1
|
Ning S, Han M, Qiu R, Hong X, Xia Z, Liu L, Liu C. Novel pathogenic variant in LMNA gene identified in a six-generation family causing atrial cardiomyopathy and associated right atrial conduction arrhythmias. Front Cardiovasc Med 2023; 10:1109008. [PMID: 37465451 PMCID: PMC10350631 DOI: 10.3389/fcvm.2023.1109008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 06/14/2023] [Indexed: 07/20/2023] Open
Abstract
Objective To characterize the cardiac phenotype associated with the novel pathogenic variant (c.1526del) of LMNA gene, which we identified in a large, six-generation family. Methods and Results A family tree was constructed. The clinical data of living and deceased family members were collected. DNA samples from 7 family members were analyzed for LMNA mutations using whole-exome high-throughput sequencing technology. The clinical presentation of pathogenic variant carriers was evaluated. In this six-generation family (n = 67), one member experienced sudden death at the age of 40-years-old. Three pathogenic variant carriers were identified to possess a novel heterozygous deletion mutation in LMNA gene (HGVS: NM_170707.4, c.1526del) located at exon 9 of LMNA chr1:156137145, which creates a premature translational stop signal (p.Pro509Leufs*39) in the LMNA gene and results in an mutant lamin A protein product. The main symptoms of the pathogenic variant carriers were palpitation, fatigue, and syncope, which typically occurred around 20-years-old. AV-conduction block and non-sustained ventricular tachycardia were the first signs of disease and would rapidly progress to atrial standstill around 30-years-old. Significant right atrial enlargement and bicuspid aortic valve malformation was also commonly seen in patients who carried this pathogenic variant. Conclusion The pathogenic variant of c.1526del p.P509Lfs*39 was a frameshift deletion located at exon 9 of LMNA chr1:156137145 and causes severe right atrial enlargement, sick sinus syndrome, atrial standstill, ventricular tachycardia, and bicuspid aortic valve malformation. Our findings expand the phenotypic spectrum of novel LMNA gene mutations.
Collapse
Affiliation(s)
| | | | | | | | | | - Li Liu
- Correspondence: Li Liu Chengwei Liu
| | | |
Collapse
|
2
|
Robl S, Bimpong-Buta NY, Iliodromitis K, Bogossian H. [Electrophysiologic study to define the underlying heart rhythm]. Herzschrittmacherther Elektrophysiol 2022; 33:243-246. [PMID: 35552485 DOI: 10.1007/s00399-022-00853-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Sebastian Robl
- Klinik für Kardiologie und Rhythmologie, Evangelisches Krankenhaus Hagen-Haspe, Brusebrinkstraße 20, 58135, Hagen, Deutschland
| | - Nana-Yaw Bimpong-Buta
- Klinik für Kardiologie und Rhythmologie, Evangelisches Krankenhaus Hagen-Haspe, Brusebrinkstraße 20, 58135, Hagen, Deutschland
| | - Konstantinos Iliodromitis
- Klinik für Kardiologie und Rhythmologie, Evangelisches Krankenhaus Hagen-Haspe, Brusebrinkstraße 20, 58135, Hagen, Deutschland
| | - Harilaos Bogossian
- Klinik für Kardiologie und Rhythmologie, Evangelisches Krankenhaus Hagen-Haspe, Brusebrinkstraße 20, 58135, Hagen, Deutschland. .,Universität Witten/Herdecke, Witten, Deutschland.
