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Groh WJ, Bhakta D, Tomaselli GF, Aleong RG, Teixeira RA, Amato A, Asirvatham SJ, Cha YM, Corrado D, Duboc D, Goldberger ZD, Horie M, Hornyak JE, Jefferies JL, Kääb S, Kalman JM, Kertesz NJ, Lakdawala NK, Lambiase PD, Lubitz SA, McMillan HJ, McNally EM, Milone M, Namboodiri N, Nazarian S, Patton KK, Russo V, Sacher F, Santangeli P, Shen WK, Sobral Filho DC, Stambler BS, Stöllberger C, Wahbi K, Wehrens XHT, Weiner MM, Wheeler MT, Zeppenfeld K. 2022 HRS expert consensus statement on evaluation and management of arrhythmic risk in neuromuscular disorders. Heart Rhythm 2022; 19:e61-e120. [PMID: 35500790 DOI: 10.1016/j.hrthm.2022.04.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 04/21/2022] [Indexed: 11/04/2022]
Abstract
This international multidisciplinary document is intended to guide electrophysiologists, cardiologists, other clinicians, and health care professionals in caring for patients with arrhythmic complications of neuromuscular disorders (NMDs). The document presents an overview of arrhythmias in NMDs followed by detailed sections on specific disorders: Duchenne muscular dystrophy, Becker muscular dystrophy, and limb-girdle muscular dystrophy type 2; myotonic dystrophy type 1 and type 2; Emery-Dreifuss muscular dystrophy and limb-girdle muscular dystrophy type 1B; facioscapulohumeral muscular dystrophy; and mitochondrial myopathies, including Friedreich ataxia and Kearns-Sayre syndrome, with an emphasis on managing arrhythmic cardiac manifestations. End-of-life management of arrhythmias in patients with NMDs is also covered. The document sections were drafted by the writing committee members according to their area of expertise. The recommendations represent the consensus opinion of the expert writing group, graded by class of recommendation and level of evidence utilizing defined criteria. The recommendations were made available for public comment; the document underwent review by the Heart Rhythm Society Scientific and Clinical Documents Committee and external review and endorsement by the partner and collaborating societies. Changes were incorporated based on these reviews. By using a breadth of accumulated available evidence, the document is designed to provide practical and actionable clinical information and recommendations for the diagnosis and management of arrhythmias and thus improve the care of patients with NMDs.
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Affiliation(s)
- William J Groh
- Ralph H. Johnson VA Medical Center and Medical University of South Carolina, Charleston, South Carolina
| | - Deepak Bhakta
- Indiana University School of Medicine, Indianapolis, Indiana
| | | | | | | | - Anthony Amato
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - Domenico Corrado
- Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy
| | - Denis Duboc
- Cardiology Department, Hôpital Cochin, AP-HP, Université de Paris, Paris, France
| | - Zachary D Goldberger
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Minoru Horie
- Shiga University of Medical Sciences, Otsu, Japan
| | | | | | - Stefan Kääb
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany
| | - Jonathan M Kalman
- Royal Melbourne Hospital and University of Melbourne, Melbourne, Victoria, Australia
| | | | - Neal K Lakdawala
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Pier D Lambiase
- Barts Heart Centre, St Bartholomew's Hospital, University College London, and St Bartholomew's Hospital London, London, United Kingdom
| | | | - Hugh J McMillan
- Montreal Children's Hospital, McGill University, Montreal, Quebec, Canada
| | | | | | - Narayanan Namboodiri
- Sree Chitra Institute for Medical Sciences and Technology, Thiruvananthapuram, India
| | | | | | | | - Frederic Sacher
- Bordeaux University Hospital, LIRYC Institute, Bordeaux, France
| | | | | | | | | | - Claudia Stöllberger
- Second Medical Department with Cardiology and Intensive Care Medicine, Klinik Landstraße, Vienna, Austria
| | - Karim Wahbi
- Cardiology Department, Hôpital Cochin, AP-HP, Université de Paris, Paris, France
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Norrish G, Rance T, Montanes E, Field E, Brown E, Bhole V, Stuart G, Uzun O, McLeod KA, Ilina M, Adwani S, Daubeney P, Delle Donne G, Linter K, Jones CB, Bharucha T, Cervi E, Kaski JP. Friedreich's ataxia-associated childhood hypertrophic cardiomyopathy: a national cohort study. Arch Dis Child 2022; 107:450-455. [PMID: 34610949 PMCID: PMC9046745 DOI: 10.1136/archdischild-2021-322455] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/17/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Hypertrophic cardiomyopathy (HCM) is an important predictor of long-term outcomes in Friedreich's ataxia (FA), but the clinical spectrum and survival in childhood is poorly described. This study aimed to describe