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Stokke MK, Bébarová M. Lessons on the non-linear path of medical progress and biological complexity from mouse models of the Brugada syndrome. Europace 2024; 26:euae152. [PMID: 38874401 PMCID: PMC11203871 DOI: 10.1093/europace/euae152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 05/31/2024] [Indexed: 06/15/2024] Open
Affiliation(s)
- Mathis Korseberg Stokke
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, PB 4956 Nydalen, NO-0424 Oslo, Norway
| | - Markéta Bébarová
- Department of Physiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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2
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Lynge TH, Albert CM, Basso C, Garcia R, Krahn AD, Semsarian C, Sheppard MN, Behr ER, Tfelt-Hansen J. Autopsy of all young sudden death cases is important to increase survival in family members left behind. Europace 2024; 26:euae128. [PMID: 38715537 PMCID: PMC11164113 DOI: 10.1093/europace/euae128] [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: 12/05/2023] [Accepted: 04/29/2024] [Indexed: 06/11/2024] Open
Abstract
Sudden cardiac death (SCD) is an important public health problem worldwide, accounting for an estimated 6-20% of total mortality. A significant proportion of SCD is caused by inherited heart disease, especially among the young. An autopsy is crucial to establish a diagnosis of inherited heart disease, allowing for subsequent identification of family members who require cardiac evaluation. Autopsy of cases of unexplained sudden death in the young is recommended by both the European Society of Cardiology and the American Heart Association. Overall autopsy rates, however, have been declining in many countries across the globe, and there is a lack of skilled trained pathologists able to carry out full autopsies. Recent studies show that not all cases of sudden death in the young are autopsied, likely due to financial, administrative, and organizational limitations as well as awareness among police, legal authorities, and physicians. Consequently, diagnoses of inherited heart disease are likely missed, along with the opportunity for treatment and prevention among surviving relatives. This article reviews the evidence for the role of autopsy in sudden death, how the cardiologist should interpret the autopsy-record, and how this can be integrated and implemented in clinical practice. Finally, we identify areas for future research along with potential for healthcare reform aimed at increasing autopsy awareness and ultimately reducing mortality from SCD.
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Affiliation(s)
- Thomas H Lynge
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christine M Albert
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Cristina Basso
- The Cardiovascular Pathology Unit, Azienda Ospedaliera, Department of Cardiac, Thoracic, and Vascular Sciences and Public Health, University of Padua, Via Aristide Gabelli, 61, 35121 Padova PD, Italy
| | - Rodrigue Garcia
- Department of Cardiology, Poitiers University Hospital, Poitiers, France
| | - Andrew D Krahn
- Center for Cardiovascular Innovation, Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, The University of Sydney, Sydney, Australia
| | - Mary N Sheppard
- Cardiovascular Pathology Unit, Cardiovascular and Genetics Research Institute, St George’s, University of London, St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Elijah R Behr
- Cardiovascular Clinical Academic Group, Cardiovascular and Genetics Research Institute, St George’s University of London and St George’s University Hospitals NHS Foundation Trust, London, UK
| | - Jacob Tfelt-Hansen
- The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- The Department of Forensic Medicine, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Marchal GA, Rivaud MR, Wolswinkel R, Basso C, van Veen TAB, Bezzina CR, Remme CA. Genetic background determines the severity of age-dependent cardiac structural abnormalities and arrhythmia susceptibility in Scn5a-1798insD mice. Europace 2024; 26:euae153. [PMID: 38875491 PMCID: PMC11203918 DOI: 10.1093/europace/euae153] [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: 02/09/2024] [Accepted: 05/12/2024] [Indexed: 06/16/2024] Open
Abstract
AIMS Patients with mutations in SCN5A encoding NaV1.5 often display variable severity of electrical and structural alterations, but the underlying mechanisms are not fully elucidated. We here investigate the combined modulatory effect of genetic background and age on disease severity in the Scn5a1798insD/+ mouse model. METHODS AND RESULTS In vivo electrocardiogram and echocardiograms, ex vivo electrical and optical mapping, and histological analyses were performed in adult (2-7 months) and aged (8-28 months) wild-type (WT) and Scn5a1798insD/+ (mutant, MUT) mice from the FVB/N and 129P2 inbred strains. Atrio-ventricular (AV) conduction, ventricular conduction, and ventricular repolarization are modulated by strain, genotype, and age. An aging effect was present in MUT mice, with aged MUT mice of both strains showing prolonged QRS interval and right ventricular (RV) conduction slowing. 129P2-MUT mice were severely affected, with adult and aged 129P2-MUT mice displaying AV and ventricular conduction slowing, prolonged repolarization, and spontaneous arrhythmias. In addition, the 129P2 strain appeared particularly susceptible to age-dependent electrical, functional, and structural alterations including RV conduction slowing, reduced left ventricular (LV) ejection fraction, RV dilatation, and myocardial fibrosis as compared to FVB/N mice. Overall, aged 129P2-MUT mice displayed the most severe conduction defects, RV dilatation, and myocardial fibrosis, in addition to the highest frequency of spontaneous arrhythmia and inducible arrhythmias. CONCLUSION Genetic background and age both modulate disease severity in Scn5a1798insD/+ mice and hence may explain, at least in part, the variable disease expressivity observed in patients with SCN5A mutations. Age- and genetic background-dependent development of cardiac structural alterations furthermore impacts arrhythmia risk. Our findings therefore emphasize the importance of continued assessment of cardiac structure and function in patients carrying SCN5A mutations.