| |
Collapse
|
3
|
Lisi DD, Di Caccamo L, Damerino G, Portelli MC, Comparato F, Stefano VD, Brighina F, Corrado E, Galassi AR, Novo G. Effectiveness and Safety of oral anticoagulants in cardiac amyloidosis: lights and shadows. Curr Probl Cardiol 2022:101188. [DOI: 10.1016/j.cpcardiol.2022.101188] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 03/22/2022] [Indexed: 12/18/2022]
|
4
|
Atrial remodeling and metabolic dysfunction in idiopathic isolated fibrotic atrial cardiomyopathy. Int J Cardiol 2018; 265:155-161. [PMID: 29706431 DOI: 10.1016/j.ijcard.2018.04.080] [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: 12/28/2017] [Revised: 03/18/2018] [Accepted: 04/18/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND Idiopathic isolated fibrotic atrial cardiomyopathy (IIF-ACM) is a novel subtype of cardiomyopathy characterized by atrial fibrosis that does not involve the ventricular myocardium and is associated with significant atrial tachyarrhythmia. The mechanisms underlying its pathogenesis are unknown. METHODS Atrium samples were obtained from 3 patients with IIF-ACM via surgical intervention. Control samples were consisted of 3 atrium biopsies from patients with congenital heart disease and normal sinus rhythm, matched for gender, age and basic clinical characteristics. Comparative histology, immunofluorescence staining, electron microscopy and proteomics analyses were carried out to explore the unique pathogenesis of IIF-ACM. RESULTS IIF-ACM atria displayed disordered myofibrils, profound fibrosis and mitochondrial damages compared to the control atria. Proteomics profiling identified metabolic pathways as the most profound changes in IIF-ACM. CONCLUSIONS Our study suggested that metabolic changes in the atrial myocardium caused mitochondrial oxidative stress and potential cell damage, which further led to atrial fibrosis and myofibril disorganization, the characteristic phenotype of IIF-ACM.
Collapse
|
5
|
Ju W, Li M, Wang DW, Yang B, Shao Y, Wang J, Tang L, Ni B, Chen H, Zhang F, Gu K, Yang G, Cui C, Qi R, Xiao F, Fan Q, Wang J, Zhang S, Cao K, Kong X, Feng D, Chen M. Idiopathic isolated fibrotic atrial cardiomyopathy underlies unexplained scar-related atrial tachycardia in younger patients. Europace 2017; 20:1657-1665. [PMID: 29293999 DOI: 10.1093/europace/eux340] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Accepted: 10/19/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Weizhu Ju
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, China
| | - Mingfang Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, China
| | - Dao Wu Wang
- The Heart and Lung Institute, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, China
| | - Bing Yang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, China
| | - Yongfeng Shao
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, China
| | - Jiaxian Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, China
| | - Lijun Tang
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, China
| | - Buqing Ni
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, China
| | - Hongwu Chen
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, China
| | - Fengxiang Zhang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, China
| | - Kai Gu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, China
| | - Gang Yang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, China
| | - Chang Cui
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, China
| | - Rundi Qi
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, China
| | - Fangyi Xiao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, China
| | - Qinhe Fan
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, China
| | - Jie Wang
- Department of Cardiology, Columbia University, New York, NY, USA
| | - Shijiang Zhang
- The Heart and Lung Institute, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, China
| | - Kejiang Cao
- The Heart and Lung Institute, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, China
| | - Xiangqing Kong
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, China
| | - DaLi Feng
- Metropolitan Heart and Vascular Institute, Minneapolis, MN, USA
| | - Minglong Chen
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, China
| |
Collapse
|
6
|
Agrawal H, Aggarwal K, Alpert MA. Persistent atrial standstill following the Cox-maze III procedure: reversal with sustained atrial pacing. Ann Noninvasive Electrocardiol 2017; 22:e12399. [PMID: 27558131 PMCID: PMC6931504 DOI: 10.1111/anec.12399] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Atrial standstill is a rare disorder of cardiac rhythm that is characterized by total absence of electrical activity in one or both atria. We report herein the case of a patient with atrial fibrillation and symptomatic 4.0 s pauses who received a ventricular demand pacemaker. The patient later underwent mitral valve replacement with a pericardial tissue valve and the Cox-maze III procedure for symptomatic mitral stenosis and atrial fibrillation. Following surgery, he developed atrial standstill and became pacemaker dependent. The pacemaker was later revised to an atrioventricular sequential pacemaker. Twelve hours after revision, atrioventricular sequential pacing was noted and mechanical function of the atria was confirmed by Doppler echocardiography.
