1
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Marijon E, Narayanan K, Smith K, Barra S, Basso C, Blom MT, Crotti L, D'Avila A, Deo R, Dumas F, Dzudie A, Farrugia A, Greeley K, Hindricks G, Hua W, Ingles J, Iwami T, Junttila J, Koster RW, Le Polain De Waroux JB, Olasveengen TM, Ong MEH, Papadakis M, Sasson C, Shin SD, Tse HF, Tseng Z, Van Der Werf C, Folke F, Albert CM, Winkel BG. The Lancet Commission to reduce the global burden of sudden cardiac death: a call for multidisciplinary action. Lancet 2023; 402:883-936. [PMID: 37647926 DOI: 10.1016/s0140-6736(23)00875-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 04/13/2023] [Accepted: 04/25/2023] [Indexed: 09/01/2023]
Abstract
Despite major advancements in cardiovascular medicine, sudden cardiac death (SCD) continues to be an enormous medical and societal challenge, claiming millions of lives every year. Efforts to prevent SCD are hampered by imperfect risk prediction and inadequate solutions to specifically address arrhythmogenesis. Although resuscitation strategies have witnessed substantial evolution, there is a need to strengthen the organisation of community interventions and emergency medical systems across varied locations and health-care structures. With all the technological and medical advances of the 21st century, the fact that survival from sudden cardiac arrest (SCA) remains lower than 10% in most parts of the world is unacceptable. Recognising this urgent need, the Lancet Commission on SCD was constituted, bringing together 30 international experts in varied disciplines. Consistent progress in tackling SCD will require a completely revamped approach to SCD prevention, with wide-sweeping policy changes that will empower the development of both governmental and community-based programmes to maximise survival from SCA, and to comprehensively attend to survivors and decedents' families after the event. International collaborative efforts that maximally leverage and connect the expertise of various research organisations will need to be prioritised to properly address identified gaps. The Commission places substantial emphasis on the need to develop a multidisciplinary strategy that encompasses all aspects of SCD prevention and treatment. The Commission provides a critical assessment of the current scientific efforts in the field, and puts forth key recommendations to challenge, activate, and intensify efforts by both the scientific and global community with new directions, research, and innovation to reduce the burden of SCD worldwide.
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Affiliation(s)
- Eloi Marijon
- Division of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France; Université Paris Cité, Inserm, PARCC, Paris, France; Paris-Sudden Death Expertise Center (Paris-SDEC), Paris, France.
| | - Kumar Narayanan
- Université Paris Cité, Inserm, PARCC, Paris, France; Paris-Sudden Death Expertise Center (Paris-SDEC), Paris, France; Medicover Hospitals, Hyderabad, India
| | - Karen Smith
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Silverchain Group, Melbourne, VIC, Australia
| | - Sérgio Barra
- Department of Cardiology, Hospital da Luz Arrábida, Vila Nova de Gaia, Portugal
| | - Cristina Basso
- Cardiovascular Pathology Unit-Azienda Ospedaliera and Department of Cardiac Thoracic and Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Marieke T Blom
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Lia Crotti
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin, Cardiomyopathy Unit and Laboratory of Cardiovascular Genetics, Department of Cardiology, Milan, Italy
| | - Andre D'Avila
- Department of Cardiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Cardiology, Hospital SOS Cardio, Santa Catarina, Brazil
| | - Rajat Deo
- Department of Cardiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Florence Dumas
- Université Paris Cité, Inserm, PARCC, Paris, France; Paris-Sudden Death Expertise Center (Paris-SDEC), Paris, France; Emergency Department, Cochin Hospital, Paris, France
| | - Anastase Dzudie
- Cardiology and Cardiac Arrhythmia Unit, Department of Internal Medicine, DoualaGeneral Hospital, Douala, Cameroon; Yaounde Faculty of Medicine and Biomedical Sciences, University of Yaounde 1, Yaounde, Cameroon
