the mechanism of BrS.
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Affiliation(s)
- Michelle M Monasky
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Emanuele Micaglio
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Sara D'Imperio
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Carlo Pappone
- Arrhythmology Department, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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Cadrin-Tourigny J, Tadros R. Predicting sudden cardiac death in genetic heart disease. Can J Cardiol 2022; 38:479-490. [DOI: 10.1016/j.cjca.2022.01.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 01/24/2022] [Accepted: 01/24/2022] [Indexed: 12/19/2022] Open
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Cheng J, Wei W, Fang Y, Zhou N, Wu Q, Zhao Q. Sudden cardiac death and cardiac sodium channel diseases. JOURNAL OF FORENSIC SCIENCE AND MEDICINE 2022. [DOI: 10.4103/jfsm.jfsm_123_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
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D'Imperio S, Monasky MM, Micaglio E, Ciconte G, Anastasia L, Pappone C. Brugada Syndrome: Warning of a Systemic Condition? Front Cardiovasc Med 2021; 8:771349. [PMID: 34722688 PMCID: PMC8553994 DOI: 10.3389/fcvm.2021.771349] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 09/23/2021] [Indexed: 12/19/2022] Open
Abstract
Brugada syndrome (BrS) is a hereditary disorder, characterized by a specific electrocardiogram pattern and highly related to an increased risk of sudden cardiac death. BrS has been associated with other cardiac and non-cardiac pathologies, probably because of protein expression shared by the heart and other tissue types. In fact, the most commonly found mutated gene in BrS, SCN5A, is expressed throughout nearly the entire body. Consistent with this, large meals and alcohol consumption can trigger arrhythmic events in patients with BrS, suggesting a role for organs involved in the digestive and metabolic pathways. Ajmaline, a drug used to diagnose BrS, can have side effects on non-cardiac tissues, such as the liver, further supporting the idea of a role for organs involved in the digestive and metabolic pathways in BrS. The BrS electrocardiogram (ECG) sign has been associated with neural, digestive, and metabolic pathways, and potential biomarkers for BrS have been found in the serum or plasma. Here, we review the known associations between BrS and various organ systems, and demonstrate support for the hypothesis that BrS is not only a cardiac disorder, but rather a systemic one that affects virtually the whole body. Any time that the BrS ECG sign is found, it should be considered not a single disease, but rather the final step in any number of pathways that ultimately threaten the patient's life. A multi-omics approach would be appropriate to study this syndrome, including genetics, epigenomics, transcriptomics, proteomics, metabolomics, lipidomics, and glycomics, resulting eventually in a biomarker for BrS and the ability to diagnose this syndrome using a minimally invasive blood test, avoiding the risk associated with ajmaline testing.
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Affiliation(s)
- Sara D'Imperio
- Arrhythmology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Donato, Milan, Italy
| | - Michelle M Monasky
- Arrhythmology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Donato, Milan, Italy
| | - Emanuele Micaglio
- Arrhythmology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Donato, Milan, Italy
| | - Giuseppe Ciconte
- Arrhythmology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Donato, Milan, Italy
| | - Luigi Anastasia
- Faculty of Medicine and Surgery, University of Vita-Salute San Raffaele, Milan, Italy
| | - Carlo Pappone
- Arrhythmology Department, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Donato, Milan, Italy.,Faculty of Medicine and Surgery, University of Vita-Salute San Raffaele, Milan, Italy
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Pappone C, Santinelli V, Mecarocci V, Tondi L, Ciconte G, Manguso F, Sturla F, Vicedomini G, Micaglio E, Anastasia L, Pica S, Camporeale A, Lombardi M. Brugada Syndrome: New Insights From Cardiac Magnetic Resonance and Electroanatomical Imaging. Circ Arrhythm Electrophysiol 2021; 14:e010004. [PMID: 34693720 DOI: 10.1161/circep.121.010004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Brugada syndrome (BrS) is considered a purely electrical disease with variable electrical substrates. Variable rates of mechanical abnormalities have been also reported. Whether exists a link between electrical and mechanical abnormalities has never been previously explored. This investigational physiopathological study aimed to determine the relationship between the substrate size/location, as exposed by ajmaline provocation, and the severity of mechanical abnormalities, as assessed by cardiac magnetic resonance in patients with BrS. METHODS Twenty-four consecutive high-risk patients with BrS (mean age, 38±11 years, 17 males), presenting with malignant syncope and documented polymorphic ventricular tachycardia/ventricular fibrillation, and candidate to implantable cardioverter defibrillator implantation, underwent cardiac magnetic resonance and electroanatomic maps. During each examination, ajmaline test (1 mg/kg over 5 minutes) was performed. Cardiac magnetic resonance findings were compared with 24 age, sex, and body surface area-matched controls. In patients with BrS, the correlation between the electrical substrate extent and right ventricular regional mechanical abnormalities before/after ajmaline challenge was analyzed. RESULTS After ajmaline, patients with BrS showed a reduction of right ventricular (RV) ejection fraction (P<0.001), associated with decreased transversal displacement (U, P<0.001) and longitudinal strain (ε, P<0.001) localized at RV outflow tract. In patients with BrS significant preajmaline/postajmaline changes of transversal displacement (ΔU, P<0.001) and longitudinal strain (Δε, P<0.001) were found. In the control group, no mechanical changes were observed after ajmaline. The electrical substrate consistently increased after ajmaline from 1.7±2.8 cm2 to 14.2±7.3 cm2 (P<0.001), extending from the RV outflow tract to the neighboring segments of the RV anterior wall. Postajmaline RV ejection fraction inversely correlated with postajmaline substrate extent (r=-0.830, P<0.001). In patients with BrS and normal controls, cardiac magnetic resonance detected neither myocardial fibrosis nor RV outflow tract morphological abnormalities. CONCLUSIONS BrS is a dynamic RV electromechanical disease, where functional abnormalities correlate with the maximal extent of the substrate size. These findings open new lights on the physiopathology of the disease. Registration: URL: https://clinicaltrial.gov; Unique identifier: NCT03524079.