Collapse
Affiliation(s)
- Harsh Agrawal
- Division of Cardiovascular MedicineUniversity of Missouri School of MedicineColumbiaMissouriUSA
| | - Kul Aggarwal
- Division of Cardiovascular MedicineUniversity of Missouri School of MedicineColumbiaMissouriUSA
| | - Martin A. Alpert
- Division of Cardiovascular MedicineUniversity of Missouri School of MedicineColumbiaMissouriUSA
| |
Collapse
|
7
|
|
8
|
Disertori M, Quintarelli S, Grasso M, Pilotto A, Narula N, Favalli V, Canclini C, Diegoli M, Mazzola S, Marini M, Del Greco M, Bonmassari R, Masè M, Ravelli F, Specchia C, Arbustini E. Autosomal recessive atrial dilated cardiomyopathy with standstill evolution associated with mutation of Natriuretic Peptide Precursor A. ACTA ACUST UNITED AC 2012; 6:27-36. [PMID: 23275345 DOI: 10.1161/circgenetics.112.963520] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Atrial dilatation and atrial standstill are etiologically heterogeneous phenotypes with poorly defined nosology. In 1983, we described 8-years follow-up of atrial dilatation with standstill evolution in 8 patients from 3 families. We later identified 5 additional patients with identical phenotypes: 1 member of the largest original family and 4 unrelated to the 3 original families. All families are from the same geographic area in Northeast Italy. METHODS AND RESULTS We followed up the 13 patients for up to 37 years, extended the clinical investigation and monitoring to living relatives, and investigated the genetic basis of the disease. The disease was characterized by: (1) clinical onset in adulthood; (2) biatrial dilatation up to giant size; (3) early supraventricular arrhythmias with progressive loss of atrial electric activity to atrial standstill; (4) thromboembolic complications; and (5) stable, normal left ventricular function and New York Heart Association functional class during the long-term course of the disease. By linkage analysis, we mapped a locus at 1p36.22 containing the Natriuretic Peptide Precursor A gene. By sequencing Natriuretic Peptide Precursor A, we identified a homozygous missense mutation (p.Arg150Gln) in all living affected individuals of the 6 families. All patients showed low serum levels of atrial natriuretic peptide. Heterozygous mutation carriers were healthy and demonstrated normal levels of atrial natriuretic peptide. CONCLUSIONS Autosomal recessive atrial dilated cardiomyopathy is a rare disease associated with homozygous mutation of the Natriuretic Peptide Precursor A gene and characterized by extreme atrial dilatation with standstill evolution, thromboembolic risk, preserved left ventricular function, and severely decreased levels of atrial natriuretic peptide.
Collapse
|
9
|
DUNCAN EDWARD, SCHILLING RICHARDJ, EARLEY MARK. Isolated Left Atrial Standstill Identified during Catheter Ablation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 36:e120-4. [DOI: 10.1111/j.1540-8159.2010.02957.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Revised: 07/06/2012] [Accepted: 08/15/2010] [Indexed: 10/18/2022]
Affiliation(s)
- EDWARD DUNCAN
- Department of Cardiology, Barts and the London NHS Trust; London; UK
| | | | - MARK EARLEY
- Department of Cardiology, Barts and the London NHS Trust; London; UK
| |
Collapse
|
10
|
Abstract
Amyloidosis is a clinical disorder caused by the extracellular deposition of misfolded, insoluble aggregated protein with a characteristic ss pleated sheet configuration that produces apple-green birefringence under polarized light when stained with Congo red dye. The spectrum of organ involvement can include the kidneys, heart, blood vessels, central and peripheral nervous systems, liver, intestines, lungs, eyes, skin, and bones. Cardiovascular amyloidosis can be primary, a part of systemic amyloidosis, or the result of chronic systemic disease elsewhere in the body. The most common presentations are congestive heart failure because of restrictive cardiomyopathy and conduction abnormalities. Recent developments in imaging techniques and extracardiac tissue sampling have minimized the need for invasive endomyocardial biopsy for amyloidosis. Cardiac amyloidosis management will vary depending on the subtype but consists of supportive treatment of cardiac related symptoms and reducing the amyloid fibrils formation attacking the underlying disease. Despite advances in treatment, the prognosis for patients with amyloidosis is still poor and depends on the underlying disease type. Early diagnosis of cardiac amyloidosis may improve outcomes but requires heightened suspicion and a systematic clinical approach to evaluation. Delays in diagnosis, uncertainties about the relative merits of available therapies, and difficulties in mounting large-scale clinical trials in rare disorders combine to keep cardiac amyloidosis a challenging problem. This review outlines current approaches to diagnosis, assessment of disease severity, and treatment of cardiac amyloidosis.
