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Li E, van der Heyden MAG. The network of cardiac K IR2.1: its function, cellular regulation, electrical signaling, diseases and new drug avenues. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024; 397:6369-6389. [PMID: 38683369 PMCID: PMC11422472 DOI: 10.1007/s00210-024-03116-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 04/19/2024] [Indexed: 05/01/2024]
Abstract
The functioning of the human heart relies on complex electrical and communication systems that coordinate cardiac contractions and sustain rhythmicity. One of the key players contributing to this intricate system is the KIR2.1 potassium ion channel, which is encoded by the KCNJ2 gene. KIR2.1 channels exhibit abundant expression in both ventricular myocytes and Purkinje fibers, exerting an important role in maintaining the balance of intracellular potassium ion levels within the heart. And by stabilizing the resting membrane potential and contributing to action potential repolarization, these channels have an important role in cardiac excitability also. Either gain- or loss-of-function mutations, but also acquired impairments of their function, are implicated in the pathogenesis of diverse types of cardiac arrhythmias. In this review, we aim to elucidate the system functions of KIR2.1 channels related to cellular electrical signaling, communication, and their contributions to cardiovascular disease. Based on this knowledge, we will discuss existing and new pharmacological avenues to modulate their function.
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Affiliation(s)
- Encan Li
- Department of Medical Physiology, Division Heart & Lungs, University Medical Center Utrecht, Yalelaan 50, 3584 CM, Utrecht, Netherlands
| | - Marcel A G van der Heyden
- Department of Medical Physiology, Division Heart & Lungs, University Medical Center Utrecht, Yalelaan 50, 3584 CM, Utrecht, Netherlands.
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2
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Roston TM, Bezzerides VJ, Roberts JD, Abrams DJ. Management of ultrarare inherited arrhythmia syndromes. Heart Rhythm 2024:S1547-5271(24)03142-4. [PMID: 39154872 DOI: 10.1016/j.hrthm.2024.08.023] [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: 05/01/2024] [Revised: 08/06/2024] [Accepted: 08/08/2024] [Indexed: 08/20/2024]
Abstract
Ultrarare inherited arrhythmia syndromes are increasingly diagnosed as a result of increased awareness as well as increased availability and reduced cost of genetic testing. Yet by definition, their rarity and heterogeneous expression make development of evidence-based management strategies more challenging, typically employing strategies garnered from similar genetic cardiac disorders. For the most part, reliance on anecdotal experiences, expert opinion, and small retrospective cohort studies is the only means to diagnose and to treat these patients. Here we review the management of specific ultrarare inherited arrhythmic syndromes together with the genetic and molecular basis, which will become increasingly important with the development of targeted therapies to correct the biologic basis of these disorders.
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Affiliation(s)
- Thomas M Roston
- Division of Cardiology and Centre for Cardiovascular Innovation, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Vassilios J Bezzerides
- Center for Cardiovascular Genetics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jason D Roberts
- Population Health Research Institute, McMaster University, and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Dominic J Abrams
- Center for Cardiovascular Genetics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
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3
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Belhassen B, Lellouche N, Frank R. Contributions of France to the field of clinical cardiac electrophysiology and pacing. Heart Rhythm O2 2024; 5:490-514. [PMID: 39119028 PMCID: PMC11305881 DOI: 10.1016/j.hroo.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024] Open
Affiliation(s)
- Bernard Belhassen
- Heart Institute, Hadassah Medical Center, Jerusalem, Israel
- Tel-Aviv University, Tel-Aviv, Israel
| | - Nicolas Lellouche
- Unité de Rythmologie, Service de Cardiologie, Centre Hospitalier Henri-Mondor, Université Paris-Est, Créteil, France
| | - Robert Frank
- Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, Université de la Sorbonne, Paris, France
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4
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Gutiérrez LK, Moreno-Manuel AI, Jalife J. Kir2.1-Na V1.5 channelosome and its role in arrhythmias in inheritable cardiac diseases. Heart Rhythm 2024; 21:630-646. [PMID: 38244712 DOI: 10.1016/j.hrthm.2024.01.017] [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: 11/20/2023] [Revised: 01/10/2024] [Accepted: 01/13/2024] [Indexed: 01/22/2024]
Abstract
Sudden cardiac death in children and young adults is a relatively rare but tragic event whose pathophysiology is unknown at the molecular level. Evidence indicates that the main cardiac sodium channel (NaV1.5) and the strong inward rectifier potassium channel (Kir2.1) physically interact and form macromolecular complexes (channelosomes) with common partners, including adapter, scaffolding, and regulatory proteins that help them traffic together to their eventual membrane microdomains. Most important, dysfunction of either or both ion channels has direct links to hereditary human diseases. For example, certain mutations in the KCNJ2 gene encoding the Kir2.1 protein result in Andersen-Tawil syndrome type 1 and alter both inward rectifier potassium and sodium inward currents. Similarly, trafficking-deficient mutations in the gene encoding the NaV1.5 protein (SCN5A) result in Brugada syndrome and may also disturb both inward rectifier potassium and sodium inward currents. Moreover, gain-of-function mutations in KCNJ2 result in short QT syndrome type 3, which is extremely rare but highly arrhythmogenic, and can modify Kir2.1-NaV1.5 interactions in a mutation-specific way, further highlighting the relevance of channelosomes in ion channel diseases. By expressing mutant proteins that interrupt or modify Kir2.1 or NaV1.5 function in animal models and patient-specific pluripotent stem cell-derived cardiomyocytes, investigators are defining for the first time the mechanistic framework of how mutation-induced dysregulation of the Kir2.1-NaV1.5 channelosome affects cardiac excitability, resulting in arrhythmias and sudden death in different cardiac diseases.
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Affiliation(s)
- Lilian K Gutiérrez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | | | - José Jalife
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan; Department of Molecular and Integrative Physiology, University of Michigan, Ann Arbor, Michigan.
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5
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de Vera McMullan P, Corella Aznar E, Granados Ruiz MÁ. [Andersen-Tawil syndrome: A long QT syndrome with variable expression]. Med Clin (Barc) 2024; 162:309-311. [PMID: 38044185 DOI: 10.1016/j.medcli.2023.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/25/2023] [Accepted: 10/28/2023] [Indexed: 12/05/2023]
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6
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Pupaza A, Cinteza E, Vasile CM, Nicolescu A, Vatasescu R. Assessment of Sudden Cardiac Death Risk in Pediatric Primary Electrical Disorders: A Comprehensive Overview. Diagnostics (Basel) 2023; 13:3551. [PMID: 38066791 PMCID: PMC10706572 DOI: 10.3390/diagnostics13233551] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 11/22/2023] [Accepted: 11/24/2023] [Indexed: 06/30/2024] Open
Abstract
Sudden cardiac death (SCD) in children is a devastating event, often linked to primary electrical diseases (PED) of the heart. PEDs, often referred to as channelopathies, are a group of genetic disorders that disrupt the normal ion channel function in cardiac cells, leading to arrhythmias and sudden cardiac death. This paper investigates the unique challenges of risk assessment and stratification for channelopathy-related SCD in pediatric patients-Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia, idiopathic ventricular fibrillation, long QT syndrome, Anderson-Tawil syndrome, short QT syndrome, and early repolarization syndrome. We explore the intricate interplay of genetic, clinical, and electrophysiological factors that contribute to the complex nature of these conditions. Recognizing the significance of early identification and tailored management, this paper underscores the need for a comprehensive risk stratification approach specifically designed for pediatric populations. By integrating genetic testing, family history, and advanced electrophysiological evaluation, clinicians can enhance their ability to identify children at the highest risk for SCD, ultimately paving the way for more effective preventive strategies and improved outcomes in this vulnerable patient group.
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Affiliation(s)
- Adelina Pupaza
- Department of Cardiology, Clinic Emergency Hospital Bucharest, 050098 Bucharest, Romania;
| | - Eliza Cinteza
- Department of Pediatrics, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
- Department of Pediatric Cardiology, “Marie Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania;
| | - Corina Maria Vasile
- Pediatric and Adult Congenital Cardiology Department, M3C National Reference Centre, Bordeaux University Hospital, 33600 Bordeaux, France;
| | - Alin Nicolescu
- Department of Pediatric Cardiology, “Marie Curie” Emergency Children’s Hospital, 041451 Bucharest, Romania;
| | - Radu Vatasescu
- Department of Cardiology, Clinic Emergency Hospital Bucharest, 050098 Bucharest, Romania;
- Cardio-Thoracic Department, “Carol Davila” University of Medicine and Pharmacy Bucharest, 020021 Bucharest, Romania
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7
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Pandit M, Finn C, Tahir UA, Frishman WH. Congenital Long QT Syndrome: A Review of Genetic and Pathophysiologic Etiologies, Phenotypic Subtypes, and Clinical Management. Cardiol Rev 2023; 31:318-324. [PMID: 35576393 DOI: 10.1097/crd.0000000000000459] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Congenital Long QT Syndrome (CLQTS) is the most common inherited arrhythmia. The QT interval, which marks the duration of ventricular depolarization and repolarization in the myocardium, can be prolonged due to mutations in genes coding for the ion channel proteins that govern the cardiac action potential. The lengthening of the QT interval can lead to a wide range of clinical symptoms, including seizures, torsades de pointes, and fatal arrhythmias. There is a growing body of evidence that has revealed the genetic mutations responsible for the pathophysiology of CLQTS, and this has led to hypotheses regarding unique triggers and clinical features associated with specific gene mutations. Epidemiologic evidence has revealed a 1-year mortality rate of approximately 20% in untreated CLQTS patients, and a <1% of 1-year mortality rate in treated patients, underscoring the importance of timely diagnosis and effective clinical management. There are many phenotypic syndromes that constitute CLQTS, including but not limited to, Jervell and Lange-Nielsen syndrome, Romano and Ward syndrome, Andersen-Tawil syndrome, and Timothy syndrome. In this review, we aim to (1) summarize the genetic, epidemiologic, and pathophysiological basis of CLQTS and (2) outline the unique features of the phenotypic subtypes and their clinical management.
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Affiliation(s)
- Maya Pandit
- From the New York Medical College, Valhalla, NY
| | - Caitlin Finn
- Department of Medicine, Division of Cardiology, Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, MA
| | - Usman A Tahir
- Department of Medicine, Division of Cardiology, Harvard Medical School/Beth Israel Deaconess Medical Center, Boston, MA
| | - William H Frishman
- Departments of Medicine and Cardiology, New York Medical College/Westchester Medical Center, Valhalla, NY
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Moreno-Manuel AI, Gutiérrez LK, Vera-Pedrosa ML, Cruz FM, Bermúdez-Jiménez FJ, Martínez-Carrascoso I, Sánchez-Pérez P, Macías Á, Jalife J. Molecular stratification of arrhythmogenic mechanisms in the Andersen Tawil syndrome. Cardiovasc Res 2023; 119:919-932. [PMID: 35892314 PMCID: PMC10153646 DOI: 10.1093/cvr/cvac118] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/20/2022] [Accepted: 07/01/2022] [Indexed: 11/12/2022] Open
Abstract
Andersen-Tawil syndrome (ATS) is a rare inheritable disease associated with loss-of-function mutations in KCNJ2, the gene coding the strong inward rectifier potassium channel Kir2.1, which forms an essential membrane protein controlling cardiac excitability. ATS is usually marked by a triad of periodic paralysis, life-threatening cardiac arrhythmias and dysmorphic features, but its expression is variable and not all patients with a phenotype linked to ATS have a known genetic alteration. The mechanisms underlying this arrhythmogenic syndrome are poorly understood. Knowing such mechanisms would be essential to distinguish ATS from other channelopathies with overlapping phenotypes and to develop individualized therapies. For example, the recently suggested role of Kir2.1 as a countercurrent to sarcoplasmic calcium reuptake might explain the arrhythmogenic mechanisms of ATS and its overlap with catecholaminergic polymorphic ventricular tachycardia. Here we summarize current knowledge on the mechanisms of arrhythmias leading to sudden cardiac death in ATS. We first provide an overview of the syndrome and its pathophysiology, from the patient's bedside to the protein and discuss the role of essential regulators and interactors that could play a role in cases of ATS. The review highlights novel ideas related to some post-translational channel interactions with partner proteins that might help define the molecular bases of the arrhythmia phenotype. We then propose a new all-embracing classification of the currently known ATS loss-of-function mutations according to their position in the Kir2.1 channel structure and their functional implications. We also discuss specific ATS pathogenic variants, their clinical manifestations, and treatment stratification. The goal is to provide a deeper mechanistic understanding of the syndrome toward the development of novel targets and personalized treatment strategies.