| | - Audrey Farrugia
- Hôpitaux Universitaires de Strasbourg, France, Strasbourg, France
| | - Kaitlyn Greeley
- Division of Cardiology, European Georges Pompidou Hospital, AP-HP, Paris, France; Université Paris Cité, Inserm, PARCC, Paris, France; Paris-Sudden Death Expertise Center (Paris-SDEC), Paris, France
| | | | - Wei Hua
- Cardiac Arrhythmia Center, FuWai Hospital, Beijing, China
| | - Jodie Ingles
- Centre for Population Genomics, Garvan Institute of Medical Research and UNSW Sydney, Sydney, NSW, Australia
| | - Taku Iwami
- Kyoto University Health Service, Kyoto, Japan
| | - Juhani Junttila
- MRC Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Rudolph W Koster
- Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | | | - Theresa M Olasveengen
- Department of Anesthesia and Intensive Care Medicine, Oslo University Hospital and Institute of Clinical Medicine, Oslo, Norway
| | - Marcus E H Ong
- Singapore General Hospital, Duke-NUS Medical School, Singapore
| | - Michael Papadakis
- Cardiovascular Clinical Academic Group, St George's University of London, London, UK
| | | | - Sang Do Shin
- Department of Emergency Medicine at the Seoul National University College of Medicine, Seoul, South Korea
| | - Hung-Fat Tse
- University of Hong Kong, School of Clinical Medicine, Queen Mary Hospital, Hong Kong Special Administrative Region, China; Cardiac and Vascular Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Zian Tseng
- Division of Cardiology, UCSF Health, University of California, San Francisco Medical Center, San Francisco, California
| | - Christian Van Der Werf
- University of Amsterdam, Heart Center, Amsterdam, Netherlands; Department of Clinical and Experimental Cardiology, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Fredrik Folke
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christine M Albert
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Bo Gregers Winkel
- Department of Cardiology, University Hospital Copenhagen, Rigshospitalet, Copenhagen, Denmark
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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: 731] [Impact Index Per Article: 365.5] [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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Krahn AD, Behr ER, Hamilton R, Probst V, Laksman Z, Han HC. Brugada Syndrome. JACC Clin Electrophysiol 2022; 8:386-405. [PMID: 35331438 DOI: 10.1016/j.jacep.2021.12.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/09/2021] [Accepted: 12/15/2021] [Indexed: 12/15/2022]
Abstract
Brugada syndrome (BrS) is an "inherited" condition characterized by predisposition to syncope and cardiac arrest, predominantly during sleep. The prevalence is ∼1:2,000, and is more commonly diagnosed in young to middle-aged males, although patient sex does not appear to impact prognosis. Despite the perception of BrS being an inherited arrhythmia syndrome, most cases are not associated with a single causative gene variant. Electrocardiogram (ECG) findings support variable extent of depolarization and repolarization changes, with coved ST-segment elevation ≥2 mm and a negative T-wave in the right precordial leads. These ECG changes are often intermittent, and may be provoked by fever or sodium channel blocker challenge. Growing evidence from cardiac imaging, epicardial ablation, and pathology studies suggests the presence of an epicardial arrhythmic substrate within the right ventricular outflow tract. Risk stratification aims to identify those who are at increased risk of sudden cardiac death, with well-established factors being the presence of spontaneous ECG changes and a history of cardiac arrest or cardiogenic syncope. Current management involves conservative measures in asymptomatic patients, including fever management and drug avoidance. Symptomatic patients typically undergo implantable cardioverter defibrillator insertion, with quinidine and epicardial ablation used for patients with recurrent arrhythmia. This review summarizes our current understanding of BrS and provides clinicians with a practical approach to diagnosis and management.