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Affiliation(s)
- Gerard A Marchal
- Department of Experimental Cardiology, Heart Centre, Amsterdam UMC location University of Amsterdam, Meibergdreef 15, PO Box 22660, 1100 DD Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, Meibergdreef 15, PO Box 22660, 1100 DD Amsterdam, The Netherlands
- OptoCARD Lab, Institute of Clinical Physiology (IFC-CNR), Florence, Italy
| | - Mathilde R Rivaud
- Department of Experimental Cardiology, Heart Centre, Amsterdam UMC location University of Amsterdam, Meibergdreef 15, PO Box 22660, 1100 DD Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, Meibergdreef 15, PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Rianne Wolswinkel
- Department of Experimental Cardiology, Heart Centre, Amsterdam UMC location University of Amsterdam, Meibergdreef 15, PO Box 22660, 1100 DD Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, Meibergdreef 15, PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Cristina Basso
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Padua, Italy
| | - Toon A B van Veen
- Department of Medical Physiology, Division Heart & Lungs, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Connie R Bezzina
- Department of Experimental Cardiology, Heart Centre, Amsterdam UMC location University of Amsterdam, Meibergdreef 15, PO Box 22660, 1100 DD Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, Meibergdreef 15, PO Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Carol Ann Remme
- Department of Experimental Cardiology, Heart Centre, Amsterdam UMC location University of Amsterdam, Meibergdreef 15, PO Box 22660, 1100 DD Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, Meibergdreef 15, PO Box 22660, 1100 DD Amsterdam, The Netherlands
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Morgat C, Fressart V, Porretta AP, Neyroud N, Messali A, Temmar Y, Algalarrondo V, Surget E, Bloch A, Leenhardt A, Denjoy I, Extramiana F. Genetic characterization of KCNQ1 variants improves risk stratification in type 1 long QT syndrome patients. Europace 2024; 26:euae136. [PMID: 38825991 PMCID: PMC11203906 DOI: 10.1093/europace/euae136] [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: 03/05/2024] [Accepted: 05/21/2024] [Indexed: 06/04/2024] Open
Abstract
AIMS KCNQ1 mutations cause QTc prolongation increasing life-threatening arrhythmias risks. Heterozygous mutations [type 1 long QT syndrome (LQT1)] are common. Homozygous KCNQ1 mutations cause type 1 Jervell and Lange-Nielsen syndrome (JLNS) with deafness and higher sudden cardiac death risk. KCNQ1 variants causing JLNS or LQT1 might have distinct phenotypic expressions in heterozygous patients. The aim of this study is to evaluate QTc duration and incidence of long QT syndrome-related cardiac events according to genetic presentation. METHODS AND RESULTS We enrolled LQT1 or JLNS patients with class IV/V KCNQ1 variants from our inherited arrhythmia clinic (September 1993 to January 2023). Medical history, ECG, and follow-up were collected. Additionally, we conducted a thorough literature review for JLNS variants. Survival curves were compared between groups, and multivariate Cox regression models identified genetic and clinical risk factors. Among the 789 KCNQ1 variant carriers, 3 groups were identified: 30 JLNS, 161 heterozygous carriers of JLNS variants (HTZ-JLNS), and 550 LQT1 heterozygous carriers of non-JLNS variants (HTZ-Non-JLNS). At diagnosis, mean age was 3.4 ± 4.7 years for JLNS, 26.7 ± 21 years for HTZ-JLNS, and 26 ± 21 years for HTZ-non-JLNS; 55.3% were female; and the mean QTc was 551 ± 54 ms for JLNS, 441 ± 32 ms for HTZ-JLNS, and 467 ± 36 ms for HTZ-Non-JLNS. Patients with heterozygous JLNS mutations (HTZ-JLNS) represented 22% of heterozygous KCNQ1 variant carriers and had a lower risk of cardiac events than heterozygous non-JLNS variant carriers (HTZ-Non-JLNS) [hazard ratio (HR) = 0.34 (0.22-0.54); P < 0.01]. After multivariate analysis, four genetic parameters were independently associated with events: haploinsufficiency [HR = 0.60 (0.37-0.97); P = 0.04], pore localization [HR = 1.61 (1.14-1.2.26); P < 0.01], C-terminal localization [HR = 0.67 (0.46-0.98); P = 0.04], and group [HR = 0.43 (0.27-0.69); P < 0.01]. CONCLUSION Heterozygous carriers of JLNS variants have a lower risk of cardiac arrhythmic events than other LQT1 patients.