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Affiliation(s)
| | - Lilian K Gutiérrez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC) Carlos III, 28029 Madrid, Spain
| | | | - Francisco Miguel Cruz
- Centro Nacional de Investigaciones Cardiovasculares (CNIC) Carlos III, 28029 Madrid, Spain
| | - Francisco José Bermúdez-Jiménez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC) Carlos III, 28029 Madrid, Spain
- Departamento de Cardiología, Hospital Virgen de las Nieves, GranadaSpain
| | | | - Patricia Sánchez-Pérez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC) Carlos III, 28029 Madrid, Spain
| | - Álvaro Macías
- Centro Nacional de Investigaciones Cardiovasculares (CNIC) Carlos III, 28029 Madrid, Spain
| | - José Jalife
- Centro Nacional de Investigaciones Cardiovasculares (CNIC) Carlos III, 28029 Madrid, Spain
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Departments of Medicine and Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, USA
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9
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Ransom JL, Wong KC, Kircher J, Usry C, Larson C. Bidirectional Ventricular Tachycardia in a Young Female: A Case of Andersen-Tawil Syndrome. Mil Med 2023; 188:e412-e416. [PMID: 33605413 DOI: 10.1093/milmed/usab076] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/02/2021] [Accepted: 02/09/2021] [Indexed: 01/11/2023] Open
Abstract
Bidirectional ventricular tachycardia (VT) is a rare ventricular dysrhythmia with a limited differential diagnosis that includes digitalis toxicity, catecholaminergic polymorphic VT, aconite poisoning, and genetic channelopathy syndromes, specifically, Andersen-Tawil syndrome (ATS). We present a case of a young female with palpitations found to have bidirectional VT on cardiac event monitor and strong family history of cardiac dysrhythmias. Her physical examination findings included minor dysmorphic features of mandibular hypoplasia, hypertelorism, and clinodactyly. The patient was clinically diagnosed with ATS and started on a beta-blocker for control of ectopy. A second Holter review demonstrated markedly decreased burden of ventricular ectopy compared to the initial monitoring. She was referred for genetic testing, which revealed a KCNJ2 mutation. Bidirectional VT is an uncommon ventricular dysrhythmia that has a limited differential diagnosis, one of which is ATS-a rare genetic disorder that results from mutations in the KCNJ2 gene. The condition is frequently associated with developmental, skeletal, and cardiac abnormalities. Although there are no strong recommendations that exist for treatment of ventricular dysrhythmias associated with this genetic disorder, we demonstrate a case of clinical improvement in a patient with ATS by using the beta-blocker metoprolol succinate. Furthermore, we propose that ATS patients may not need exercise restrictions as overall ventricular ectopy burden decreased with exercise and there was no prolongation of the QT interval. This patient will continue to follow up in our clinic to reassess symptom burden and for continued monitoring for the development of any new features.
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Affiliation(s)
- Jacob L Ransom
- Department of Cardiology, William Beaumont Army Medical Center, El Paso, TX 79920, USA
| | - Ka C Wong
- Department of Cardiology, William Beaumont Army Medical Center, El Paso, TX 79920, USA
| | - Jacqueline Kircher
- Department of Cardiology, William Beaumont Army Medical Center, El Paso, TX 79920, USA
| | - Courtney Usry
- Department of Cardiology, William Beaumont Army Medical Center, El Paso, TX 79920, USA
| | - Christopher Larson
- Department of Cardiology, William Beaumont Army Medical Center, El Paso, TX 79920, USA
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10
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Krijger Juárez C, Amin AS, Offerhaus JA, Bezzina CR, Boukens BJ. Cardiac Repolarization in Health and Disease. JACC Clin Electrophysiol 2023; 9:124-138. [PMID: 36697193 DOI: 10.1016/j.jacep.2022.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 09/16/2022] [Accepted: 09/21/2022] [Indexed: 12/03/2022]
Abstract
Abnormal cardiac repolarization is at the basis of life-threatening arrhythmias in various congenital and acquired cardiac diseases. Dysfunction of ion channels involved in repolarization at the cellular level are often the underlying cause of the repolarization abnormality. The expression pattern of the gene encoding the affected ion channel dictates its impact on the shape of the T-wave and duration of the QT interval, thereby setting the stage for both the occurrence of the trigger and the substrate for maintenance of the arrhythmia. Here we discuss how research into the genetic and electrophysiological basis of repolarization has provided us with insights into cardiac repolarization in health and disease and how this in turn may provide the basis for future improved patient-specific management.
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Affiliation(s)
- Christian Krijger Juárez
- Department of Experimental Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Ahmad S Amin
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Joost A Offerhaus
- Department of Experimental Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Connie R Bezzina
- Department of Experimental Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Bastiaan J Boukens
- Department of Medical Biology, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands.
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11
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Zeppenfeld K, Tfelt-Hansen J, de Riva M, Winkel BG, Behr ER, Blom NA, Charron P, Corrado D, Dagres N, de Chillou C, Eckardt L, Friede T, Haugaa KH, Hocini M, Lambiase PD, Marijon E, Merino JL, Peichl P, Priori SG, Reichlin T, Schulz-Menger J, Sticherling C, Tzeis S, Verstrael A, Volterrani M. 2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Eur Heart J 2022; 43:3997-4126. [PMID: 36017572 DOI: 10.1093/eurheartj/ehac262] [Citation(s) in RCA: 901] [Impact Index Per Article: 450.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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12
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Macías Á, González-Guerra A, Moreno-Manuel AI, Cruz FM, Gutiérrez LK, García-Quintáns N, Roche-Molina M, Bermúdez-Jiménez F, Andrés V, Vera-Pedrosa ML, Martínez-Carrascoso I, Bernal JA, Jalife J. Kir2.1 dysfunction at the sarcolemma and the sarcoplasmic reticulum causes arrhythmias in a mouse model of Andersen-Tawil syndrome type 1. NATURE CARDIOVASCULAR RESEARCH 2022; 1:900-917. [PMID: 39195979 PMCID: PMC11358039 DOI: 10.1038/s44161-022-00145-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 09/02/2022] [Indexed: 08/29/2024]
Abstract
Andersen-Tawil syndrome type 1 (ATS1) is associated with life-threatening arrhythmias of unknown mechanism. In this study, we generated and characterized a mouse model of ATS1 carrying the trafficking-deficient mutant Kir2.1Δ314-315 channel. The mutant mouse recapitulates the electrophysiological phenotype of ATS1, with QT prolongation exacerbated by flecainide or isoproterenol, drug-induced QRS prolongation, increased vulnerability to reentrant arrhythmias and multifocal discharges resembling catecholaminergic polymorphic ventricular tachycardia (CPVT). Kir2.1Δ314-315 cardiomyocytes display significantly reduced inward rectifier K+ and Na+ currents, depolarized resting membrane potential and prolonged action potentials. We show that, in wild-type mouse cardiomyocytes and skeletal muscle cells, Kir2.1 channels localize to sarcoplasmic reticulum (SR) microdomains, contributing to intracellular Ca2+ homeostasis. Kir2.1Δ314-315 cardiomyocytes exhibit defective SR Kir2.1 localization and function, as intact and permeabilized Kir2.1Δ314-315 cardiomyocytes display abnormal spontaneous Ca2+ release events. Overall, defective Kir2.1 channel function at the sarcolemma and the SR explain the life-threatening arrhythmias in ATS1 and its overlap with CPVT.
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Affiliation(s)
- Álvaro Macías
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | | | | | - Francisco M Cruz
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | - Lilian K Gutiérrez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | | | - Marta Roche-Molina
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | | | - Vicente Andrés
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | | | | | - Juan A Bernal
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
| | - José Jalife
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
- Departments of Medicine and Molecular and Integrative Physiology, University of Michigan, Ann Arbor, MI, USA.
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Beverley KM, Pattnaik BR. Inward rectifier potassium (Kir) channels in the retina: living our vision. Am J Physiol Cell Physiol 2022; 323:C772-C782. [PMID: 35912989 PMCID: PMC9448332 DOI: 10.1152/ajpcell.00112.2022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 07/25/2022] [Accepted: 07/25/2022] [Indexed: 11/22/2022]
Abstract
Channel proteins are vital for conducting ions throughout the body and are especially relevant to retina physiology. Inward rectifier potassium (Kir) channels are a class of K+ channels responsible for maintaining membrane potential and extracellular K+ concentrations. Studies of the KCNJ gene (that encodes Kir protein) expression identified the presence of all of the subclasses (Kir 1-7) of Kir channels in the retina or retinal-pigmented epithelium (RPE). However, functional studies have established the involvement of the Kir4.1 homotetramer and Kir4.1/5.1 heterotetramer in Müller glial cells, Kir2.1 in bipolar cells, and Kir7.1 in the RPE cell physiology. Here, we propose the potential roles of Kir channels in the retina based on the physiological contributions to the brain, pancreatic, and cardiac tissue functions. There are several open questions regarding the expressed KCNJ genes in the retina and RPE. For example, why does not the Kir channel subtype gene expression correspond with protein expression? Catching up with multiomics or functional "omics" approaches might shed light on posttranscriptional changes that might influence Kir subunit mRNA translation within the retina that guides our vision.
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Affiliation(s)
- Katie M Beverley
- Endocrinology and Reproductive Physiology Graduate Program, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- McPherson Eye Research Institute, University of Wisconsin, Madison, Wisconsin
| | - Bikash R Pattnaik
- Endocrinology and Reproductive Physiology Graduate Program, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
- McPherson Eye Research Institute, University of Wisconsin, Madison, Wisconsin
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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14
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Villar-Quiles RN, Sternberg D, Tredez G, Beatriz Romero N, Evangelista T, Lafôret P, Cintas P, Sole G, Sacconi S, Bendahhou S, Franques J, Cances C, Noury JB, Delmont E, Blondy P, Perrin L, Hezode M, Fournier E, Fontaine B, Stojkovic T, Vicart S. Phenotypical variability and atypical presentations in a French cohort of Andersen-Tawil syndrome. Eur J Neurol 2022; 29:2398-2411. [PMID: 35460302 DOI: 10.1111/ene.15369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/31/2022] [Accepted: 04/18/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND PURPOSE Andersen-Tawil syndrome (ATS) is a skeletal muscle channelopathy caused by KCNJ2 mutations, characterized by a clinical triad of periodic paralysis, cardiac arrhythmias and dysmorphism. The muscle phenotype, particularly the atypical forms with prominent permanent weakness or predominantly painful symptoms, remains incompletely characterized. METHODS A retrospective clinical, histological, electroneuromyography (ENMG) and genetic analysis of molecularly confirmed ATS patients, diagnosed and followed up at neuromuscular reference centers in France, was conducted. RESULTS Thirty-five patients from 27 unrelated families carrying 17 different missense KCNJ2 mutations (four novel mutations) and a heterozygous KCNJ2 duplication are reported. The typical triad was observed in 42.9% of patients. Cardiac abnormalities were observed in 65.7%: 56.5% asymptomatic and 39.1% requiring antiarrhythmic drugs. 71.4% of patients exhibited dysmorphic features. Muscle symptoms were reported in 85.7%, amongst whom 13.3% had no cardiopathy and 33.3% no dysmorphic features. Periodic paralysis was present in 80% and was significantly more frequent in men. Common triggers were exercise, immobility and carbohydrate-rich diet. Ictal serum potassium concentrations were low in 53.6%. Of the 35 patients, 45.7% had permanent weakness affecting proximal muscles, which was mild and stable or slowly progressive over several decades. Four patients presented with exercise-induced pain and myalgia attacks. Diagnostic delay was 14.4 ± 9.5 years. ENMG long-exercise test performed in 25 patients (71.4%) showed in all a decremental response up to 40%. Muscle biopsy performed in 12 patients revealed tubular aggregates in six patients (associated in two of them with vacuolar lesions), dystrophic features in one patient and non-specific myopathic features in one patient; it was normal in four patients. DISCUSSION Recognition of atypical features (exercise-induced pain or myalgia and permanent weakness) along with any of the elements of the triad should arouse suspicion. The ENMG long-exercise test has a high diagnostic yield and should be performed. Early diagnosis is of utmost importance to improve disease prognosis.