the clinical characteristics of children with FA-HCM. DESIGN AND SETTING Retrospective, longitudinal cohort study of children with FA-HCM from the UK. PATIENTS 78 children (<18 years) with FA-HCM diagnosed over four decades. INTERVENTION Anonymised retrospective demographic and clinical data were collected from baseline evaluation and follow-up. MAIN OUTCOME MEASURES The primary study end-point was all-cause mortality (sudden cardiac death, atrial arrhythmia-related death, heart failure-related death, non-cardiac death) or cardiac transplantation. RESULTS The mean age at diagnosis of FA-HCM was 10.9 (±3.1) years. Diagnosis was within 1 year of cardiac referral in 34 (65.0%) patients, but preceded the diagnosis of FA in 4 (5.3%). At baseline, 65 (90.3%) had concentric left ventricular hypertrophy and 6 (12.5%) had systolic impairment. Over a median follow-up of 5.1 years (IQR 2.4-7.3), 8 (10.5%) had documented supraventricular arrhythmias and 8 (10.5%) died (atrial arrhythmia-related n=2; heart failure-related n=1; non-cardiac n=2; or unknown cause n=3), but there were no sudden cardiac deaths. Freedom from death or transplantation at 10 years was 80.8% (95% CI 62.5 to 90.8). CONCLUSIONS This is the largest cohort of childhood FA-HCM reported to date and describes a high prevalence of atrial arrhythmias and impaired systolic function in childhood, suggesting early progression to end-stage disease. Overall mortality is similar to that reported in non-syndromic childhood HCM, but no patients died suddenly.
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Affiliation(s)
- Gabrielle Norrish
- Centre for Inherited Cardiovascular Disease, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK,Institute of Cardiovascular Science, University College London, London, UK
| | - Thomas Rance
- Centre for Inherited Cardiovascular Disease, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Elena Montanes
- Centre for Inherited Cardiovascular Disease, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Ella Field
- Centre for Inherited Cardiovascular Disease, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Elspeth Brown
- Paediatric Cardiology, Leeds General Infirmary, Leeds, UK
| | - Vinay Bhole
- Paediatric Cardiology, Birmingham Women and Children’s NHS Foundation Trust, Birmingham, UK
| | - Graham Stuart
- Bristol Congenital Heart Centre, Bristol Heart Institute, Bristol, UK
| | - Orhan Uzun
- Paediatric cardiology, University Hospital of Wales, Cardiff, UK
| | - Karen A McLeod
- Paediatric cardiology, Royal Hospital for Sick Children, Glasgow, UK
| | - Maria Ilina
- Paediatric cardiology, Royal Hospital for Children, Glasgow, UK
| | - Satish Adwani
- Paediatric Cardiology, John Radcliffe Hospital, Oxford, UK
| | - Piers Daubeney
- Paediatric cardiology, Royal Brompton and Harefield NHS Trust and National Heart and Lung Institute, London, UK
| | - Grazia Delle Donne
- Paediatric cardiology, Royal Brompton and Harefield NHS Trust and National Heart and Lung Institute, London, UK
| | - Katie Linter
- Paediatric cardiology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Caroline B Jones
- Paediatric cardiology, Alder Hey Children’s Hospital, Liverpool, UK
| | - Tara Bharucha
- Department of Congenital Cardiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Elena Cervi
- Centre for Inherited Cardiovascular Disease, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK
| | - Juan Pablo Kaski
- Centre for Inherited Cardiovascular Disease, Great Ormond Street Hospital For Children NHS Foundation Trust, London, UK .,Institute of Cardiovascular Science, University College London, London, UK
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Monda E, Lioncino M, Rubino M, Passantino S, Verrillo F, Caiazza M, Cirillo A, Fusco A, Di Fraia F, Fimiani F, Amodio F, Borrelli N, Mauriello A, Natale F, Scarano G, Girolami F, Favilli S, Limongelli G. Diagnosis and Management of Cardiovascular Involvement in Friedreich Ataxia. Heart Fail Clin 2021; 18:31-37. [PMID: 34776081 DOI: 10.1016/j.hfc.2021.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Friedreich ataxia (FRDA) is an autosomal recessive neurodegenerative disorder caused by a homozygous GAA triplet repeat expansion in the frataxin gene. Cardiac involvement, usually manifesting as hypertrophic cardiomyopathy, can range from asymptomatic cases to severe cardiomyopathy with progressive deterioration of the left ventricular ejection fraction and chronic heart failure. The management of cardiac involvement is directed to prevent disease progression and cardiovascular complications. However, direct-disease therapies are not currently available for FRDA. The present review aims to describe the current state of knowledge regarding cardiovascular involvement of FRDA, focusing on clinical-instrumental features and management of cardiac manifestation.