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Affiliation(s)
- Charles Morgat
- CNMR Maladies Cardiaques Héréditaires Rares, APHP, Hôpital Bichat, 46 rue Henri Huchard, 75018 Paris, France
| | - Véronique Fressart
- AP-HP, Service de Biochimie Métabolique, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Alessandra Pia Porretta
- CNMR Maladies Cardiaques Héréditaires Rares, APHP, Hôpital Bichat, 46 rue Henri Huchard, 75018 Paris, France
- Service of Cardiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Nathalie Neyroud
- Sorbonne Université, Inserm, Research Unit on Cardiovascular and Metabolic Diseases, UMRS-1166, Paris, France
| | - Anne Messali
- CNMR Maladies Cardiaques Héréditaires Rares, APHP, Hôpital Bichat, 46 rue Henri Huchard, 75018 Paris, France
| | - Yassine Temmar
- AP-HP, Unité Rythmologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Vincent Algalarrondo
- CNMR Maladies Cardiaques Héréditaires Rares, APHP, Hôpital Bichat, 46 rue Henri Huchard, 75018 Paris, France
| | - Elodie Surget
- CNMR Maladies Cardiaques Héréditaires Rares, APHP, Hôpital Bichat, 46 rue Henri Huchard, 75018 Paris, France
| | - Adrien Bloch
- AP-HP, Service de Biochimie Métabolique, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
| | - Antoine Leenhardt
- CNMR Maladies Cardiaques Héréditaires Rares, APHP, Hôpital Bichat, 46 rue Henri Huchard, 75018 Paris, France
| | - Isabelle Denjoy
- CNMR Maladies Cardiaques Héréditaires Rares, APHP, Hôpital Bichat, 46 rue Henri Huchard, 75018 Paris, France
| | - Fabrice Extramiana
- CNMR Maladies Cardiaques Héréditaires Rares, APHP, Hôpital Bichat, 46 rue Henri Huchard, 75018 Paris, France
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Leung HT, Kwok SY, Kwong KY, Shih FY, Tsao S, Chung BHY. Prioritize Variant Reclassification in Pediatric Long QT Syndrome-Time to Revisit. Pediatr Cardiol 2024; 45:1023-1035. [PMID: 38565666 DOI: 10.1007/s00246-024-03461-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/26/2024] [Indexed: 04/04/2024]
Abstract
Congenital long QT syndrome (LQTS) is an inherited arrhythmia syndrome associated with sudden cardiac death. Accurate interpretation and classification of genetic variants in LQTS patients are crucial for effective management. All patients with LQTS with a positive genetic test over the past 18 years (2002-2020) in our single tertiary pediatric cardiac center were identified. Reevaluation of the reported variants in LQTS genes was conducted using the American College of Genetics and Genomics (ACMG) guideline after refinement by the US ClinGen SVI working group and guideline by Walsh et al. on genetic variant reclassification, under multidisciplinary input. Among the 59 variants identified. 18 variants (30.5%) were reclassified. A significant larger portion of variants of unknown significance (VUS) were reclassified compared to likely pathogenic (LP)/pathogenic (P) variants (57.7% vs 9.1%, p < 0.001). The rate of reclassification was significantly higher in the limited/disputed evidence group compared to the definite/moderate evidence group (p = 0.0006). All LP/P variants were downgraded in the limited/disputed evidence group (p = 0.0057). VUS upgrades are associated with VUS located in genes within the definite/moderate evidence group (p = 0.0403) and with VUS present in patients exhibiting higher corrected QT intervals (QTc) (p = 0.0445). A significant number of pediatric LQTS variants were reclassified, particularly for VUS. The strength of the gene-disease association of the genes influences the reclassification performance. The study provides important insights and guidance for pediatricians to seek for reclassification of "outdated variants" in order to facilitate contemporary precision medicine.