Collapse
|
11
|
Turitto G, Saponieri C, Onuora A, El-Sherif N. Prolonged transient atrial electrical silence following termination of chronic atrial tachyarrhythmias. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 30:1311-5. [PMID: 17976091 DOI: 10.1111/j.1540-8159.2007.00863.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Atrial standstill is a rare heterogeneous arrhythmia characterized by electrical and mechanical standstill and electrical inexcitability. A long-lasting progressive form is seen with cardiac and neuromuscular diseases, and a familial or idiopathic form may have a genetic basis. A transient form was described secondary to drug intoxication, electrolyte imbalance, cardiac inflammation, and ischemia. METHODS We investigated three patients with long-standing atrial tachyarrhythmia (AT) (atrial flutter in two, and focal atrial tachycardia in one). All patients underwent a complete electrophysiological study with mapping of right and left atrial activity and radiofrequency ablation (RF Abl) of AT. RESULTS Following RF Abl of AT, all three patients manifested transient atrial electrical silence in the absence of known reversible causes. Atrial electrical silence was observed when, following AT termination, an escape atrioventricular (AV) junctional rhythm (in two patients) and an escape VVI pacemaker rhythm (in one patient) showed transient ventriculo-atrial (VA) conduction block (up to 30 seconds). A dominant sinus rhythm was observed to return 30 minutes, 90 minutes, and 12 hours, respectively, in the three patients. Two patients received a dual chamber pacemaker and a decision was made not to upgrade the patient with VVI pacemaker. DISCUSSION AND CONCLUSIONS The present report expands the spectrum of the syndrome of atrial standstill and raises interesting questions regarding possible electrophysiologic mechanism(s) of prolonged post overdrive atrial standstill. The report suggests that chronic overdrive of sinus and subsidiary atrial pacemakers may result in calcium overloading of cardiac cells, which is known to cause suppression of pacemaker activity as well as increased intracellular resistance. These mechanisms can possibly result in either prolonged suppression of sinus and atrial pacemaker activity and/or pacemaker exit block.
Collapse
Affiliation(s)
- Gioia Turitto
- Cardiac Electrophysiology Services, New York Methodist Hospital, 506 Sixth Street, Brooklyn, NY 11215, USA.
| | | | | | | |
Collapse
|
12
|
Sanders P, Kalman JM. Progressive and Persistent Atrial Inexcitability. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2006; 29:546-8. [PMID: 16689854 DOI: 10.1111/j.1540-8159.2006.00392.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Sinus node disease is characterized by the presence of significant sinus bradycardia or prolonged sinus pauses, and is attributed to either primary failure of sinus node automaticity or sino-atrial conduction disturbance. We present two patients with symptomatic bradycardia due to idiopathic global atrial inexcitability.
Collapse
Affiliation(s)
- Prashanthan Sanders
- Department of Cardiology, Royal Melbourne Hospital, and Department of Medicine, University of Melbourne, Australia.
| | | |
Collapse
|
13
|
Fazelifar AF, Arya A, Haghjoo M, Sadr-Ameli MA. Familial Atrial Standstill in Association with Dilated Cardiomyopathy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2005; 28:1005-8. [PMID: 16176547 DOI: 10.1111/j.1540-8159.2005.00198.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
. Atrial standstill is an extremely uncommon arrhythmia that rarely appears to be familial and genetically determined. Atrial standstill has been associated with several conditions including, but not restricted to, congenital heart disease, valvular heart disease, conduction disturbances, Brugada syndrome, myocardial infarction, and amyloidosis. Only a few cases of familial clustering of atrial standstill have been reported so far. This report represents a family with atrial standstill associated with syncope, dilated cardiomyopathy, and sudden cardiac death.