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Affiliation(s)
- Emanuele Monda
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, 80131 Naples, Italy
| | - Michele Lioncino
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, 80131 Naples, Italy
| | - Marta Rubino
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, 80131 Naples, Italy
| | - Silvia Passantino
- Department of Pediatric Cardiology, Meyer Children's Hospital, Viale Gaetano Pieraccini, 24, 50139 Florence, Italy
| | - Federica Verrillo
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, 80131 Naples, Italy
| | - Martina Caiazza
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, 80131 Naples, Italy
| | - Annapaola Cirillo
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, 80131 Naples, Italy
| | - Adelaide Fusco
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, 80131 Naples, Italy
| | - Francesco Di Fraia
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, 80131 Naples, Italy
| | - Fabio Fimiani
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, 80131 Naples, Italy
| | - Federica Amodio
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, 80131 Naples, Italy
| | - Nunzia Borrelli
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, 80131 Naples, Italy
| | - Alfredo Mauriello
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, 80131 Naples, Italy
| | - Francesco Natale
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, 80131 Naples, Italy
| | - Gioacchino Scarano
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, 80131 Naples, Italy
| | - Francesca Girolami
- Department of Pediatric Cardiology, Meyer Children's Hospital, Viale Gaetano Pieraccini, 24, 50139 Florence, Italy
| | - Silvia Favilli
- Department of Pediatric Cardiology, Meyer Children's Hospital, Viale Gaetano Pieraccini, 24, 50139 Florence, Italy
| | - Giuseppe Limongelli
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Via L. Bianchi, 80131 Naples, Italy; Institute of Cardiovascular Sciences, University College of London and St. Bartholomew's Hospital, Grower Street, London WC1E 6DD, UK.
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Zipse MM, Aleong RG. Acquired Pulmonary Vein Isolation in a Patient with Friedreich Ataxia. Card Electrophysiol Clin 2016; 8:151-3. [PMID: 26920184 DOI: 10.1016/j.ccep.2015.10.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The electrophysiologic nature of atrial fibrillation (AF) and related atrial arrhythmias in Friedreich ataxia has not previously been characterized. In the presented case, dense atrial scar had progressed to the point of acquired pulmonary vein (PV) isolation before the delivery of a single radiofrequency lesion. AF was induced, and ultimately organized spontaneously into a microreentrant atrial tachycardia. Other atrial tachycardias were also identified near scar border zones; these potentially served as triggers for AF in this patient, independent of the PVs. This case emphasizes the need to address non-PV substrate in some patients undergoing catheter ablation of AF.
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Affiliation(s)
- Matthew M Zipse
- Cardiac Electrophysiology, Cardiology Division, University of Colorado, Denver, Anschutz Medical Campus, 12401 East 17th Avenue, B-132, Aurora, CO 80045, USA.
| | - Ryan G Aleong
- Cardiac Electrophysiology, Cardiology Division, University of Colorado, Denver, Anschutz Medical Campus, 12401 East 17th Avenue, B-132, Aurora, CO 80045, USA.
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Lynch DR, Regner SR, Schadt KA, Friedman LS, Lin KY, Sutton MGSJ. Management and therapy for cardiomyopathy in Friedreich’s ataxia. Expert Rev Cardiovasc Ther 2014; 10:767-77. [DOI: 10.1586/erc.12.57] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Dedobbeleer C, Rai M, Donal E, Pandolfo M, Unger P. Normal left ventricular ejection fraction and mass but subclinical myocardial dysfunction in patients with Friedreich's ataxia. Eur Heart J Cardiovasc Imaging 2011; 13:346-52. [DOI: 10.1093/ejechocard/jer267] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bourke T, Keane D. Friedreich's Ataxia: a review from a cardiology perspective. Ir J Med Sci 2011; 180:799-805. [PMID: 21822977 DOI: 10.1007/s11845-011-0744-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Accepted: 07/16/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Neuromuscular disorders are not among the common causes of cardiomyopathy in the general population; however, cardiomyopathy is known to occur in several neuromuscular disorders including Friedreich's Ataxia (FA). In patients with neuromuscular disorders, concomitant cardiac involvement contributes significantly to morbidity and mortality and often leads to premature death. METHODS An extensive literature search of Medline and Pubmed was conducted to include all published reports on cardiac involvement in FA. Secondary articles were identified from key paper reference listings. CONCLUSION Hypertrophic cardiomyopathy is a cardinal feature of FA; therefore all FA patients should be screened for cardiomyopathy. A cardiac examination, ECG and ECHO are advised at diagnosis, and also on the development of any cardiac symptoms. Treatment is determined by the presence of symptoms, the presence of left ventricular outflow gradient and the sudden death risk. Institution of aggressive medical therapy early in the course of the disease may help improve quality of life and provide survival benefit.
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Affiliation(s)
- T Bourke
- Cardiac Arrhythmia Service, St Vincent's University Hospital, Elm Park, Dublin, Ireland.
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