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Affiliation(s)
- Andrew D Krahn
- Center for Cardiovascular Innovation, Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Elijah R Behr
- Cardiovascular Clinical Academic Group and Cardiology Research Centre, St. George's, University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Robert Hamilton
- Department of Pediatrics (Cardiology), The Labatt Family Heart Centre and Translational Medicine, The Hospital for Sick Children & Research Institute and the University of Toronto, Toronto, Canada
| | - Vincent Probst
- Cardiologic Department and Reference Center for Hereditary Arrhythmic Diseases, Nantes University Hospital, Nantes, France
| | - Zachary Laksman
- Center for Cardiovascular Innovation, Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hui-Chen Han
- Center for Cardiovascular Innovation, Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada; Victorian Heart Institute, Monash University, Clayton, Victoria, Australia
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Blich M, Oron H, Darawsha W, Suleiman M, Avraham L, Asaad K, Boulos M, Gepstein L. Non-ischemic sudden cardiac arrest: Role of 12 lead Holter, family screening and genetic testing. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2021; 44:1347-1354. [PMID: 34105179 DOI: 10.1111/pace.14294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/12/2021] [Accepted: 06/06/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE AND BACKGROUND To evaluate the diagnostic and prognostic yield of a comprehensive protocol involving clinical and broad genetic testing in consecutive sudden cardiac arrest (SCA) population. Determining the pathogenesis of non-ischemic SCA is crucial for management and SCA prevention in other family members METHODS: Families with unexplained non-ischemic SCA event underwent rigorous clinical and genetic protocol after referral to our inherited arrhythmia clinic, during 2011-2017. RESULTS One hundred and four index cases, 29 ± 16 years, and 421 family members were studied. After a thorough evaluation, diagnosis was made in 80 (77%) of families. The most prevalent 47/104 (45%) diagnosis was inherited channelopathy. The genetic test was positive, in 37 /69 (54%) of patients. Using the Mann Whitney test, we found that electrocardiography (ECG) (effect size 0.5, p < .001), 12 lead Holter (effect size 0.33, p = .001) and family screening (effect size 0.4, p = .001) had the highest yield in reaching the final diagnosis. Family screening, genetic testing, and cardiac MRI were the exclusive modalities for final diagnosis in 14%, 9%, and 2% of families, respectively. Among 421 family members evaluated through cascade screening, 127 (30%), were diagnosed and medically treated. Nine family members from 25 (40%) patients who underwent implantable cardioverter defibrillator (ICD) implantation have experienced appropriate ICD shock. CONCLUSIONS A rigorous, systematic protocol in a specialized inherited arrhythmia clinic has a high diagnostic and prognostic yield. ECG, 12 lead Holter and family screening significantly increased the diagnostic yield. In nine families, without genetic testing, the diagnosis would have been missed.
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Affiliation(s)
- Miry Blich
- Inherited Arrhythmia Clinic, Rambam Health Care Campus, Haifa, Israel.,Division of Pacing and Electrophysiology, Rambam Health Care Campus, Haifa, Israel
| | - Hodaya Oron
- Inherited Arrhythmia Clinic, Rambam Health Care Campus, Haifa, Israel
| | - Wisam Darawsha
- Division of Pacing and Electrophysiology, Rambam Health Care Campus, Haifa, Israel
| | - Mahmoud Suleiman
- Division of Pacing and Electrophysiology, Rambam Health Care Campus, Haifa, Israel
| | - Lorber Avraham
- Department of Pediatric Cardiology, Rambam Health Care Campus, Haifa, Israel
| | - Kchoury Asaad
- Department of Pediatric Cardiology, Rambam Health Care Campus, Haifa, Israel
| | - Monther Boulos
- Division of Pacing and Electrophysiology, Rambam Health Care Campus, Haifa, Israel
| | - Lior Gepstein
- Division of Pacing and Electrophysiology, Rambam Health Care Campus, Haifa, Israel