Collapse
Affiliation(s)
- Amir Farjam Fazelifar
- Department of Pacemaker and Electrophysiology, Rajaie Cardiovascular Medical Center, Iran University of Medical Sciences, Mellat Park, Vali-Asr Avenue, Tehran 1996911151, Iran
| | | | | | | |
Collapse
|
14
|
Modesto KM, Dispenzieri A, Cauduro SA, Lacy M, Khandheria BK, Pellikka PA, Belohlavek M, Seward JB, Kyle R, Tajik AJ, Gertz M, Abraham TP. Left atrial myopathy in cardiac amyloidosis: implications of novel echocardiographic techniques. Eur Heart J 2004; 26:173-9. [PMID: 15618074 DOI: 10.1093/eurheartj/ehi040] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
AIMS To assess left atrial (LA) function and determine the prevalence of LA dysfunction in AL amyloidosis (AL) using conventional and strain echocardiography. METHODS AND RESULTS LA ejection fraction, LA filling fraction, LA ejection force, peak LA systolic strain rate (LAsSR), and LA systolic strain (LA epsilon) were determined in 95 AL patients (70 with and 25 without echocardiographic evidence of cardiac involvement, abbreviated CAL and NCAL, respectively), 30 age-matched controls (CON), and 20 patients with diastolic dysfunction and LA dilatation (DD). Peak LAsSR >2 standard deviations below mean CON value was used as the cut-off for normal LA function. LA ejection fraction was lower in CAL when compared with CON (40.4+/-13.6 vs. 67.0+/-6%, P=0.01). Left atrial septal strain rate and strain were lower in CAL (0.8+/-0.5 s(-1) and 5.5+/-4%, respectively) compared with CON (1.8+/-0.8 s(-1) and 14+/-4%, respectively, P=<0.0001), NCAL (1.6+/-0.8 s(-1) and 13+/-7%, respectively, P<0.0001) and DD (1.3+/-0.4 s(-1) and 10+/-2%, respectively, P<0.0001). Based on peak LA systolic strain rate criteria, the cut-off values for normal LA function were -1.1 s(-1) and -1.05 s(-1) for lateral and septal walls. Using these criteria, LA dysfunction was identified in 32% (lateral LA criteria) and 60% (septal LA criteria) of CAL patients. Lateral and septal LAsSR were lower in CAL patients with vs. those without symptoms of heart failure. Inter- and intra-observer agreement was high for LA strain echocardiography. CONCLUSION LA function assessment using strain echocardiography is feasible with low intra- and inter-observer variability. LA dysfunction is observed in AL patients without other echocardiographic features of cardiac involvement and may contribute to cardiac symptoms in CAL.
Collapse
Affiliation(s)
- Karen M Modesto
- Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Groenewegen WA, Firouzi M, Bezzina CR, Vliex S, van Langen IM, Sandkuijl L, Smits JPP, Hulsbeek M, Rook MB, Jongsma HJ, Wilde AAM. A cardiac sodium channel mutation cosegregates with a rare connexin40 genotype in familial atrial standstill. Circ Res 2003; 92:14-22. [PMID: 12522116 DOI: 10.1161/01.res.0000050585.07097.d7] [Citation(s) in RCA: 182] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Atrial standstill (AS) is a rare arrhythmia that occasionally appears to be genetically determined. This study investigates the genetic background of this arrhythmogenic disorder in a large family. Forty-four family members were clinically evaluated. One deceased and three living relatives were unambiguously affected by AS. All other relatives appeared unaffected. Candidate gene screening revealed a novel mutation in the cardiac sodium channel gene SCN5A (D1275N) in all three affected living relatives and in five unaffected relatives, and the deceased relative was an obligate carrier. In addition, two closely linked polymorphisms were detected within regulatory regions of the gene for the atrial-specific gap junction protein connexin40 (Cx40) at nucleotides -44 (G-->A) and +71 (A-->G). Eight relatives were homozygous for both polymorphisms, which occurred in only approximately 7% of control subjects, and three of these relatives were affected by AS. The three living AS patients exclusively coinherited both the rare Cx40 genotype and the SCN5A-D1275N mutation. SCN5A-D1275N channels showed a small depolarizing shift in activation compared with wild-type channels. Rare Cx40 genotype reporter gene analysis showed a reduction in reporter gene expression compared with the more common Cx40 genotype. In this study, familial AS was associated with the concurrence of a cardiac sodium channel mutation and rare polymorphisms in the atrial-specific Cx40 gene. We propose that, although the functional effect of each genetic change is relatively benign, the combined effect of genetic changes eventually progresses to total AS.