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Affiliation(s)
- Rocio Nur Villar-Quiles
- Reference Center for Neuromuscular Disorders, APHP, Institute of Myology, Pitié-Salpêtrière Hospital, Paris, France.,Institute of Myology, Centre de Recherche en Myologie, UMRS974, Sorbonne Université - INSERM, Paris, France
| | - Damien Sternberg
- Reference Center for Muscle Channelopathies, Service de Biochimie et Centre de Génétique, APHP, Pitié-Salpêtrière Hospital, Paris, France
| | - Grégoire Tredez
- Reference Center for Neuromuscular Disorders, APHP, Institute of Myology, Pitié-Salpêtrière Hospital, Paris, France
| | - Norma Beatriz Romero
- Institute of Myology, Centre de Recherche en Myologie, UMRS974, Sorbonne Université - INSERM, Paris, France.,Neuromuscular Morphology Unit, Institute of Myology, Pitié-Salpêtrière Hospital, Paris, France
| | - Teresinha Evangelista
- Reference Center for Neuromuscular Disorders, APHP, Institute of Myology, Pitié-Salpêtrière Hospital, Paris, France.,Institute of Myology, Centre de Recherche en Myologie, UMRS974, Sorbonne Université - INSERM, Paris, France.,Neuromuscular Morphology Unit, Institute of Myology, Pitié-Salpêtrière Hospital, Paris, France
| | - Pascal Lafôret
- Reference Center for Neuromuscular Disorders, APHP, Raymond-Poincaré Hospital, Paris, France
| | - Pascal Cintas
- Neurology Department, Pierre-Paul Riquet Hospital, CHU Toulouse, Toulouse, France
| | - Guilhem Sole
- Reference Centre for Neuromuscular Disorders, Pellegrin Hospital CHU Bordeaux, Bordeaux, France
| | - Sabrina Sacconi
- Neuromuscular Diseases and ALS Specialized Center, University of Nice-Sophia Antipolis, Nice, France
| | - Said Bendahhou
- UMR7370 CNRS, LP2M, Labex ICST, Faculty of Medicine, University of Nice-Sophia Antipolis, Nice, France
| | - Jérôme Franques
- Assistance Publique-Hôpitaux de Marseille, Department of Neurology and Neuromuscular Diseases, La Timone Hospital, Marseille, France
| | - Claude Cances
- AOC (Atlantique-Occitanie-Caraïbe) Reference Centre for Neuromuscular Disorders, Neuropediatric Department, Toulouse University Hospital, Toulouse, France
| | - J B Noury
- Neurology Department, Neuromuscular Center, CHRU Cavale Blanche, Brest, France
| | - Emilien Delmont
- Department of Neurology, University Hospital Timone, Marseille, France
| | - Patricia Blondy
- Reference Center for Muscle Channelopathies, Service de Biochimie et Centre de Génétique, APHP, Pitié-Salpêtrière Hospital, Paris, France
| | - Laurence Perrin
- Pediatrics Department, APHP, Robert-Débré Hospital, Paris, France
| | - Marianne Hezode
- Reference Center for Neuromuscular Disorders, APHP, Institute of Myology, Pitié-Salpêtrière Hospital, Paris, France
| | - Emmanuel Fournier
- Reference Center for Neuromuscular Disorders, APHP, Institute of Myology, Pitié-Salpêtrière Hospital, Paris, France
| | - Bertrand Fontaine
- Reference Center for Neuromuscular Disorders, APHP, Institute of Myology, Pitié-Salpêtrière Hospital, Paris, France.,Institute of Myology, Centre de Recherche en Myologie, UMRS974, Sorbonne Université - INSERM, Paris, France.,Reference Center for Muscle Channelopathies, APHP, Institut de Myologie, Pitié-Salpêtrière Hospital, Paris, France
| | - Tanya Stojkovic
- Reference Center for Neuromuscular Disorders, APHP, Institute of Myology, Pitié-Salpêtrière Hospital, Paris, France.,Institute of Myology, Centre de Recherche en Myologie, UMRS974, Sorbonne Université - INSERM, Paris, France
| | - Savine Vicart
- Reference Center for Neuromuscular Disorders, APHP, Institute of Myology, Pitié-Salpêtrière Hospital, Paris, France.,Reference Center for Muscle Channelopathies, APHP, Institut de Myologie, Pitié-Salpêtrière Hospital, Paris, France
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15
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Ünal Yüksekgönül A, Azak E, Akalın A, Ertuğrul İ, Kılıç E, Utine GE, Karagöz T. Efficacy of flecainide in bidirectional ventricular tachycardia and tachycardia-induced cardiomyopathy with Andersen-Tawil syndrome. Eur J Med Genet 2022; 65:104499. [DOI: 10.1016/j.ejmg.2022.104499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 01/31/2022] [Accepted: 03/29/2022] [Indexed: 11/30/2022]
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16
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Le Tanno P, Folacci M, Revilloud J, Faivre L, Laurent G, Pinson L, Amedro P, Millat G, Janin A, Vivaudou M, Roux-Buisson N, Fauré J. Characterization of Loss-Of-Function KCNJ2 Mutations in Atypical Andersen Tawil Syndrome. Front Genet 2021; 12:773177. [PMID: 34899860 PMCID: PMC8655864 DOI: 10.3389/fgene.2021.773177] [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: 09/09/2021] [Accepted: 11/03/2021] [Indexed: 12/02/2022] Open
Abstract
Andersen-Tawil Syndrome (ATS) is a rare disease defined by the association of cardiac arrhythmias, periodic paralysis and dysmorphic features, and is caused by KCNJ2 loss-of-function mutations. However, when extracardiac symptoms are atypical or absent, the patient can be diagnosed with Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT), a rare arrhythmia at high risk of sudden death, mostly due to RYR2 mutations. The identification of KCNJ2 variants in CPVT suspicion is very rare but important because beta blockers, the cornerstone of CPVT therapy, could be less efficient. We report here the cases of two patients addressed for CPVT-like phenotypes. Genetic investigations led to the identification of p. Arg82Trp and p. Pro186Gln de novo variants in the KCNJ2 gene. Functional studies showed that both variants forms of Kir2.1 monomers act as dominant negative and drastically reduced the activity of the tetrameric channel. We characterize here a new pathogenic variant (p.Pro186Gln) of KCNJ2 gene and highlight the interest of accurate cardiologic evaluation and of attention to extracardiac signs to distinguish CPVT from atypical ATS, and guide therapeutic decisions. We also confirm that the KCNJ2 gene must be investigated during CPVT molecular analysis.
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Affiliation(s)
- Pauline Le Tanno
- Université Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France
| | - Mathilde Folacci
- CEA, CNRS, Institut de Biologie Structurale, Université Grenoble Alpes, Grenoble, France
| | - Jean Revilloud
- CEA, CNRS, Institut de Biologie Structurale, Université Grenoble Alpes, Grenoble, France
| | - Laurence Faivre
- Medical Genetics Department, Dijon Bourgogne University Hospital, François Mitterand Hospital, Dijon, France
| | - Gabriel Laurent
- Cardiology Department, Dijon Bourgogne University Hospital, François Mitterand Hospital, Dijon, France
| | - Lucile Pinson
- Medical Genetics Department, University Hospital, Montpellier, France.,Département de Génétique Médicale, Maladies Rares et Médecine Personnalisée, Montpellier, France.,Genetic Department for Rare Diseases and Personalized Medicine, Clinical Division, Montpellier, France
| | - Pascal Amedro
- Pediatric and Congenital Cardiology Department, Clinical Investigation Centre, PhyMedExp, CNRS, INSERM, University of Montpellier, University Hospital, Montpellier, France
| | - Gilles Millat
- Laboratoire de Cardiogénétique Moléculaire, Centre de Biologie et Pathologie Est, Hospices Civils de Lyon, Lyon, France
| | - Alexandre Janin
- Laboratoire de Cardiogénétique Moléculaire, Centre de Biologie et Pathologie Est, Hospices Civils de Lyon, Lyon, France
| | - Michel Vivaudou
- CEA, CNRS, Institut de Biologie Structurale, Université Grenoble Alpes, Grenoble, France
| | - Nathalie Roux-Buisson
- Université Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France
| | - Julien Fauré
- Université Grenoble Alpes, Inserm, U1216, CHU Grenoble Alpes, Grenoble Institut Neurosciences, Grenoble, France
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17
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Akyuz E, Koklu B, Uner A, Angelopoulou E, Paudel YN. Envisioning the role of inwardly rectifying potassium (Kir) channel in epilepsy. J Neurosci Res 2021; 100:413-443. [PMID: 34713909 DOI: 10.1002/jnr.24985] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 09/23/2021] [Accepted: 10/01/2021] [Indexed: 01/29/2023]
Abstract
Epilepsy is a devastating neurological disorder characterized by recurrent seizures attributed to the disruption of the dynamic excitatory and inhibitory balance in the brain. Epilepsy has emerged as a global health concern affecting about 70 million people worldwide. Despite recent advances in pre-clinical and clinical research, its etiopathogenesis remains obscure, and there are still no treatment strategies modifying disease progression. Although the precise molecular mechanisms underlying epileptogenesis have not been clarified yet, the role of ion channels as regulators of cellular excitability has increasingly gained attention. In this regard, emerging evidence highlights the potential implication of inwardly rectifying potassium (Kir) channels in epileptogenesis. Kir channels consist of seven different subfamilies (Kir1-Kir7), and they are highly expressed in both neuronal and glial cells in the central nervous system. These channels control the cell volume and excitability. In this review, we discuss preclinical and clinical evidence on the role of the several subfamilies of Kir channels in epileptogenesis, aiming to shed more light on the pathogenesis of this disorder and pave the way for future novel therapeutic approaches.
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Affiliation(s)
- Enes Akyuz
- Faculty of International Medicine, Department of Biophysics, University of Health Sciences, Istanbul, Turkey
| | - Betul Koklu
- Faculty of Medicine, Namık Kemal University, Tekirdağ, Turkey
| | - Arda Uner
- Faculty of Medicine, Yozgat Bozok University, Yozgat, Turkey
| | - Efthalia Angelopoulou
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Yam Nath Paudel
- Neuropharmacology Research Strength, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
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18
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[17-year-old patient with polymorphic premature ventricular contractions]. Herzschrittmacherther Elektrophysiol 2021; 32:484-488. [PMID: 34664083 DOI: 10.1007/s00399-021-00813-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/27/2021] [Indexed: 10/20/2022]
Abstract
A 17-year-old patient with premature ventricular contractions and normal left ventricular function was referred for reablation after an unsuccessful catheter ablation attempt. Holter monitoring demonstrated a high burden of premature ventricular contractions, present throughout the whole recording. The patient reported occasional paralytic attacks; his face had a dysmorphic appearance with a wide distance between the eyes, a caudal insertion of the ears, and a high forehead. These three features resulted in a clinical diagnosis that was confirmed by molecular biology and completely changed the therapeutic strategy.