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Stiles MK, Wilde AAM, Abrams DJ, Ackerman MJ, Albert CM, Behr ER, Chugh SS, Cornel MC, Gardner K, Ingles J, James CA, Juang JMJ, Kääb S, Kaufman ES, Krahn AD, Lubitz SA, MacLeod H, Morillo CA, Nademanee K, Probst V, Saarel EV, Sacilotto L, Semsarian C, Sheppard MN, Shimizu W, Skinner JR, Tfelt-Hansen J, Wang DW. 2020 APHRS/HRS expert consensus statement on the investigation of decedents with sudden unexplained death and patients with sudden cardiac arrest, and of their families. J Arrhythm 2021; 37:481-534. [PMID: 34141003 PMCID: PMC8207384 DOI: 10.1002/joa3.12449] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 10/14/2020] [Indexed: 12/26/2022] Open
Abstract
This international multidisciplinary document intends to provide clinicians with evidence-based practical patient-centered recommendations for evaluating patients and decedents with (aborted) sudden cardiac arrest and their families. The document includes a framework for the investigation of the family allowing steps to be taken, should an inherited condition be found, to minimize further events in affected relatives. Integral to the process is counseling of the patients and families, not only because of the emotionally charged subject, but because finding (or not finding) the cause of the arrest may influence management of family members. The formation of multidisciplinary teams is essential to provide a complete service to the patients and their families, and the varied expertise of the writing committee was formulated to reflect this need. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by Class of Recommendation and Level of Evidence. The recommendations were opened for public comment and reviewed by the relevant scientific and clinical document committees of the Asia Pacific Heart Rhythm Society (APHRS) and the Heart Rhythm Society (HRS); the document underwent external review and endorsement by the partner and collaborating societies. While the recommendations are for optimal care, it is recognized that not all resources will be available to all clinicians. Nevertheless, this document articulates the evaluation that the clinician should aspire to provide for patients with sudden cardiac arrest, decedents with sudden unexplained death, and their families.
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Affiliation(s)
- Martin K Stiles
- Waikato Clinical School Faculty of Medicine and Health Science The University of Auckland Hamilton New Zealand
| | - Arthur A M Wilde
- Heart Center Department of Clinical and Experimental Cardiology Amsterdam University Medical Center University of Amsterdam Amsterdam the Netherlands
| | | | | | | | - Elijah R Behr
- Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Institute St George's University of London, and St George's University Hospitals NHS Foundation Trust London UK
| | | | - Martina C Cornel
- Amsterdam University Medical Center Vrije Universiteit Amsterdam Clinical Genetics Amsterdam Public Health Research Institute Amsterdam the Netherlands
| | | | - Jodie Ingles
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute The University of Sydney Sydney Australia
| | | | - Jyh-Ming Jimmy Juang
- Cardiovascular Center and Division of Cardiology Department of Internal Medicine National Taiwan University Hospital and National Taiwan University College of Medicine Taipei Taiwan
| | - Stefan Kääb
- Department of Medicine I University Hospital LMU Munich Munich Germany
| | | | | | | | - Heather MacLeod
- Data Coordinating Center for the Sudden Death in the Young Case Registry Okemos MI USA
| | | | - Koonlawee Nademanee
- Chulalongkorn University Faculty of Medicine, and Pacific Rim Electrophysiology Research Institute at Bumrungrad Hospital Bangkok Thailand
| | | | - Elizabeth V Saarel
- Cleveland Clinic Lerner College of Cardiology at Case Western Reserve University Cleveland OH USA
- St Luke's Medical Center Boise ID USA
| | - Luciana Sacilotto
- Heart Institute University of São Paulo Medical School São Paulo Brazil
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute The University of Sydney Sydney Australia
| | - Mary N Sheppard
- Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Institute St George's University of London, and St George's University Hospitals NHS Foundation Trust London UK
| | - Wataru Shimizu
- Department of Cardiovascular Medicine Nippon Medical School Tokyo Japan
| | | | - Jacob Tfelt-Hansen
- Department of Forensic Medicine Faculty of Medical Sciences Rigshospitalet Copenhagen Denmark
| | - Dao Wu Wang
- The First Affiliated Hospital of Nanjing Medical University Nanjing China
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6