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Affiliation(s)
- Hei-To Leung
- Department of Paediatrics & Adolescent Medicine, Hong Kong Children's Hospital, 1 Shing Cheong Rd, Ngau Tau Kok, Hong Kong SAR, China
| | - Sit-Yee Kwok
- Department of Paediatrics & Adolescent Medicine, Hong Kong Children's Hospital, 1 Shing Cheong Rd, Ngau Tau Kok, Hong Kong SAR, China.
| | - Ka-Yee Kwong
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
| | - Fong-Ying Shih
- Clinical Genetics Service Unit, Hong Kong Children's Hospital, Kowloon Bay, Hong Kong SAR, China
| | - Sabrina Tsao
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
| | - Brian Hon-Yin Chung
- Department of Paediatrics and Adolescent Medicine, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China
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Scrocco C, Ben-Haim Y, Ensam B, Aldous R, Tome-Esteban M, Specterman M, Papadakis M, Sharma S, Behr ER. The role for ambulatory electrocardiogram monitoring in the diagnosis and prognostication of Brugada syndrome: a sub-study of the Rare Arrhythmia Syndrome Evaluation (RASE) Brugada study. Europace 2024; 26:euae091. [PMID: 38584469 DOI: 10.1093/europace/euae091] [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: 01/11/2024] [Accepted: 03/10/2024] [Indexed: 04/09/2024] Open
Abstract
AIMS Brugada syndrome (BrS) diagnosis and risk stratification rely on the presence of a spontaneous type 1 (spT1) electrocardiogram (ECG) pattern; however, its spontaneous fluctuations may lead to misdiagnosis and risk underestimation. This study aims to assess the role for repeat high precordial lead (HPL) resting and ambulatory ECG monitoring in identifying a spT1, and evaluate its prognostic role. METHODS AND RESULTS HPL resting and ambulatory monitoring ECGs of BrS subjects were reviewed retrospectively, and the presence of a spT1 associated with ventricular dysrhythmias and sudden cardiac death (SCD). Three-hundred and fifty-eight subjects (77 with spT1 pattern at presentation, Group 1, and 281 without, Group 2) were included. In total, 1651 resting HPL resting and 621 ambulatory monitoring ECGs were available for review, or adequately described. Over a median follow-up of 72 months (interquartile range - IQR - 75), 42/77 (55%) subjects in Group 1 showed a spT1 in at least one ECG. In Group 2, 36/281 subjects (13%) had a newly detected spT1 (1.9 per 100 person-year) and 23 on an HPL ambulatory recording (8%). Seven previously asymptomatic subjects, five of whom had a spT1 (four at presentation and one at follow-up), experienced arrhythmic events; survival analysis indicated that a spT1, either at presentation or during lifetime, was associated with events. Univariate models showed that a spT1 was consistently associated with increased risk [spT1 at presentation: hazard ratio (HR) 6.3, 95% confidence interval (CI) 1.4-28, P = 0.016; spT1 at follow-up: HR 3.1, 95% CI 1.3-7.2, P = 0.008]. CONCLUSION Repeated ECG evaluation and HPL ambulatory monitoring are vital in identifying transient spT1 Brugada pattern and its associated risk.
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Affiliation(s)
- Chiara Scrocco
- Cardiovascular Clinical Academic Group St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, Cranmer Terrace, London SW17 0RE, UK
| | - Yael Ben-Haim
- Cardiovascular Clinical Academic Group St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, Cranmer Terrace, London SW17 0RE, UK
| | - Bode Ensam
- Cardiovascular Clinical Academic Group St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, Cranmer Terrace, London SW17 0RE, UK
| | - Robert Aldous
- Cardiovascular Clinical Academic Group St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, Cranmer Terrace, London SW17 0RE, UK
| | - Maite Tome-Esteban
- Cardiovascular Clinical Academic Group St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, Cranmer Terrace, London SW17 0RE, UK
| | - Mark Specterman
- Cardiovascular Clinical Academic Group St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, Cranmer Terrace, London SW17 0RE, UK
| | - Michael Papadakis
- Cardiovascular Clinical Academic Group St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, Cranmer Terrace, London SW17 0RE, UK
| | - Sanjay Sharma
- Cardiovascular Clinical Academic Group St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, Cranmer Terrace, London SW17 0RE, UK
| | - Elijah R Behr
- Cardiovascular Clinical Academic Group St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, Cranmer Terrace, London SW17 0RE, UK
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Finocchiaro G, Radaelli D, Johnson D, Bhatia RT, Westaby J, D’Errico S, Papadakis M, Sharma S, Sheppard MN, Behr ER. Yield of molecular autopsy in sudden cardiac death in athletes: data from a large registry in the UK. Europace 2024; 26:euae029. [PMID: 38289717 PMCID: PMC10858643 DOI: 10.1093/europace/euae029] [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: 10/20/2023] [Accepted: 01/02/2024] [Indexed: 02/01/2024] Open
Abstract