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19
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Catheter ablation of frequent monomorphic ventricular arrhythmias in Andersen-Tawil syndrome: case report and focused literature review. J Interv Card Electrophysiol 2021; 66:729-736. [PMID: 34665385 DOI: 10.1007/s10840-021-01077-w] [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: 08/09/2021] [Accepted: 10/10/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND/PURPOSE Andersen-Tawil syndrome type 1 is a rare autosomal dominant disease caused by a KCNJ2 gene mutation and clinically characterized by dysmorphic features, periodic muscular paralysis, and frequent ventricular arrhythmias (VAs). Although polymorphic and bidirectional ventricular tachycardias are prevalent, PVCs are the most frequent VAs. In addition, a "dominant" morphology with RBBB pattern associated with either superior or inferior axis is seen in most of the patients. Due to the limited efficacy of most antiarrhythmic drugs, catheter ablation (CA) is an alternative in patients with monomorphic VAs. Based on our experience, we aimed to review the arrhythmogenic mechanisms and substrates for VAs, and we analyzed the potential reasons for CA failure in this group of patients. METHODS Case report and focused literature review. RESULTS Catheter ablation has been reported to be unsuccessful in all of the few cases published so far. Most of the information suggests that VAs are mainly originated from the left ventricle and probably in the Purkinje network. Although identifying well-established and accepted mapping criteria for successful ablation of a monomorphic ventricular arrhythmia, papillary muscles seem not to be the right target. CONCLUSIONS More research is needed to understand better the precise mechanism and site of origin of VAs in Andersen-Tawil syndrome patients with this particular "dominant" monomorphic ventricular pattern to establish the potential role of CA.
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20
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Crotti L, Odening KE, Sanguinetti MC. Heritable arrhythmias associated with abnormal function of cardiac potassium channels. Cardiovasc Res 2021; 116:1542-1556. [PMID: 32227190 DOI: 10.1093/cvr/cvaa068] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/24/2020] [Accepted: 03/26/2020] [Indexed: 12/16/2022] Open
Abstract
Cardiomyocytes express a surprisingly large number of potassium channel types. The primary physiological functions of the currents conducted by these channels are to maintain the resting membrane potential and mediate action potential repolarization under basal conditions and in response to changes in the concentrations of intracellular sodium, calcium, and ATP/ADP. Here, we review the diversity and functional roles of cardiac potassium channels under normal conditions and how heritable mutations in the genes encoding these channels can lead to distinct arrhythmias. We briefly review atrial fibrillation and J-wave syndromes. For long and short QT syndromes, we describe their genetic basis, clinical manifestation, risk stratification, traditional and novel therapeutic approaches, as well as insights into disease mechanisms provided by animal and cellular models.
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Affiliation(s)
- Lia Crotti
- Center for Cardiac Arrhythmias of Genetic Origin, Istituto Auxologico Italiano, IRCCS, Milan, Italy.,Laboratory of Cardiovascular Genetics, Istituto Auxologico Italiano, IRCCS, Milan, Italy.,Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Katja E Odening
- Department of Cardiology and Angiology I, Heart Center University of Freiburg, Medical Faculty, Freiburg, Germany.,Institute of Experimental Cardiovascular Medicine, Heart Center University of Freiburg, Medical Faculty, Freiburg, Germany.,Department of Cardiology, Translational Cardiology, Inselspital, Bern University Hospital, and Institute of Physiology, University of Bern, Bern, Switzerland
| | - Michael C Sanguinetti
- Department of Internal Medicine, Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, UT, USA
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21
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Yilmaz S, Kanat S. Failure of radiofrequency catheter ablation and success of flecainide to suppress premature ventricular contractions in Andersen-Tawil syndrome: A case report. J Electrocardiol 2021; 68:37-40. [PMID: 34311212 DOI: 10.1016/j.jelectrocard.2021.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/28/2021] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
This case report presents a 33-year-old woman with premature ventricular contractions (PVCs). Her genetic testing was positive for KCNJ2 missense mutation at chr17:68171832;NM_000891.2. This mutation was compatible with Andersen-Tawil syndrome. We made an electrophysiological study to determine origin of PVCs however at endocardial mapping there was not any focus of PVC and at epicardial mapping we ablated low voltage areas in the inferior segments of both ventricles. She was discharged with flecainide and metoprolol therapy. After 3 months, her PVC burden was significantly decreased at Holter monitoring.
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Affiliation(s)
- Samet Yilmaz
- Cardiology Department, Pamukkale University Hospitals, Pamukkale, Denizli, Turkey.
| | - Selcuk Kanat
- Cardiology Clinic, Bursa Yüksek Ihtisas Training and Research Hospital, Bursa, Turkey
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22
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Déri S, Borbás J, Hartai T, Hategan L, Csányi B, Visnyovszki Á, Madácsy T, Maléth J, Hegedűs Z, Nagy I, Arora R, Labro AJ, Környei L, Varró A, Sepp R, Ördög B. Impaired cytoplasmic domain interactions cause co-assembly defect and loss of function in the p.Glu293Lys KNCJ2 variant isolated from an Andersen-Tawil syndrome patient. Cardiovasc Res 2021; 117:1923-1934. [PMID: 32810216 DOI: 10.1093/cvr/cvaa249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/16/2020] [Accepted: 08/12/2020] [Indexed: 02/07/2023] Open
Abstract
AIMS Subunit interactions at the cytoplasmic domain interface (CD-I) have recently been shown to control gating in inward rectifier potassium channels. Here we report the novel KCNJ2 variant p.Glu293Lys that has been found in a patient with Andersen-Tawil syndrome type 1 (ATS1), causing amino acid substitution at the CD-I of the inward rectifier potassium channel subunit Kir2.1. Neither has the role of Glu293 in gating control been investigated nor has a pathogenic variant been described at this position. This study aimed to assess the involvement of Glu293 in CD-I subunit interactions and to establish the pathogenic role of the p.Glu293Lys variant in ATS1. METHODS AND RESULTS The p.Glu293Lys variant produced no current in homomeric form and showed dominant-negative effect over wild-type (WT) subunits. Immunocytochemical labelling showed the p.Glu293Lys subunits to distribute in the subsarcolemmal space. Salt bridge prediction indicated the presence of an intersubunit salt bridge network at the CD-I of Kir2.1, with the involvement of Glu293. Subunit interactions were studied by the NanoLuc® Binary Technology (NanoBiT) split reporter assay. Reporter constructs carrying NanoBiT tags on the intracellular termini produced no bioluminescent signal above background with the p.Glu293Lys variant in homomeric configuration and significantly reduced signals in cells co-expressing WT and p.Glu293Lys subunits simultaneously. Extracellularly presented reporter tags, however, generated comparable bioluminescent signals with heteromeric WT and p.Glu293Lys subunits and with homomeric WT channels. CONCLUSIONS Loss of function and dominant-negative effect confirm the causative role of p.Glu293Lys in ATS1. Co-assembly of Kir2.1 subunits is impaired in homomeric channels consisting of p.Glu293Lys subunits and is partially rescued in heteromeric complexes of WT and p.Glu293Lys Kir2.1 variants. These data point to an important role of Glu293 in mediating subunit assembly, as well as in gating of Kir2.1 channels.
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Affiliation(s)
- Szilvia Déri
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Dóm tér 12, PO Box 427, Szeged 6720, Hungary
- Department of Pharmacology and Pharmacotherapy, Interdisciplinary Excellence Centre, University of Szeged, Dóm tér 12, 6720 Szeged, Hungary
| | - János Borbás
- 2nd Department of Internal Medicine and Cardiology Centre, University of Szeged, Semmelweis u. 8, 6725 Szeged, Hungary
| | - Teodóra Hartai
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Dóm tér 12, PO Box 427, Szeged 6720, Hungary
| | - Lidia Hategan
- 2nd Department of Internal Medicine and Cardiology Centre, University of Szeged, Semmelweis u. 8, 6725 Szeged, Hungary
| | - Beáta Csányi
- 2nd Department of Internal Medicine and Cardiology Centre, University of Szeged, Semmelweis u. 8, 6725 Szeged, Hungary
| | - Ádám Visnyovszki
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Dóm tér 12, PO Box 427, Szeged 6720, Hungary
| | - Tamara Madácsy
- 1st Department of Internal Medicine, University of Szeged, Korányi fasor 8-10, 6720 Szeged, Hungary, Hungary
| | - József Maléth
- 1st Department of Internal Medicine, University of Szeged, Korányi fasor 8-10, 6720 Szeged, Hungary, Hungary
| | - Zoltán Hegedűs
- Institute of Biophysics, Biological Research Centre of the Hungarian Academy of Sciences, Temesvári krt. 62, 6726 Szeged, Hungary
- Department of Biochemistry and Medical Chemistry, University of Pécs, Szigeti út 12, 7624 Pécs, Hungary
| | - István Nagy
- Institute of Biochemistry, Biological Research Centre the Hungarian Academy of Sciences, Temesvári krt. 62, 6726 Szeged, Hungary
- Seqomics Biotechnology Ltd, Vállalkozók útja 7, 6782 Mórahalom, Hungary
| | - Rohit Arora
- Department of Veterinary Sciences, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium
| | - Alain J Labro
- Department of Biomedical Sciences, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium
- Department of Basic Medical Sciences, University of Ghent, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - László Környei
- Gottsegen György National Institute of Cardiology, Haller u. 9, 1096 Budapest, Hungary
| | - András Varró
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Dóm tér 12, PO Box 427, Szeged 6720, Hungary
- Department of Pharmacology and Pharmacotherapy, Interdisciplinary Excellence Centre, University of Szeged, Dóm tér 12, 6720 Szeged, Hungary
- MTA-SZTE Research Group for Cardiovascular Pharmacology, Hungarian Academy of Sciences, Dóm tér 12, 6720 Szeged, Hungary
| | - Róbert Sepp
- 2nd Department of Internal Medicine and Cardiology Centre, University of Szeged, Semmelweis u. 8, 6725 Szeged, Hungary
| | - Balázs Ördög
- Department of Pharmacology and Pharmacotherapy, University of Szeged, Dóm tér 12, PO Box 427, Szeged 6720, Hungary
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23
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Marked reduction in paralytic attacks in a patient with Andersen-Tawil syndrome switched from acetazolamide to dichlorphenamide. Neuromuscul Disord 2021; 31:656-659. [PMID: 34078557 DOI: 10.1016/j.nmd.2021.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/19/2021] [Accepted: 04/11/2021] [Indexed: 11/20/2022]
Abstract
Andersen-Tawil syndrome is a rare, autosomal dominant, multisystem disorder for which the majority of cases are caused by pathogenic variants in the KCNJ2 gene. The syndrome is characterized by the clinical triad of episodic paralysis, cardiac conduction abnormalities, and dysmorphic facial and skeletal features. Treatment of Andersen-Tawil syndrome is primarily focused on management of cardiac arrhythmias and preventive management of paralytic attacks. Dichlorphenamide is approved by the US Food and Drug Administration for use in primary periodic paralysis based on several randomized, controlled trials but has not been studied in patients with Andersen-Tawil syndrome. Here, we report a case of the syndrome caused by a de novo pathogenic variant in the KCNJ2 gene (c.95_98del). The paralytic attack rate for this patient was better controlled with dichlorphenamide compared with acetazolamide, further supporting the use of dichlorphenamide in patients with Andersen-Tawil syndrome.