Collapse
|
16
|
Davies MK. Images in cardiology. Infective endocarditis. Heart 1995; 74:540. [PMID: 8562242 PMCID: PMC484077 DOI: 10.1136/hrt.74.5.540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
|
17
|
Wang K, Gibson DG. Non-invasive detection of left atrial mechanical failure in patients with left ventricular disease. Heart 1995; 74:536-40. [PMID: 8562241 PMCID: PMC484076 DOI: 10.1136/hrt.74.5.536] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE To define patients with left atrial mechanical failure and identify its echocardiographic, physiological, and clinical associations. DESIGN Prospective study with cross sectionally guided M mode and Doppler echocardiograms, and with apexcardiograms, electrocardiograms, and phonocardiograms. SETTING Tertiary cardiac referral centre. PATIENTS 10 patients with left atrial mechanical failure and 20 healthy controls of similar age. RESULTS 10 patients with left atrial mechanical paralysis were identified among 4036 adults over a 1 year interval. Nine were in sinus rhythm and one had a DDD pacemaker. Left atrial mechanical activity was absent on M mode echocardiograms of the left sided atrioventricular ring and the aortic root. A Doppler A wave on transmitral flow and a clearly defined A wave on the left ventricular apexcardiogram were also absent, though evidence of right atrial mechanical movement was present in nine patients. Mean (SD) age was 63 (19) years and six were men. Nine had left ventricular disease and one had undergone extensive resection of the left atrium. Abnormal measurements of left ventricular end diastolic dimension (62 (13) mm), fractional shortening (15 (6)%), isovolumic relaxation time (19 (12) ms), left atrial size (45 (10) mm), and transmitral Doppler E wave deceleration time (110 (35) ms) were recorded. CONCLUSION Left atrial mechanical failure may be present in patients with left ventricular disease despite normal sinus rhythm. Normal atrial activation on 12 lead electrocardiogram suggests it is primarily mechanical in origin. The possibility of left atrial mechanical failure must be considered when Doppler patterns of transmitral flow are used to assess left ventricular diastolic function.
Collapse
Affiliation(s)
- K Wang
- Cardiac Department, Royal Brompton Hospital, London
| | | |
Collapse
|
18
|
Nakazato Y, Nakata Y, Hisaoka T, Sumiyoshi M, Ogura S, Yamaguchi H. Clinical and electrophysiological characteristics of atrial standstill. Pacing Clin Electrophysiol 1995; 18:1244-54. [PMID: 7659578 DOI: 10.1111/j.1540-8159.1995.tb06964.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
To clarify the clinical and electrophysiological characteristics of atrial standstill (AS) we studied 11 patients (7 males and 4 females), whose average age was 62 years and who were followed over a period of 4-179 months. Underlying heart disease was present in nine patients and two cases were idiopathic. Major clinical symptoms in the 11 cases included Adams-Stokes attacks, and dyspnea on exertion. In the standard 12-lead ECGs obtained on admission, the P wave was absent in six cases. Atrial flutter (AF) was noted in 3, atrial fibrillation (Af) in 1, and multifocal atrial tachycardia in 1. In some cases, the ECG initially showed AF or Af, and was transformed after several years into ectopic atrial tachycardia or an ectopic atrial rhythm with a markedly decreased amplitude of the P wave. Finally, the P wave disappeared over a prolonged period. When intracardiac mapping was performed, the atrial electrograms tended to diminish at the site of high, mid-lateral right atrium (RA). Electrograms were remained present in the vicinity of the tricuspid valve (TV) annulus. A repeated mapping and pacing study conducted in two patients revealed that the "silent" area spread toward the lower site of RA. During the average follow-up period of 64 months, four patients died. The interval until death in one patient with myocarditis was 6 months, and in another with dilated cardiomyopathy (DCM) it was 8 months. It appears that the atrial muscular lesion starts in the high lateral RA and progresses toward the lower RA, then to the vicinity of the TV annulus. A diffuse and progressive disturbance may occur not only in the atrial muscle, but also in the atrioventricular conduction system in patients with AS who had progressive myocarditis or DCM.