AIMS Sudden cardiac death (SCD) may occur in apparently healthy individuals, including athletes. The aim was to investigate the diagnostic role of post-mortem genetic testing, molecular autopsy (MA), in elucidating the cause of SCD in athletes. METHODS AND RESULTS We reviewed a database of 6860 consecutive cases of SCD referred to our specialist cardiac pathology centre. All cases underwent detailed cardiac autopsy, and 748 were deemed to be athletes. Of these, 42 (6%) were investigated with MA (28 using a targeted sequencing, 14 exome sequencing). Variants were classified as pathogenic, likely pathogenic, or variant of unknown significance using international guidelines. Clinical information was obtained from referring coroners who completed a detailed health questionnaire. Out of the 42 decedents (average age 35 years old, 98% males) who were investigated with MA, the autopsy was in keeping with a structurally normal heart [sudden arrhythmic death syndrome (SADS)] in n = 33 (78%) cases, followed by arrhythmogenic cardiomyopathy (ACM) in eight (19%) individuals and idiopathic left ventricular fibrosis in one (2%). Death occurred during exercise and at rest in 26 (62%) and 16 (38%) individuals, respectively. Variants that were adjudicated clinically actionable were present in seven cases (17%). There was concordance between the genetic and phenotypic findings in two cases of ACM (in FLNC and TMEM43 genes). None of the variants identified in SADS cases were previously linked to channelopathies. Clinically actionable variants in cardiomyopathy-associated genes were found in five cases of SADS. CONCLUSION The yield of MA in athletes who died suddenly is 17%. In SADS cases, clinically actionable variants were found in cardiomyopathy-associated genes and not in channelopathy-associated genes. Arrhythmogenic cardiomyopathy is a common cause of SCD in athletes, and one in four decedents with this condition had a clinically actionable variant in FLNC and TMEM43 genes.
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Affiliation(s)
- Gherardo Finocchiaro
- Cardiovascular Clinical Academic Group and Cardiology Research Section, St George’s, University of London, St George’s University Hospitals NHS Foundation Trust, Cranmer Terrace, London SW17 0RE, UK
| | - Davide Radaelli
- Cardiovascular Clinical Academic Group and Cardiology Research Section, St George’s, University of London, St George’s University Hospitals NHS Foundation Trust, Cranmer Terrace, London SW17 0RE, UK
- Department of Medicine, Surgery and Health, University of Trieste, Trieste, Italy
| | - David Johnson
- Cardiovascular Clinical Academic Group and Cardiology Research Section, St George’s, University of London, St George’s University Hospitals NHS Foundation Trust, Cranmer Terrace, London SW17 0RE, UK
| | - Raghav T Bhatia
- Cardiovascular Clinical Academic Group and Cardiology Research Section, St George’s, University of London, St George’s University Hospitals NHS Foundation Trust, Cranmer Terrace, London SW17 0RE, UK
| | - Joseph Westaby
- Cardiovascular Clinical Academic Group and Cardiology Research Section, St George’s, University of London, St George’s University Hospitals NHS Foundation Trust, Cranmer Terrace, London SW17 0RE, UK
| | - Stefano D’Errico
- Department of Medicine, Surgery and Health, University of Trieste, Trieste, Italy
| | - Michael Papadakis
- Cardiovascular Clinical Academic Group and Cardiology Research Section, St George’s, University of London, St George’s University Hospitals NHS Foundation Trust, Cranmer Terrace, London SW17 0RE, UK
| | - Sanjay Sharma
- Cardiovascular Clinical Academic Group and Cardiology Research Section, St George’s, University of London, St George’s University Hospitals NHS Foundation Trust, Cranmer Terrace, London SW17 0RE, UK
| | - Mary N Sheppard
- Cardiovascular Clinical Academic Group and Cardiology Research Section, St George’s, University of London, St George’s University Hospitals NHS Foundation Trust, Cranmer Terrace, London SW17 0RE, UK
| | - Elijah R Behr
- Cardiovascular Clinical Academic Group and Cardiology Research Section, St George’s, University of London, St George’s University Hospitals NHS Foundation Trust, Cranmer Terrace, London SW17 0RE, UK
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8
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Peltenburg PJ, van den Heuvel LM, Kallas D, Bell C, Denjoy I, Behr ER, Field E, Kammeraad JAE, Yap SC, Probst V, Ackerman MJ, Blom NA, Wilde AAM, Clur SAB, van der Werf C. Insights into adherence to medication and lifestyle recommendations in an international cohort of patients with catecholaminergic polymorphic ventricular tachycardia. Europace 2024; 26:euae044. [PMID: 38349347 PMCID: PMC10886442 DOI: 10.1093/europace/euae044] [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: 11/18/2023] [Accepted: 01/30/2024] [Indexed: 02/24/2024] Open
Abstract