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24
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Nakajima T, Tamura S, Kurabayashi M, Kaneko Y. Towards Mutation-Specific Precision Medicine in Atypical Clinical Phenotypes of Inherited Arrhythmia Syndromes. Int J Mol Sci 2021; 22:ijms22083930. [PMID: 33920294 PMCID: PMC8069124 DOI: 10.3390/ijms22083930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 04/08/2021] [Indexed: 12/19/2022] Open
Abstract
Most causal genes for inherited arrhythmia syndromes (IASs) encode cardiac ion channel-related proteins. Genotype-phenotype studies and functional analyses of mutant genes, using heterologous expression systems and animal models, have revealed the pathophysiology of IASs and enabled, in part, the establishment of causal gene-specific precision medicine. Additionally, the utilization of induced pluripotent stem cell (iPSC) technology have provided further insights into the pathophysiology of IASs and novel promising therapeutic strategies, especially in long QT syndrome. It is now known that there are atypical clinical phenotypes of IASs associated with specific mutations that have unique electrophysiological properties, which raises a possibility of mutation-specific precision medicine. In particular, patients with Brugada syndrome harboring an SCN5A R1632C mutation exhibit exercise-induced cardiac events, which may be caused by a marked activity-dependent loss of R1632C-Nav1.5 availability due to a marked delay of recovery from inactivation. This suggests that the use of isoproterenol should be avoided. Conversely, the efficacy of β-blocker needs to be examined. Patients harboring a KCND3 V392I mutation exhibit both cardiac (early repolarization syndrome and paroxysmal atrial fibrillation) and cerebral (epilepsy) phenotypes, which may be associated with a unique mixed electrophysiological property of V392I-Kv4.3. Since the epileptic phenotype appears to manifest prior to cardiac events in this mutation carrier, identifying KCND3 mutations in patients with epilepsy and providing optimal therapy will help prevent sudden unexpected death in epilepsy. Further studies using the iPSC technology may provide novel insights into the pathophysiology of atypical clinical phenotypes of IASs and the development of mutation-specific precision medicine.
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25
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Fadilah A, Mordekar SR, Matthai S. Mutation in KCNJ2 Gene in a Boy with Atypical Features of Andersen–Tawil Syndrome, ADHD, and ASD: An Expanding Phenotype. JOURNAL OF PEDIATRIC NEUROLOGY 2021. [DOI: 10.1055/s-0040-1701503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AbstractAndersen–Tawil syndrome, a potassium ion channelopathy, is caused by mutations in the KCNJ2 gene, and accounts for approximately 10% of channelopathies. Phenotype is variable. An 11-year-old boy presented with periodic paralysis without localizing neurological signs, associated in only two of three occasions with hypokalemia, on a background of a diagnosis of attention deficit hyperactivity disorder and autism spectrum disorder. There was a history of syncope and palpitations. This was a matter of diagnostic uncertainty due to the difficulty in interpreting his neurological signs, and inconsistency of abnormal potassium levels. In children/young people with recurrent episodes of weakness without localizing signs on physical examination, and syncope, the possibility of a channelopathy should be considered, even in the absence of serum electrolyte abnormalities. There is a possible link between KCNJ2 mutations and difficulties in attention and a specific neurocognitive profile.
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Affiliation(s)
- Ala Fadilah
- Department of Paediatric Neurology, Ryegate Children's Centre, Sheffield Children's Hospital, Sheffield, United Kingdom
| | - Santosh R. Mordekar
- Department of Paediatric Neurology, Ryegate Children's Centre, Sheffield Children's Hospital, Sheffield, United Kingdom
| | - Sona Matthai
- Department of General Paediatrics, Sheffield Children's Hospital, Sheffield, United Kingdom
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26
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Inagaki M, Tatsumi T, Yomogita H, Hirose A, Kubo T, Sekiguchi M, Miyasaka N. Obstetric management of a patient with Andersen-Tawil syndrome: A case report. J Obstet Gynaecol Res 2020; 47:446-451. [PMID: 33205612 DOI: 10.1111/jog.14553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 10/12/2020] [Accepted: 10/16/2020] [Indexed: 11/27/2022]
Abstract
Andersen-Tawil syndrome (ATS) is a rare hereditary long QT syndrome type 7 caused by a missense mutation in the KCNJ2 gene. ATS is characterized by ventricular arrhythmia, periodic limb paralysis and minor external malformations. Although only three reports of pregnant women with Andersen-Tawil syndrome have been reported to date, no exacerbation of ventricular arrhythmia was observed from pre-partum to delivery in all cases compared to that before pregnancy, and it was suggested that the risk of arrhythmic events from pre-partum to delivery is not high. Unlike these previous reports, we herein present a case of Andersen-Tawil syndrome in which ventricular arrhythmias increased and sustained ventricular tachycardia was developed during labor progression. We also advise caution that pregnant patients with Andersen-Tawil syndrome may have varying times of exacerbation of the arrhythmia, and ventricular arrhythmias may be associated with painful uterine contractions.
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Affiliation(s)
- Mai Inagaki
- Comprehensive Reproductive Medicine, Regulation of Internal Environment and Reproduction, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takayuki Tatsumi
- Department of Pediatrics, Perinatal and Maternal Medicine (Ibaraki), Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hiroshi Yomogita
- Comprehensive Reproductive Medicine, Regulation of Internal Environment and Reproduction, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
| | - Asuka Hirose
- Comprehensive Reproductive Medicine, Regulation of Internal Environment and Reproduction, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takuyuki Kubo
- Comprehensive Reproductive Medicine, Regulation of Internal Environment and Reproduction, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masaki Sekiguchi
- Comprehensive Reproductive Medicine, Regulation of Internal Environment and Reproduction, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
| | - Naoyuki Miyasaka
- Comprehensive Reproductive Medicine, Regulation of Internal Environment and Reproduction, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
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Abstract
Andersen-Tawil syndrome (ATS) is a very rare orphan genetic multisystem channelopathy without structural heart disease (with rare exceptions). ATS type 1 is inherited in an autosomal dominant fashion and is caused by mutations in the KCNJ2 gene, which encodes the α subunit of the K+ channel protein Kir2.1 (in ≈ 50-60% of cases). ATS type 2 is in turn linked to a rare mutation in the KCNJ5-GIRK4 gene that encodes the G protein-sensitive-activated inwardly rectifying K+ channel Kir3.4 (15%), which carries the acetylcholine-induced potassium current. About 30% of cases are de novo/sporadic, suggesting that additional as-yet unidentified genes also cause the disorder. A triad of periodic muscle paralysis, repolarization changes in the electrocardiogram, and structural body changes characterize ATS. The typical muscular change is episodic flaccid muscle weakness. Prolongation of the QU/QUc intervals and normal or minimally prolonged QT/QTc intervals with a tendency to ventricular arrhythmias are typical repolarization changes. Bidirectional ventricular tachycardia is the hallmark ventricular arrhythmia, but also premature ventricular contractions, and rarely, polymorphic ventricular tachycardia of torsade de pointes type may be present. Patients with ATS have characteristic physical developmental dysmorphisms that affect the face, skull, limbs, thorax, and stature. Mild learning difficulties and a distinct neurocognitive phenotype (deficits in executive function and abstract reasoning) have been described. About 60% of affected individuals have all features of the major triad. The purpose of this review is to present historical aspects, nomenclature (observations/criticisms), epidemiology, genetics, electrocardiography, arrhythmias, electrophysiological mechanisms, diagnostic criteria/clues of periodic paralysis, prognosis, and management of ATS.
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Sachdeva S, Gupta SK, Naik N. Every face tells a story-unravelling a case of bidirectional ventricular tachycardia. Indian Pacing Electrophysiol J 2020; 20:199-202. [PMID: 32615315 PMCID: PMC7517587 DOI: 10.1016/j.ipej.2020.06.002] [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: 04/21/2020] [Revised: 05/02/2020] [Accepted: 06/05/2020] [Indexed: 11/29/2022] Open
Abstract
Bidirectional ventricular tachycardia is a rare form of tachycardia. We hereby report a case of bidirectional ventricular tachycardia in an 8-year-old boy wherein careful clinical exami-nation led to the diagnosis of Andersen Tawil syndrome. The case also demonstrates the efficacy of flecainide in managing bidirectional ventricular tachycardia in the setting of Andersen Tawil syndrome.
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Affiliation(s)
- Sakshi Sachdeva
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
| | - Saurabh Kumar Gupta
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
| | - Nitish Naik
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
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"Electrifying dysmorphology": Potassium channelopathies causing dysmorphic syndromes. ADVANCES IN GENETICS 2020; 105:137-174. [PMID: 32560786 DOI: 10.1016/bs.adgen.2020.03.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Potassium channels are a heterogeneous group of membrane-bound proteins, whose functions support a diverse range of biological processes. Genetic disorders arising from mutations in potassium channels are classically recognized by symptoms arising from acute channel dysfunction, such as periodic paralysis, ataxia, seizures, or cardiac conduction abnormalities, often in a patient with otherwise normal examination findings. In this chapter, we review a distinct subgroup of rare potassium channelopathies whose presentations are instead suggestive of a developmental disorder, with features including intellectual disability, craniofacial dysmorphism or other physical anomalies. Known conditions within this subgroup are: Andersen-Tawil syndrome, Birk-Barel syndrome, Cantú syndrome, Keppen-Lubinsky syndrome, Temple-Baraitser syndrome, Zimmerman-Laband syndrome and a very similar disorder called Bauer-Tartaglia or FHEIG syndrome. Ion channelopathies are unlikely to be routinely considered in the differential diagnosis of children presenting with developmental concerns, and so detailed description and photographs of the clinical phenotype are provided to aid recognition. For several of these disorders, functional characterization of the genetic mutations responsible has led to identification of candidate therapies, including drugs already commonly used for other indications, which adds further impetus to their prompt recognition. Together, these cases illustrate the potential for mechanistic insights gained from genetic diagnosis to drive translational work toward targeted, disease-modifying therapies for rare disorders.
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Ackerman MJ, Giudicessi JR. Time to Redefine the Natural History and Clinical Management of Type 1 Andersen-Tawil Syndrome? J Am Coll Cardiol 2020; 75:1785-1787. [PMID: 32299590 DOI: 10.1016/j.jacc.2020.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 03/04/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Michael J Ackerman
- Departments of Cardiovascular Medicine (Division of Heart Rhythm Services), Pediatric and Adolescent Medicine (Division of Pediatric Cardiology), and Molecular Pharmacology & Experimental Therapeutics (Windland Smith Rice Sudden Death Genomics Laboratory), Mayo Clinic, Rochester, Minnesota.
| | - John R Giudicessi
- Department of Cardiovascular Medicine (Clinician-Investigator Training Program), Mayo Clinic, Rochester, Minnesota
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Mazzanti A, Guz D, Trancuccio A, Pagan E, Kukavica D, Chargeishvili T, Olivetti N, Biernacka EK, Sacilotto L, Sarquella-Brugada G, Campuzano O, Nof E, Anastasakis A, Sansone VA, Jimenez-Jaimez J, Cruz F, Sánchez-Quiñones J, Hernandez-Afonso J, Fuentes ME, Średniawa B, Garoufi A, Andršová I, Izquierdo M, Marinov R, Danon A, Expósito-García V, Garcia-Fernandez A, Muñoz-Esparza C, Ortíz M, Zienciuk-Krajka A, Tavazzani E, Monteforte N, Bloise R, Marino M, Memmi M, Napolitano C, Zorio E, Monserrat L, Bagnardi V, Priori SG. Natural History and Risk Stratification in Andersen-Tawil Syndrome Type 1. J Am Coll Cardiol 2020; 75:1772-1784. [PMID: 32299589 DOI: 10.1016/j.jacc.2020.02.033] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 01/25/2020] [Accepted: 02/11/2020] [Indexed: 11/25/2022]
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Maffè S, Paffoni P, Bergamasco L, Dellavesa P, Zenone F, Baduena L, Franchetti Pardo N, Careri G, Facchini E, Sansone V, Parravicini U. Therapeutic management of ventricular arrhythmias in Andersen-Tawil syndrome. J Electrocardiol 2020; 58:37-42. [DOI: 10.1016/j.jelectrocard.2019.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 10/08/2019] [Accepted: 10/28/2019] [Indexed: 10/25/2022]
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Sato A, Takano T, Chinushi M, Minamino T. Usefulness of the intravenous flecainide challenge test before oral flecainide treatment in a patient with Andersen-Tawil syndrome. BMJ Case Rep 2019; 12:12/7/e229628. [PMID: 31311787 DOI: 10.1136/bcr-2019-229628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Andersen-Tawil syndrome (ATS) is an inherited disorder characterised by the triad of ventricular arrhythmias (VAs), periodic paralysis and dysmorphic features. A 31-year-old woman diagnosed with ATS caused by a KCNJ2 mutation (p.R228ins) was urgently admitted to our hospital following an episode of syncope during exercise. Electrocardiography revealed frequent premature ventricular complexes and non-sustained ventricular tachycardias (VTs) with pleomorphic QRS patterns. During the intravenous flecainide test (30 mg), the frequent VAs were inhibited completely. After oral flecainide (100 mg) was started, VAs, except for a brief bigeminy, were suppressed during the exercise test. On 24-hour Holter recordings, the VAs decreased from 50 133 to 13 363 beats/day (-73%). Sustained VT and syncope were not observed during a 3-year follow-up period. Intravenous flecainide challenge test may be useful in predicting the efficacy of oral flecainide treatment for patients with ATS.