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Affiliation(s)
- Carlo Pappone
- Arrhythmology Department (C.P., V.S., V.M., G.C., F.M., G.V., E.M., L.A.), IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Vincenzo Santinelli
- Arrhythmology Department (C.P., V.S., V.M., G.C., F.M., G.V., E.M., L.A.), IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Valerio Mecarocci
- Arrhythmology Department (C.P., V.S., V.M., G.C., F.M., G.V., E.M., L.A.), IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Lara Tondi
- Multimodality Cardiac Imaging Section (L.T., S.P., A.C., M.L.), IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Giuseppe Ciconte
- Arrhythmology Department (C.P., V.S., V.M., G.C., F.M., G.V., E.M., L.A.), IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Francesco Manguso
- Arrhythmology Department (C.P., V.S., V.M., G.C., F.M., G.V., E.M., L.A.), IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Francesco Sturla
- Computer Simulation Laboratory (F.S.), IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Gabriele Vicedomini
- Arrhythmology Department (C.P., V.S., V.M., G.C., F.M., G.V., E.M., L.A.), IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Emanuele Micaglio
- Arrhythmology Department (C.P., V.S., V.M., G.C., F.M., G.V., E.M., L.A.), IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Luigi Anastasia
- Arrhythmology Department (C.P., V.S., V.M., G.C., F.M., G.V., E.M., L.A.), IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Silvia Pica
- Multimodality Cardiac Imaging Section (L.T., S.P., A.C., M.L.), IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Antonia Camporeale
- Multimodality Cardiac Imaging Section (L.T., S.P., A.C., M.L.), IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Massimo Lombardi
- Multimodality Cardiac Imaging Section (L.T., S.P., A.C., M.L.), IRCCS Policlinico San Donato, San Donato Milanese, Italy
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48
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Pappone C, Negro G, Ciconte G. Ventricular fibrillation ablation in cardiomyopathies and arrhythmic storm. Eur Heart J Suppl 2021; 23:E112-E117. [PMID: 34650368 PMCID: PMC8503529 DOI: 10.1093/eurheartj/suab104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Sudden cardiac death (SCD) is a relevant contributor to cardiovascular mortality, often occurring as a dramatic event. It can be the consequence of a ventricular tachycardia/fibrillation (VT/VF), a common and life-threatening arrhythmia. The underlying mechanisms of this catastrophic arrhythmia are poorly known. In fact, it can occur in the presence of a structural heart condition which itself generates the suitable substrate for this arrhythmia. Nevertheless, a VF may cause SCD also in young and otherwise healthy individuals, without overt structural abnormalities, generating difficulties in the screening and prevention of these patients. The implantable cardioverter-defibrillator represents the only therapy to contrast SCD by treating a VT/VF; however, it cannot prevent the occurrence of such arrhythmias. Catheter ablation is emerging as an essential therapeutic tool in the management of patients experiencing ventricular arrhythmias.
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Affiliation(s)
- Carlo Pappone
- Vita-Salute San Raffaele University, Piazza Malan 2, 20097 Milano, Italy.,Arrhythmia and Electrophysiology Center, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Gabriele Negro
- Arrhythmia and Electrophysiology Center, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
| | - Giuseppe Ciconte
- Arrhythmia and Electrophysiology Center, IRCCS Policlinico San Donato, San Donato Milanese, Milano, Italy
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49
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Sigmundsson F, Kuchalik J, Fadl S, Holy M, Joelson A. The unique challenges of Brugada syndrome in spinal deformity surgery. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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50
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Wilde AAM, Wu CI. Does function trump bioinformatics in Brugada syndrome-associated SCN5A mutation calling? Patients, computers, and patches. Eur Heart J 2021; 42:2864-2865. [PMID: 34333601 PMCID: PMC8325777 DOI: 10.1093/eurheartj/ehab292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Arthur A M Wilde
- Amsterdam UMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Cheng-I Wu
- Amsterdam UMC, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.,Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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