AIMS In patients with catecholaminergic polymorphic ventricular tachycardia (CPVT), a rare inherited arrhythmia syndrome, arrhythmic events can be prevented by medication and lifestyle recommendations. In patients who experience breakthrough arrhythmic events, non-adherence plays an essential role. We aimed to investigate the incidence and potential reasons for non-adherence to medication and lifestyle recommendations in a large, international cohort of patients with CPVT. METHODS AND RESULTS An online multilingual survey was shared with CPVT patients worldwide by their cardiologists, through peer-recruitment, and on social media from November 2022 until July 2023. Self-reported non-adherence was measured using the validated Medication Adherence Rating Scale (MARS) and a newly developed questionnaire about lifestyle. Additionally, validated questionnaires were used to assess potential reasons for medication non-adherence. Two-hundred-and-eighteen patients completed the survey, of whom 200 (92%) were prescribed medication [122 (61%) female; median age 33.5 years (interquartile range: 22-50)]. One-hundred-and-three (52%) were prescribed beta-blocker and flecainide, 85 (43%) beta-blocker, and 11 (6%) flecainide. Thirty-four (17%) patients experienced a syncope, aborted cardiac arrest or appropriate implantable cardioverter defibrillator shock after diagnosis. Nineteen (13.4%) patients were exercising more than recommended. Thirty (15%) patients were non-adherent to medication. Female sex [odds ratio (OR) 3.7, 95% confidence interval (CI) 1.3-12.0, P = 0.019], flecainide monotherapy compared to combination therapy (OR 6.8, 95% CI 1.6-31.0, P = 0.010), and a higher agreement with statements regarding concerns about CPVT medication (OR 1.2, 95% CI 1.1-1.3, P < 0.001) were independently associated with non-adherence. CONCLUSION The significant rate of non-adherence associated with concerns regarding CPVT-related medication, emphasizes the potential for improving therapy adherence by targeted patient education.
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Affiliation(s)
- Puck J Peltenburg
- Deparment of Clinical and Exprimental Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Pediatric Cardiology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Lieke M van den Heuvel
- Department of Genetics, University Medical Centre Utrecht, Utrecht, The Netherlands
- Netherlands Heart Institute, Utrecht, the Netherlands
| | - Dania Kallas
- Department of Pediatrics, BC Children’s Hospital, University of British Columbia, Vancouver, Canada
| | - Cheyanne Bell
- Windland Smith Rice Sudden Death Genomics Laboratory, Division of Heart Rhythm Services and Pediatric Cardiology, Departments of Cardiovascular Medicine, Pediatric and Adolescent Medicine, and Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota, USA
| | - Isabelle Denjoy
- Service de Cardiologie et CNMR Maladies Cardiaques Héréditaires Rares, Hôpital Bichat APHP, Université de Paris, Paris, France
| | - Elijah R Behr
- Cardiovascular Clinical Academic Group and Cardiology Research Centre, Molecular and Clinical Sciences Research Institute, St. George’s, University of London, St. George’s University Hospitals NHS Foundation Trust, Cranmer Terrace, London, UK
| | - Ella Field
- Department of Pediatric Cardiology, Great Ormond Street Hospital, London, UK
| | | | - Sing-Chien Yap
- Department of Cardiology, Cardiovascular Institute, Erasmus MC, Rotterdam, The Netherlands
| | - Vincent Probst
- Service de cardiologie, Université de Nantes, CNRS, INSERM, l’institut du thorax, Nantes, France
| | - Michael J Ackerman
- Windland Smith Rice Sudden Death Genomics Laboratory, Division of Heart Rhythm Services and Pediatric Cardiology, Departments of Cardiovascular Medicine, Pediatric and Adolescent Medicine, and Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota, USA
| | - Nico A Blom
- Department of Pediatric Cardiology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Pediatric Cardiology, Willem-Alexander Children’s Hospital, Leiden University Medical Centre, Leiden, The Netherlands
| | - Arthur A M Wilde
- Deparment of Clinical and Exprimental Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Sally-Ann B Clur
- Department of Pediatric Cardiology, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Christian van der Werf
- Deparment of Clinical and Exprimental Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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9
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Auricchio A. Editorial. Europace 2023; 26:euae008. [PMID: 38207128 PMCID: PMC10803038 DOI: 10.1093/europace/euae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Indexed: 01/13/2024] Open
Affiliation(s)
- Angelo Auricchio
- Istituto Cardiocentro Ticino - Ente Ospedaliero Cantonale, Via Tesserete 48, 6900 Lugano, Switzerland
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10
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Conte G, Probst V. Time to consider catheter ablation as an alternative to implantable cardioverter-defibrillator therapy in high-risk patients with Brugada syndrome? Europace 2023; 25:euad338. [PMID: 37949829 PMCID: PMC10751804 DOI: 10.1093/europace/euad338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 11/12/2023] Open
Affiliation(s)
- Giulio Conte