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Affiliation(s)
- Akinori Sato
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Toshiki Takano
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masaomi Chinushi
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.,Graduate School of Health Science, Niigata University School of Medicine, Niigata, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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34
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Wilde AA, Garan H, Boyden PA. Role of the Purkinje system in heritable arrhythmias. Heart Rhythm 2019; 16:1121-1126. [DOI: 10.1016/j.hrthm.2019.01.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Indexed: 12/28/2022]
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Arnar DO, Mairesse GH, Boriani G, Calkins H, Chin A, Coats A, Deharo JC, Svendsen JH, Heidbüchel H, Isa R, Kalman JM, Lane DA, Louw R, Lip GYH, Maury P, Potpara T, Sacher F, Sanders P, Varma N, Fauchier L, Haugaa K, Schwartz P, Sarkozy A, Sharma S, Kongsgård E, Svensson A, Lenarczyk R, Volterrani M, Turakhia M, Obel IWP, Abello M, Swampillai J, Kalarus Z, Kudaiberdieva G, Traykov VB, Dagres N, Boveda S, Vernooy K, Kalarus Z, Kudaiberdieva G, Mairesse GH, Kutyifa V, Deneke T, Hastrup Svendsen J, Traykov VB, Wilde A, Heinzel FR. Management of asymptomatic arrhythmias: a European Heart Rhythm Association (EHRA) consensus document, endorsed by the Heart Failure Association (HFA), Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), Cardiac Arrhythmia Society of Southern Africa (CASSA), and Latin America Heart Rhythm Society (LAHRS). Europace 2019; 21:844–845. [DOI: 10.1093/europace/euz046] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 02/24/2019] [Indexed: 12/22/2022] Open
Abstract
AbstractAsymptomatic arrhythmias are frequently encountered in clinical practice. Although studies specifically dedicated to these asymptomatic arrhythmias are lacking, many arrhythmias still require proper diagnostic and prognostic evaluation and treatment to avoid severe consequences, such as stroke or systemic emboli, heart failure, or sudden cardiac death. The present document reviews the evidence, where available, and attempts to reach a consensus, where evidence is insufficient or conflicting.
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Affiliation(s)
- David O Arnar
- Department of Medicine, Landspitali - The National University Hospital of Iceland and University of Iceland, Reykjavik, Iceland
| | | | - Giuseppe Boriani
- Division of Cardiology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Hugh Calkins
- Department of Arrhythmia Services, Johns Hopkins Medical Institutions Baltimore, MD, USA
| | - Ashley Chin
- Division of Cardiology, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Andrew Coats
- Department of Cardiology, University of Warwick, Warwickshire, UK
| | - Jean-Claude Deharo
- Department of Rhythmology, Hôpital Universitaire La Timone, Marseille, France
| | - Jesper Hastrup Svendsen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Hein Heidbüchel
- Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Rodrigo Isa
- Clínica RedSalud Vitacura and Hospital el Carmen de Maipú, Santiago, Chile
| | - Jonathan M Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
| | - Ruan Louw
- Department Cardiology (Electrophysiology), Mediclinic Midstream Hospital, Centurion, South Africa
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
| | - Philippe Maury
- Cardiology, University Hospital Rangueil, Toulouse, France
| | - Tatjana Potpara
- Cardiology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Serbia
| | - Frederic Sacher
- Service de Cardiologie, Institut Lyric, CHU de Bordeaux, Bordeaux, France
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Niraj Varma
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Laurent Fauchier
- Service de Cardiologie et Laboratoire d'Electrophysiologie Cardiaque, Centre Hospitalier Universitaire Trousseau et Université François Rabelais, Tours, France
| | - Kristina Haugaa
- Department of Cardiology, Center for Cardiological Innovation and Institute for Surgical Research, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Peter Schwartz
- Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin, Milan, Italy
| | - Andrea Sarkozy
- Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium
| | | | - Erik Kongsgård
- Department of Cardiology, OUS-Rikshospitalet, Oslo, Norway
| | - Anneli Svensson
- Department of Cardiology, University Hospital of Linkoping, Sweden
| | | | | | - Mintu Turakhia
- Stanford University, Cardiac Arrhythmia & Electrophysiology Service, Stanford, USA
| | | | | | - Janice Swampillai
- Electrophysiologist & Cardiologist, Waikato Hospital, University of Auckland, New Zealand
| | - Zbigniew Kalarus
- SMDZ in Zabrze, Medical University of Silesia, Katowice, Poland
- Department of Cardiology, Silesian Center for Heart Diseases, Zabrze
| | | | - Vassil B Traykov
- Department of Invasive Electrophysiology and Cardiac Pacing, Clinic of Cardiology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
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Rai MK, Pai R, Prabhu MA, Pasha SW, Kedambadi RC, Kamath P, Augustine AJ, Bhavani GS, Girisha KM. Short-term response to phenytoin sodium in Andersen-Tawil syndrome-1 with a cardiac-dominant phenotype. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 42:201-207. [DOI: 10.1111/pace.13569] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 11/11/2018] [Accepted: 11/28/2018] [Indexed: 01/10/2023]
Affiliation(s)
- Maneesh K. Rai
- Department of Cardiology; Kasturba Medical College, Manipal Academy of Higher Education; Mangalore Karnataka India
| | - Rohith Pai
- Department of Neurology; Kasturba Medical College, Manipal Academy of Higher Education; Mangalore Karnataka India
| | - Mukund A. Prabhu
- Department of Cardiology; Kasturba Medical College, Manipal Academy of Higher Education; Mangalore Karnataka India
| | - Syed Waleem Pasha
- Department of Cardiology; Kasturba Medical College, Manipal Academy of Higher Education; Mangalore Karnataka India
| | - Rakshith C. Kedambadi
- Department of Neurology; Kasturba Medical College, Manipal Academy of Higher Education; Mangalore Karnataka India
| | - Padmanabh Kamath
- Department of Cardiology; Kasturba Medical College, Manipal Academy of Higher Education; Mangalore Karnataka India
| | - Alfred J. Augustine
- Department of Surgery; Kasturba Medical College, Manipal Academy of Higher Education; Mangalore Karnataka India
| | - Gangham SriLakshmi Bhavani
- Department of Medical Genetics; Kasturba Medical College, Manipal Academy of Higher Education; Manipal Karnataka India
| | - Katta M. Girisha
- Department of Medical Genetics; Kasturba Medical College, Manipal Academy of Higher Education; Manipal Karnataka India
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Son MJ, Kim MK, Yang KM, Choi BH, Lee BW, Yoo SH. Retrospective Genetic Analysis of 200 Cases of Sudden Infant Death Syndrome and Its Relationship with Long QT Syndrome in Korea. J Korean Med Sci 2018; 33:e200. [PMID: 30079003 PMCID: PMC6070466 DOI: 10.3346/jkms.2018.33.e200] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 05/16/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND There has been a campaign by the National Education on Sleeping Habits and Living Environment, to reduce the incidence of sudden infant death syndrome (SIDS). However, more than 100 infants die suddenly and unexplainably before the age of 1 year in Korea. Long QT syndrome (LQTS), an inheritable cardiac disease, has been reported to likely be associated with up to 14% of SIDS cases. However, genetic studies of the association between SIDS and LQTS have not yet been conducted in Korea. METHODS We conducted genetic analysis using genomic DNA extracted from paraffin-embedded tissue blocks from 200 SIDS cases autopsied between 2005 and 2013. We analyzed the following genetic mutations associated with LQTS, KCNQ1, SCN5A, KCNE1, KCNE2, KCNJ2, and CAV3. RESULTS Of the 200 SIDS cases, 58% involved male infants (116 male and 84 female infants, respectively), the mean age was 140 days (median, 107 days; range, 24-270 days), and they were all of Asian-Korean ethnicity. SIDS IA category criteria comprised 45 cases (22.5%) while the rest were SIDS IB. Fifteen infants (7.5%) had R1193Q in SCN5A, of doubtful pathogenicity, and no pathogenic LQTS variants were observed. CONCLUSION This genetic investigation of LQTS in SIDS showed a low diagnostic yield. These findings suggest that LQTS molecular autopsy could be cautiously conducted in selected cases with family involvement to improve the available genetic counseling information. Meanwhile, a national SIDS registry should be established to document and evaluate the genetic risk of SIDS in Korea.
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Affiliation(s)
- Min-Jeong Son
- Department of Forensic Medicine and Institute of Forensic Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Min-Kyoung Kim
- Department of Forensic Medicine and Institute of Forensic Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung-moo Yang
- Division of Forensic Medicine, National Forensic Service, Seoul, Korea
| | - Byung-Ha Choi
- Medical Examiner's Office, National Forensic Service, Wonju, Korea
| | - Bong Woo Lee
- Medical Examiner's Office, National Forensic Service, Wonju, Korea
| | - Seong Ho Yoo
- Department of Forensic Medicine and Institute of Forensic Medicine, Seoul National University College of Medicine, Seoul, Korea
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Olivotto I, Finocchiaro G, Maurizi N, Crotti L. Common presentation of rare cardiac diseases: Arrhythmias. Int J Cardiol 2018; 257:351-357. [PMID: 29506731 DOI: 10.1016/j.ijcard.2018.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 12/13/2017] [Accepted: 01/02/2018] [Indexed: 02/07/2023]
Abstract
Ventricular or supraventricular ectopic beats or atrial fibrillation may be the first presentation of uncommon cardiac disease, both acquired and genetically determined. In some patients, these manifestations can be the first sign of the underlying cardiac disorder. In others, however, they are also important as prognostic indicators, reflecting electrical instability and risk. Most cardiology clinics are busy environments where the implementation of complex diagnostic algorithms is not feasible. However, it is equally impossible to reach a final diagnosis, among the thousands of rare diseases that involve the heart, moving from a first line clinical and instrumental examination. Cardiac and extra-cardiac red flags, an accurate family and clinical history and ECG interpretation may be of help in identifying a rare disease. Advanced imaging and laboratory testing at experienced referral centers is then necessary to reach a final diagnosis, but the first step in the right direction, based on these simple elements, is the most important. We here review arrhythmic presentations of rare or relatively rare diseases, and suggest a simple "rule out-rule in" approach to help direct clinical suspicion and minimize risk of neglect.