Collapse
Affiliation(s)
- Y Nakazato
- Department of Internal Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | | | | | | | | | | |
Collapse
|
19
|
Abstract
Atrial standstill is a rare disorder usually seen in adults with extreme myocardial disease. Etiologies described in the literature have included muscular dystrophy, familial amyloidosis, and rarely myocarditis. These etiologies usually lead to permanent atrial standstill and require ventricular pacing. We present a case of an 11-year-old black female who developed atrial standstill secondary to biopsy proven acute necrotizing myocarditis. Absence of atrial function was confirmed by surface electrocardiogram, echocardiogram, and an invasive electrophysiology study. Atrial function returned within 3 days of initiation of methyl-prednisolone. In cases of atrial standstill due to myocarditis, a delay in the placement of a permanent pacemaker with or without a trial of methylprednisolone may prove beneficial.
Collapse
Affiliation(s)
- J P Straumanis
- Medical University of South Carolina, Department of Pediatrics, Charleston
| | | | | |
Collapse
|
20
|
de Freitas AF, Costa PP. Atrial systolic failure in cardiac amyloidosis. N Engl J Med 1993; 328:1198; author reply 1198-9. [PMID: 8455693 DOI: 10.1056/nejm199304223281613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
|
21
|
Affiliation(s)
- J F Plehn
- Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, N.H. 03756
| | | | | |
Collapse
|
22
|
Talwar KK, Dev V, Chopra P, Dave TH, Radhakrishnan S. Persistent atrial standstill--clinical, electrophysiological, and morphological study. Pacing Clin Electrophysiol 1991; 14:1274-80. [PMID: 1719505 DOI: 10.1111/j.1540-8159.1991.tb02867.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Persistent atrial standstill (PAS) is a rare disorder characterized by absence of atrial activity on the surface and intracavity electrograms, absence of atrial mechanical activity, and inability to electrically stimulate the atria. Four patients (ages 18-60 years) with PAS were evaluated. One of these (no. 3) only had right atrial (RA) standstill, whereas left atrium (LA) showed spontaneous activity and could be stimulated electrically. As RA biopsy is not possible, right ventricular (RV) endomyocardial biopsy (EMB) was obtained to identify possible atrial pathology that revealed inflammatory myocarditis, 2; amyloidosis, 1; and myocardial hypertrophy with fibrosis, 1. Three patients were given permanent pacemakers. One of these with amyloidosis died suddenly. One is lost to follow-up. The others cases are persisting with PAS.
Collapse
Affiliation(s)
- K K Talwar
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi
| | | | | | | | | |
Collapse
|
23
|
Abstract
Atrial standstill (atrial paralysis) is a rare reason for permanent bradycardia. A case of atrial standstill is presented. A 35-year-old man had suffered from bradycardia since his childhood. For 2 years he had complaints (diminishment of his working capacity, and dyspnea occurred with effort) as well. On admission, a slow (38/min) junctional escape rhythm could be detected. There were no signs of atrial mechanical activity (atrial contraction) according to chest x ray, echocardiography, and the atrial pressure curve. The electrophysiological study revealed that the atria could not be electrically stimulated, and no P wave (A wave) could be recorded on right atrial electrograms. The patient received a rate responsive pacemaker. After pacemaker implantation, he became symptom-free; his working capacity improved markedly and his heart size decreased. Owing to the permanent bradycardia and the lack of atrial stimulation, the atrial standstill represents an indication for ventricular rate responsive pacing. Atrial standstill, permanent bradycardia, and the inability to stimulate the atrium are indications for ventricular rate responsive pacing.
Collapse
Affiliation(s)
- F Solti
- Cardiovascular Surgical Clinic, Budapest, Hungary
| | | | | |
Collapse
|