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, Via Tesserete 48, Lugano CH-6900, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland (USI)
| | - Vincent Probst
- Service de Cardiologie, L'institut du thorax, CHU Nantes, Nantes, France
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11
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Kaizer AM, Winbo A, Clur SAB, Etheridge SP, Ackerman MJ, Horigome H, Herberg U, Dagradi F, Spazzolini C, Killen SAS, Wacker-Gussmann A, Wilde AAM, Sinkovskaya E, Abuhamad A, Torchio M, Ng CA, Rydberg A, Schwartz PJ, Cuneo BF. Effects of cohort, genotype, variant, and maternal β-blocker treatment on foetal heart rate predictors of inherited long QT syndrome. Europace 2023; 25:euad319. [PMID: 37975542 PMCID: PMC10655062 DOI: 10.1093/europace/euad319] [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: 08/03/2023] [Accepted: 10/16/2023] [Indexed: 11/19/2023] Open
Abstract
AIMS In long QT syndrome (LQTS), primary prevention improves outcome; thus, early identification is key. The most common LQTS phenotype is a foetal heart rate (FHR) < 3rd percentile for gestational age (GA) but the effects of cohort, genotype, variant, and maternal β-blocker therapy on FHR are unknown. We assessed the influence of these factors on FHR in pregnancies with familial LQTS and developed a FHR/GA threshold for LQTS. METHODS AND RESULTS In an international cohort of pregnancies in which one parent had LQTS, LQTS genotype, familial variant, and maternal β-blocker effects on FHR were assessed. We developed a testing algorithm for LQTS using FHR and GA as continuous predictors. Data included 1966 FHRs at 7-42 weeks' GA from 267 pregnancies/164 LQTS families [220 LQTS type 1 (LQT1), 35 LQTS type 2 (LQT2), and 12 LQTS type 3 (LQT3)]. The FHRs were significantly lower in LQT1 and LQT2 but not LQT3 or LQTS negative. The LQT1 variants with non-nonsense and severe function loss (current density or β-adrenergic response) had lower FHR. Maternal β-blockers potentiated bradycardia in LQT1 and LQT2 but did not affect FHR in LQTS negative. A FHR/GA threshold predicted LQT1 and LQT2 with 74.9% accuracy, 71% sensitivity, and 81% specificity. CONCLUSION Genotype, LQT1 variant, and maternal β-blocker therapy affect FHR. A predictive threshold of FHR/GA significantly improves the accuracy, sensitivity, and specificity for LQT1 and LQT2, above the infant's a priori 50% probability. We speculate this model may be useful in screening for LQTS in perinatal subjects without a known LQTS family history.
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Affiliation(s)
- Alexander M Kaizer
- Biostatistics and Informatics, Colorado School of Public Health, University of Colorado-Anschutz Medical Campus, Aurora, CO, USA
| | - Annika Winbo
- Department of Clinical Sciences, Pediatrics, Umeå University, Umea, Sweden
- Department of Physiology, University of Auckland, Auckland, New Zealand
| | - Sally-Ann B Clur
- Department of Pediatric Cardiology, Emma Children’s Hospital, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Cardiology, University Medical Center, Amsterdam, The Netherlands
| | - Susan P Etheridge
- Department of Pediatrics, Division of Cardiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Michael J Ackerman
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Mayo Clinic, Rochester, MN, USA
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN, USA
- Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
- Windland Smith Rice Genetic Heart Rhythm Clinic and Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Hitoshi Horigome
- Department of Pediatrics, Section of Cardiology, Tsukuba University, Tsukuba, Japan
| | - Ulrike Herberg
- Department of Pediatric Cardiology, RWTH University Hospital Aachen, Aachen, Germany
- Department of Pediatric Cardiology, University Hospital Bonn, Bonn, Germany
| | - Federica Dagradi
- Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, IRCCS Istituto Auxologico Italiano, Via Pier Lombardo 22, 2015 Milan, Italy
| | - Carla Spazzolini
- Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, IRCCS Istituto Auxologico Italiano, Via Pier Lombardo 22, 2015 Milan, Italy
| | - Stacy A S Killen
- Department of Pediatrics, Division of Cardiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Annette Wacker-Gussmann
- Department of Congenital Heart Disease and Paediatric Cardiology, German Heart Center, Munich, Germany
| | - Arthur A M Wilde
- Department of Cardiology, University Medical Center, Amsterdam, The Netherlands
- Department of Cardiology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Department of Cardiology, Amseterdam University Medical Center, Amsterdam, The Netherlands
| | - Elena Sinkovskaya
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Alfred Abuhamad
- Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Margherita Torchio
- Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, IRCCS Istituto Auxologico Italiano, Via Pier Lombardo 22, 2015 Milan, Italy
| | - Chai-Ann Ng
- Mark Cowley Lidwill Research Program in Cardiac Electrophysiology, Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia