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Affiliation(s)
- Iacopo Olivotto
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy.
| | - Gherardo Finocchiaro
- Cardiology Clinical and Academic Group, St George's University of London, United Kingdom
| | - Niccolò Maurizi
- Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Lia Crotti
- IRCCS Istituto Auxologico Italiano, Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, Milan, Italy; Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milan, Italy; Department of Medicine and Surgery, University of Milan Bicocca, Italy
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39
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Dan GA, Martinez-Rubio A, Agewall S, Boriani G, Borggrefe M, Gaita F, van Gelder I, Gorenek B, Kaski JC, Kjeldsen K, Lip GYH, Merkely B, Okumura K, Piccini JP, Potpara T, Poulsen BK, Saba M, Savelieva I, Tamargo JL, Wolpert C, Sticherling C, Ehrlich JR, Schilling R, Pavlovic N, De Potter T, Lubinski A, Svendsen JH, Ching K, Sapp JL, Chen-Scarabelli C, Martinez F. Antiarrhythmic drugs–clinical use and clinical decision making: a consensus document from the European Heart Rhythm Association (EHRA) and European Society of Cardiology (ESC) Working Group on Cardiovascular Pharmacology, endorsed by the Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS) and International Society of Cardiovascular Pharmacotherapy (ISCP). Europace 2018; 20:731-732an. [DOI: 10.1093/europace/eux373] [Citation(s) in RCA: 101] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 12/11/2017] [Indexed: 12/22/2022] Open
Affiliation(s)
- Gheorghe-Andrei Dan
- Colentina University Hospital, University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
| | - Antoni Martinez-Rubio
- University Hospital of Sabadell (University Autonoma of Barcelona), Plaça Cívica, Campus de la UAB, Barcelona, Spain
| | - Stefan Agewall
- Oslo University Hospital Ullevål, Norway
- Institute of Clinical Sciences, University of Oslo, Søsterhjemmet, Oslo, Norway
| | - Giuseppe Boriani
- Policlinico di Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Martin Borggrefe
- Universitaetsmedizin Mannheim, Medizinische Klinik, Mannheim, Germany
| | - Fiorenzo Gaita
- Department of Medical Sciences, University of Turin, Citta' della Salute e della Scienza Hospital, Turin, Italy
| | - Isabelle van Gelder
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bulent Gorenek
- Department of Cardiology, Eskisehir Osmangazi University, Büyükdere Mahallesi, Odunpazarı/Eskişehir, Turkey
| | - Juan Carlos Kaski
- Molecular and Clinical Sciences Research Institute, St. George’s, University of London, London, UK
| | - Keld Kjeldsen
- Copenhagen University Hospital (Holbæk Hospital), Holbæk, Institute for Clinical Medicine, Copenhagen University, Copenhagen, Denmark
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, Centre For Cardiovascular Sciences, City Hospital, Birmingham, UK
- Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
| | - Bela Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Ken Okumura
- Saiseikai Akumamoto Hospital, Kumamoto, Japan
| | | | - Tatjana Potpara
- School of Medicine, Belgrade University; Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | | | - Magdi Saba
- Molecular and Clinical Sciences Research Institute, St. George’s, University of London, London, UK
| | - Irina Savelieva
- Molecular and Clinical Sciences Research Institute, St. George’s, University of London, London, UK
| | - Juan L Tamargo
- Department of Pharmacology, School of Medicine, Universidad Complutense Madrid, Madrid, Spain
| | - Christian Wolpert
- Department of Medicine - Cardiology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | | | - Joachim R Ehrlich
- Medizinische Klinik I-Kardiologie, Angiologie, Pneumologie, Wiesbaden, Germany
| | - Richard Schilling
- Barts Heart Centre, Trustee Arrhythmia Alliance and Atrial Fibrillation Association, London, UK
| | - Nikola Pavlovic
- Department of Cardiology, University Hospital Centre Sestre milosrdnice, Croatia
| | | | - Andrzej Lubinski
- Uniwersytet Medyczny w Łodzi, Kierownik Kliniki Kardiologii Interwencyjnej, i Zaburzeń Rytmu Serca, Kierownik Katedry Chorób Wewnętrznych i Kardiologii, Uniwersytecki Szpital Kliniczny im WAM-Centralny Szpital Weteranów, Poland
| | | | - Keong Ching
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | | | | | - Felipe Martinez
- Instituto DAMIC/Fundacion Rusculleda, Universidad Nacional de Córdoba, Córdoba, Argentina
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40
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Different responses to exercise between Andersen–Tawil syndrome and catecholaminergic polymorphic ventricular tachycardia. Europace 2017; 20:1675-1682. [DOI: 10.1093/europace/eux351] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 10/31/2017] [Indexed: 11/15/2022] Open
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Statland JM, Fontaine B, Hanna MG, Johnson NE, Kissel JT, Sansone VA, Shieh PB, Tawil RN, Trivedi J, Cannon SC, Griggs RC. Review of the Diagnosis and Treatment of Periodic Paralysis. Muscle Nerve 2017; 57:522-530. [PMID: 29125635 PMCID: PMC5867231 DOI: 10.1002/mus.26009] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 10/24/2017] [Accepted: 11/07/2017] [Indexed: 01/16/2023]
Abstract
Periodic paralyses (PPs) are rare neuromuscular disorders caused by mutations in skeletal muscle sodium, calcium, and potassium channel genes. PPs include hypokalemic paralysis, hyperkalemic paralysis, and Andersen‐Tawil syndrome. Common features of PP include autosomal dominant inheritance, onset typically in the first or second decades, episodic attacks of flaccid weakness, which are often triggered by diet or rest after exercise. Diagnosis is based on the characteristic clinic presentation then confirmed by genetic testing. In the absence of an identified genetic mutation, documented low or high potassium levels during attacks or a decrement on long exercise testing support diagnosis. The treatment approach should include both management of acute attacks and prevention of attacks. Treatments include behavioral interventions directed at avoidance of triggers, modification of potassium levels, diuretics, and carbonic anhydrase inhibitors. Muscle Nerve57: 522–530, 2018
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Affiliation(s)
- Jeffrey M Statland
- Department of Neurology, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, Kansas, 66160, USA
| | - Bertrand Fontaine
- Sorbonne-Université, INSERM, AP-HP, Reference Center for Channelopathies, Department of Neuology, University Hospital Pitié-Salpêtrière, Paris, France
| | - Michael G Hanna
- MRC Center for Neuromuscular Diseases, University College of London Institute of Neurology, London, England
| | - Nicholas E Johnson
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - John T Kissel
- Department of Neurology, The Ohio State University, Columbus, Ohio, USA
| | - Valeria A Sansone
- The NEMO Center, Neurorehabilitation Unit, University of Milan, Italy
| | - Perry B Shieh
- Department of Neurology, University of California at Los Angeles School of Medicine, Los Angeles, California, USA
| | - Rabi N Tawil
- Department of Neurology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Jaya Trivedi
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Stephen C Cannon
- Department of Physiology, University of California at Los Angeles School of Medicine, Los Angeles, California, USA
| | - Robert C Griggs
- Department of Neurology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
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Fernández M, Marín MDR, Fernández-Armenta J, Mora-López F, Fernández Rivero R, Berruezo A, Cano Calabria L, Vázquez García R. Response to flecainide test in Andersen-Tawil syndrome with incessant ventricular tachycardia. Pacing Clin Electrophysiol 2017; 41:429-432. [PMID: 29023786 DOI: 10.1111/pace.13204] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 09/06/2017] [Accepted: 09/14/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Marcos Fernández
- Arrhythmia Section, Cardiology Department, Puerta del Mar University Hospital, Cádiz, Spain
| | | | - Juan Fernández-Armenta
- Arrhythmia Section, Cardiology Department, Puerta del Mar University Hospital, Cádiz, Spain
| | | | | | - Antonio Berruezo
- Arrhythmia Section, Cardiovascular Institute, Hospital Clínic, Barcelona, Spain
| | - Lucas Cano Calabria
- Arrhythmia Section, Cardiology Department, Puerta del Mar University Hospital, Cádiz, Spain
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Wolpert C, Vogel M, Nagel C, Herrera-Siklody C, Rüb N. [Ventricular arrhythmias in ion channel diseases]. Herzschrittmacherther Elektrophysiol 2017; 28:169-176. [PMID: 28534204 DOI: 10.1007/s00399-017-0510-6] [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: 04/04/2017] [Accepted: 04/13/2017] [Indexed: 06/07/2023]
Abstract
In patients with ion channel disease the predominant arrhythmias are polymorphic ventricular tachycardias (VT), torsade de pointes tachycardia and ventricular fibrillation (VF). In only extremely rare cases is very rapid monomorphic ventricular tachycardia observed. This is why implantable cardioverter-defibrillators (ICDs) should always be programmed for treatment of VF only with high detection rates to avoid inappropriate discharges. In idiopathic VF and catecholaminergic polymorphic ventricular tachycardia (CPVT), no baseline electrocardiographic abnormalities can be detected, whereas in Brugada syndrome, long QT syndrome, early repolarisation syndrome and Anderson-Tawil syndrome alterations of the baseline ECG are very important to identify patients at risk.
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Affiliation(s)
- Christian Wolpert
- Medizinische Klinik für Kardiologie, Nephrologie und Internistische Intensivmedizin, Klinikum Ludwigsburg, Posilipostrasse 4, 71640, Ludwigsburg, Deutschland.
| | - Mara Vogel
- Medizinische Klinik für Kardiologie, Nephrologie und Internistische Intensivmedizin, Klinikum Ludwigsburg, Posilipostrasse 4, 71640, Ludwigsburg, Deutschland
| | - Christian Nagel
- Medizinische Klinik für Kardiologie, Nephrologie und Internistische Intensivmedizin, Klinikum Ludwigsburg, Posilipostrasse 4, 71640, Ludwigsburg, Deutschland
| | - Claudia Herrera-Siklody
- Medizinische Klinik für Kardiologie, Nephrologie und Internistische Intensivmedizin, Klinikum Ludwigsburg, Posilipostrasse 4, 71640, Ludwigsburg, Deutschland
| | - Norman Rüb
- Medizinische Klinik für Kardiologie, Nephrologie und Internistische Intensivmedizin, Klinikum Ludwigsburg, Posilipostrasse 4, 71640, Ludwigsburg, Deutschland
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Krych M, Biernacka EK, Ponińska J, Kukla P, Filipecki A, Gajda R, Hasdemir C, Antzelevitch C, Kosiec A, Szperl M, Płoski R, Trusz-Gluza M, Mizia-Stec K, Hoffman P. Andersen-Tawil syndrome: Clinical presentation and predictors of symptomatic arrhythmias - Possible role of polymorphisms K897T in KCNH2 and H558R in SCN5A gene. J Cardiol 2017; 70:504-510. [PMID: 28336205 DOI: 10.1016/j.jjcc.2017.01.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 12/27/2016] [Accepted: 01/12/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Andersen-Tawil syndrome (ATS) is rare channelopathy caused by KCNJ2 mutation and probably KCNJ5. It is characterized by arrhythmias, neurological symptoms, and dysmorphic features. The present study retrospectively examined the characteristics of 11 unrelated families with ATS. METHODS This study consisted of 11 probands positive for KCNJ2 variants and 33 family members (mean age 30.0±17.3 years, female n=31). Additional genetic screening of 3 LQTS genes (KCNQ1, KCNH2, SCN5A) was performed in 9 families. Predictors of arrhythmias [premature ventricular beats>2000/24h, biventricular and polymorphic ventricular tachycardia (VT)], syncope, and/or cardiac arrest (CA) were evaluated. RESULTS In KCNJ2 mutation carriers vs non-carriers (n=25 vs n=19) significant differences were observed in U-wave manifestations in V2-V4, Tpeak-Tend duration, QTUc duration (p<0.0001), dysmorphic features, and neurological symptoms. Compared to asymptomatic carriers (n=9), in those with arrhythmias and/or syncope and/or CA (n=16) micrognathia (p=0.004), periodic paralysis (p=0.019), palpitation (p=0.005), U-wave n V2-V4 (p=0.049) were more frequent; QTU (p=0.045) and Tpeak-Tend (p=0.014) were also longer (n=9). In the subgroup of carriers with syncope and/or cardiac arrest (n=10, 90% women), K897T-KCNH2 polymorphism (p=0.02), periodic paralysis (p=0.004), muscle weakness (p=0.04), palpitations (p=0.04), arrhythmias (biventricular VT, p=0.003; polymorphic VT, p=0.009) were observed more frequently. Tpeak-Tend duration was longer (p=0.007) and the percentage of patients with premature ventricular contraction >2000/24h was higher (p=0.005). CONCLUSION A higher risk of arrhythmia, syncope, and/or CA is associated with the presence of micrognathia, periodic paralysis, and prolonged Tpeak-Tend time. Our findings suggest that K897T may contribute to the occurrence of syncope.