- The School of Clinical Medicine, UNSW Sydney, Darlinghurst, New South Wales, Australia
| | - Annika Rydberg
- Department of Clinical Sciences, Pediatrics, Umeå University, Umea, Sweden
- Department of Cardiology, University Medical Center, Amsterdam, The Netherlands
| | - Peter J Schwartz
- Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, IRCCS Istituto Auxologico Italiano, Via Pier Lombardo 22, 2015 Milan, Italy
| | - Bettina F Cuneo
- Department of Pediatrics, Section of Cardiology, University of Denver School of Medicine, 13123 16th Ave, Box 100, Aurora, CO 80045, USA
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12
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Verheul LM, van der Ree MH, Groeneveld SA, Mulder BA, Christiaans I, Kapel GFL, Alings M, Bootsma M, Barge-Schaapveld DQCM, Balt JC, Yap SC, Krapels IPC, Ter Bekke RMA, Volders PGA, van der Crabben SN, Postema PG, Wilde AAM, Dooijes D, Baas AF, Hassink RJ. The genetic basis of apparently idiopathic ventricular fibrillation: a retrospective overview. Europace 2023; 25:euad336. [PMID: 37967257 PMCID: PMC10665040 DOI: 10.1093/europace/euad336] [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: 09/19/2023] [Accepted: 11/03/2023] [Indexed: 11/17/2023] Open
Abstract
AIMS During the diagnostic work-up of patients with idiopathic ventricular fibrillation (VF), next-generation sequencing panels can be considered to identify genotypes associated with arrhythmias. However, consensus for gene panel testing is still lacking, and variants of uncertain significance (VUS) are often identified. The aim of this study was to evaluate genetic testing and its results in idiopathic VF patients. METHODS AND RESULTS We investigated 419 patients with available medical records from the Dutch Idiopathic VF Registry. Genetic testing was performed in 379 (91%) patients [median age at event 39 years (27-51), 60% male]. Single-gene testing was performed in 87 patients (23%) and was initiated more often in patients with idiopathic VF before 2010. Panel testing was performed in 292 patients (77%). The majority of causal (likely) pathogenic variants (LP/P, n = 56, 15%) entailed the DPP6 risk haplotype (n = 39, 70%). Moreover, 10 LP/P variants were found in cardiomyopathy genes (FLNC, MYL2, MYH7, PLN (two), TTN (four), RBM20), and 7 LP/P variants were identified in genes associated with cardiac arrhythmias (KCNQ1, SCN5A (2), RYR2 (four)). For eight patients (2%), identification of an LP/P variant resulted in a change of diagnosis. In 113 patients (30%), a VUS was identified. Broad panel testing resulted in a higher incidence of VUS in comparison to single-gene testing (38% vs. 3%, P < 0.001). CONCLUSION Almost all patients from the registry underwent, albeit not broad, genetic testing. The genetic yield of causal LP/P variants in idiopathic VF patients is 5%, increasing to 15% when including DPP6. In specific cases, the LP/P variant is the underlying diagnosis. A gene panel specifically for idiopathic VF patients is proposed.
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Affiliation(s)
- Lisa M Verheul
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | - Martijn H van der Ree
- Department of Cardiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Heart Failure and Arrhythmias, Amsterdam, Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Sanne A Groeneveld
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
| | - Bart A Mulder
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Imke Christiaans
- Department of Human Genetics, University Medical Center Groningen, Groningen, The Netherlands
| | - Gijs F L Kapel
- Department of Cardiology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Marco Alings
- Department of Cardiology, Amphia Hospital, Breda, The Netherlands
| | - Marianne Bootsma
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Jippe C Balt
- Department of Cardiology, St.Antonius Hospital, Nieuwegein, The Netherlands
| | - Sing-Chien Yap
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Ingrid P C Krapels
- Department of Human Genetics, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Rachel M A Ter Bekke
- Department of Cardiology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Paul G A Volders
- Department of Cardiology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Saskia N van der Crabben
- Department of Human Genetics, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
| | - Pieter G Postema
- Department of Cardiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Heart Failure and Arrhythmias, Amsterdam, Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Arthur A M Wilde
- Department of Cardiology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Heart Failure and Arrhythmias, Amsterdam, Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Dennis Dooijes
- Department of Human Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Annette F Baas
- Department of Human Genetics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rutger J Hassink
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands
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