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Affiliation(s)
- Michalina Krych
- Department of Congenital Cardiac Defects, Institute of Cardiology, Warsaw, Poland.
| | | | - Joanna Ponińska
- Department of Molecular Biology, Institute of Cardiology, Warsaw, Poland
| | - Piotr Kukla
- Department of Cardiology and Internal Medicine, Specialistic Hospital, Gorlice, Poland
| | - Artur Filipecki
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | | | - Can Hasdemir
- Department of Cardiology, Ege University School of Medicine, Izmir, Turkey
| | | | - Agnieszka Kosiec
- Department of Molecular Biology, Institute of Cardiology, Warsaw, Poland
| | - Małgorzata Szperl
- Department of Molecular Biology, Institute of Cardiology, Warsaw, Poland
| | - Rafał Płoski
- Department of Medical Genetics, Warsaw Medical University, Poland
| | - Maria Trusz-Gluza
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Katarzyna Mizia-Stec
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Piotr Hoffman
- Department of Congenital Cardiac Defects, Institute of Cardiology, Warsaw, Poland
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Kuroda Y, Yuasa S, Watanabe Y, Ito S, Egashira T, Seki T, Hattori T, Ohno S, Kodaira M, Suzuki T, Hashimoto H, Okata S, Tanaka A, Aizawa Y, Murata M, Aiba T, Makita N, Furukawa T, Shimizu W, Kodama I, Ogawa S, Kokubun N, Horigome H, Horie M, Kamiya K, Fukuda K. Flecainide ameliorates arrhythmogenicity through NCX flux in Andersen-Tawil syndrome-iPS cell-derived cardiomyocytes. Biochem Biophys Rep 2017; 9:245-256. [PMID: 28956012 PMCID: PMC5614591 DOI: 10.1016/j.bbrep.2017.01.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 12/09/2016] [Accepted: 01/10/2017] [Indexed: 12/15/2022] Open
Abstract
Andersen-Tawil syndrome (ATS) is a rare inherited channelopathy. The cardiac phenotype in ATS is typified by a prominent U wave and ventricular arrhythmia. An effective treatment for this disease remains to be established. We reprogrammed somatic cells from three ATS patients to generate induced pluripotent stem cells (iPSCs). Multi-electrode arrays (MEAs) were used to record extracellular electrograms of iPSC-derived cardiomyocytes, revealing strong arrhythmic events in the ATS-iPSC-derived cardiomyocytes. Ca2+ imaging of cells loaded with the Ca2+ indicator Fluo-4 enabled us to examine intracellular Ca2+ handling properties, and we found a significantly higher incidence of irregular Ca2+ release in the ATS-iPSC-derived cardiomyocytes than in control-iPSC-derived cardiomyocytes. Drug testing using ATS-iPSC-derived cardiomyocytes further revealed that antiarrhythmic agent, flecainide, but not the sodium channel blocker, pilsicainide, significantly suppressed these irregular Ca2+ release and arrhythmic events, suggesting that flecainide's effect in these cardiac cells was not via sodium channels blocking. A reverse-mode Na+/Ca2+exchanger (NCX) inhibitor, KB-R7943, was also found to suppress the irregular Ca2+ release, and whole-cell voltage clamping of isolated guinea-pig cardiac ventricular myocytes confirmed that flecainide could directly affect the NCX current (INCX). ATS-iPSC-derived cardiomyocytes recapitulate abnormal electrophysiological phenotypes and flecainide suppresses the arrhythmic events through the modulation of INCX. iPS cells are generated from three patients with ATS. ATS-iPS cell-derived cardiomyocytes show abnormal electrophysiological phenotypes. Flecainide suppresses abnormal electrophysiological phenotypes in ATS-iPS cell-derived cardiomyocytes.
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Affiliation(s)
- Yusuke Kuroda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.,Department of Cardiovascular Research, Research Institute of Environmental Medicine, Nagoya University, Aichi, Japan.,Department of Cardiology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Shinsuke Yuasa
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yasuhide Watanabe
- Division of Pharmacological Science, Department of Health Science, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Shogo Ito
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Toru Egashira
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Tomohisa Seki
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Tetsuhisa Hattori
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Shiga, Japan
| | - Seiko Ohno
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Shiga, Japan.,Center for Epidemiologic Research in Asia, Shiga University of Medical Science, Shiga, Japan
| | - Masaki Kodaira
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Tomoyuki Suzuki
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.,Department of Cardiovascular Research, Research Institute of Environmental Medicine, Nagoya University, Aichi, Japan.,Department of Cardiology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Hisayuki Hashimoto
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Shinichiro Okata
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Atsushi Tanaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Yoshiyasu Aizawa
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Mitsushige Murata
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.,Department of Laboratory Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Takeshi Aiba
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Naomasa Makita
- Department of Molecular Pathophysiology-1, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tetsushi Furukawa
- Department of Bio-informational Pharmacology, Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Itsuo Kodama
- Department of Cardiovascular Research, Research Institute of Environmental Medicine, Nagoya University, Aichi, Japan
| | - Satoshi Ogawa
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Norito Kokubun
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
| | - Hitoshi Horigome
- Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Minoru Horie
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Shiga, Japan
| | - Kaichiro Kamiya
- Department of Cardiovascular Research, Research Institute of Environmental Medicine, Nagoya University, Aichi, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
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Song J, Luo S, Cheng X, Yue D, Zhu W, Lin J, Huang J, Lu J, Zhao C, Qiao K. Clinical features and long exercise test in Chinese patients with Andersen-Tawil syndrome. Muscle Nerve 2016; 54:1059-1063. [PMID: 27145478 DOI: 10.1002/mus.25169] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 03/13/2016] [Accepted: 04/25/2016] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Andersen-Tawil syndrome (ATS) is a rare multisystem channelopathy characterized by periodic paralysis, ventricular arrhythmias, and developmental dysmorphology. There are few reports concerning ATS in the Chinese population. We analyzed clinical features and evaluated the long exercise test as a tool for diagnosis of periodic paralysis in ATS. METHODS Direct sequencing of KCNJ2 was performed in 12 subjects from mainland China with suspected ATS. Clinical features, therapeutic responses, and long exercise tests (LET) were retrospectively analyzed. RESULTS Twelve patients were genetically confirmed to have ATS. A small mandible and clinodactyly were demonstrated in all patients. Premature ventricular contractions were the most prevalent form of cardiac arrhythmia. The LET revealed an early amplitude decrement. CONCLUSIONS Chinese ATS patients shared some common clinical features with reported subjects in other countries. An early amplitude decrement in LET may be useful for diagnosis of ATS. Muscle Nerve 54: 1059-1063, 2016.
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Affiliation(s)
- Jie Song
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Sushan Luo
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xin Cheng
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Dongyue Yue
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Wenhua Zhu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jie Lin
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jun Huang
- Department of clinical electrophysiology, Institute of Neurology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
| | - Jiahong Lu
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Chongbo Zhao
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Kai Qiao
- Department of clinical electrophysiology, Institute of Neurology, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, 200040, China
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Amarouch MY, Swan H, Leinonen J, Marjamaa A, Lahtinen AM, Kontula K, Toivonen L, Widen E, Abriel H. Antiarrhythmic Action of Flecainide in Polymorphic Ventricular Arrhythmias Caused by a Gain-of-Function Mutation in the Nav 1.5 Sodium Channel. Ann Noninvasive Electrocardiol 2015; 21:343-51. [PMID: 26965448 DOI: 10.1111/anec.12312] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 07/04/2015] [Accepted: 07/15/2015] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The cardiac sodium channel Nav 1.5, encoded by the gene SCN5A, is associated with a wide spectrum of hereditary arrhythmias. The gain-of-function mutation p.I141V in SCN5A was identified in a large multigenerational family with exercise-induced polymorphic ventricular arrhythmias. The purpose of this study was to evaluate the molecular and clinical effects of flecainide administration on patients with this syndrome. METHODS Eleven p.I141V carriers who exhibited frequent multiformic premature ventricular complexes (PVCs) during exercise were subjected to exercise stress tests, both before and after intravenous infusion of 2 mg/kg flecainide. The in vitro effects of flecainide were evaluated using the patch-clamp technique with HEK293 cells expressing the Nav 1.5 channel. RESULTS The flecainide treatment significantly reduced the frequency of PVCs during and after exercise. Next, the sensitivity of the p.I141V mutant channel to flecainide was compared to that of the wild type channel. Perfusion of flecainide inhibited the peak and window currents in both groups. CONCLUSION The clinical investigations of the affected patients, as well as the molecular and pharmacological characterization of the SCN5A p.I141V mutation, provide new evidence supporting the association of this mutation with exercise-induced polymorphic ventricular arrhythmias. These data also demonstrate that flecainide may serve as an effective treatment for the defect in Nav 1.5 that leads to an increased sodium window current.
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Affiliation(s)
| | - Heikki Swan
- Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland
| | - Jaakko Leinonen
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Annukka Marjamaa
- Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland
| | - Annukka M Lahtinen
- Department of Medicine, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Kimmo Kontula
- Department of Medicine, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Lauri Toivonen
- Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland
| | - Elisabeth Widen
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Hugues Abriel
- Department of Clinical Research, University of Bern, Bern, Switzerland
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Fadahunsi O, Shaikh B, Rettew A, Bennett K, Scollan D. Atrial pacing for the management of ventricular arrhythmias in Andersen-Tawil syndrome. HeartRhythm Case Rep 2015; 1:352-355. [PMID: 28491582 PMCID: PMC5419674 DOI: 10.1016/j.hrcr.2015.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Opeyemi Fadahunsi
- Department of Medicine, Reading Health System, West Reading, Pennsylvania
| | - Bilal Shaikh
- Department of Medicine, Reading Health System, West Reading, Pennsylvania
| | - Andrew Rettew
- Department of Medicine, Reading Health System, West Reading, Pennsylvania
| | - Kyle Bennett
- Department of Medicine, Reading Health System, West Reading, Pennsylvania
| | - David Scollan
- Cardiology Associates of West Reading, West Reading, Pennsylvania
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49
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Tadros R, Cadrin-Tourigny J, Abadir S, Rivard L, Nattel S, Talajic M, Khairy P. Pharmacotherapy for inherited arrhythmia syndromes: mechanistic basis, clinical trial evidence and practical application. Expert Rev Cardiovasc Ther 2015; 13:769-82. [DOI: 10.1586/14779072.2015.1049156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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50
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Miyamoto K, Aiba T, Kimura H, Hayashi H, Ohno S, Yasuoka C, Tanioka Y, Tsuchiya T, Yoshida Y, Hayashi H, Tsuboi I, Nakajima I, Ishibashi K, Okamura H, Noda T, Ishihara M, Anzai T, Yasuda S, Miyamoto Y, Kamakura S, Kusano K, Ogawa H, Horie M, Shimizu W. Efficacy and safety of flecainide for ventricular arrhythmias in patients with Andersen-Tawil syndrome with KCNJ2 mutations. Heart Rhythm 2015; 12:596-603. [DOI: 10.1016/j.hrthm.2014.12.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Indexed: 11/24/2022]
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