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Dose response to nadolol in congenital long QT syndrome. Heart Rhythm 2021; 18:1377-1383. [PMID: 33905813 DOI: 10.1016/j.hrthm.2021.04.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Beta-blocker therapy is the cornerstone of treatment for patients with long QT syndrome (LQTS). Few details on the dose to be used are available. As the response is variable between patients, we systematically evaluated the effect of treatment by performing an exercise test. OBJECTIVE The purpose of this study was to explore dose response to nadolol on exercise test in LQTS patients in order to propose a more personalized therapeutic approach. METHODS LQTS patients followed at the Reference Centre for Hereditary Arrhythmic Diseases of Nantes with at least 1 exercise test under nadolol were included retrospectively between 1993 and 2017. All patients underwent gradual cycle exercise tests. Doses adjusted to weight and response to treatment were recorded and evaluated by the percentage of age-predicted maximum heart rate reached on exercise test. RESULTS Ninety-five patients were included in the study, and 337 stress tests under nadolol were analyzed. No correlation existed between dose and percentage of age-predicted maximum heart rate on exercise tests. Twenty-one patients were overresponders, mostly LQTS1, and 20 were underresponders, mainly LQTS2 (P = .0229). Forty-two patients had at least 3 stress tests under nadolol. We found a negative correlation between dose change and percentage of age-predicted maximum heart rate change (P <.0001). We then proposed a table to adapt dose according to exercise test response. CONCLUSION Our study demonstrated a major variability of dose response to nadolol in patients with LQTS, thus underlining the need for a tailored dosage for each patient. Intraindividual analysis showed a relatively constant dose-response relationship, allowing guided dose adaptation after the first exercise test.
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7
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Stiles MK, Wilde AAM, Abrams DJ, Ackerman MJ, Albert CM, Behr ER, Chugh SS, Cornel MC, Gardner K, Ingles J, James CA, Jimmy Juang JM, Kääb S, Kaufman ES, Krahn AD, Lubitz SA, MacLeod H, Morillo CA, Nademanee K, Probst V, Saarel EV, Sacilotto L, Semsarian C, Sheppard MN, Shimizu W, Skinner JR, Tfelt-Hansen J, Wang DW. 2020 APHRS/HRS expert consensus statement on the investigation of decedents with sudden unexplained death and patients with sudden cardiac arrest, and of their families. Heart Rhythm 2021; 18:e1-e50. [PMID: 33091602 PMCID: PMC8194370 DOI: 10.1016/j.hrthm.2020.10.010] [Citation(s) in RCA: 140] [Impact Index Per Article: 46.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 10/09/2020] [Indexed: 12/13/2022]
Abstract
This international multidisciplinary document intends to provide clinicians with evidence-based practical patient-centered recommendations for evaluating patients and decedents with (aborted) sudden cardiac arrest and their families. The document includes a framework for the investigation of the family allowing steps to be taken, should an inherited condition be found, to minimize further events in affected relatives. Integral to the process is counseling of the patients and families, not only because of the emotionally charged subject, but because finding (or not finding) the cause of the arrest may influence management of family members. The formation of multidisciplinary teams is essential to provide a complete service to the patients and their families, and the varied expertise of the writing committee was formulated to reflect this need. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by Class of Recommendation and Level of Evidence. The recommendations were opened for public comment and reviewed by the relevant scientific and clinical document committees of the Asia Pacific Heart Rhythm Society (APHRS) and the Heart Rhythm Society (HRS); the document underwent external review and endorsement by the partner and collaborating societies. While the recommendations are for optimal care, it is recognized that not all resources will be available to all clinicians. Nevertheless, this document articulates the evaluation that the clinician should aspire to provide for patients with sudden cardiac arrest, decedents with sudden unexplained death, and their families.
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Affiliation(s)
- Martin K Stiles
- Waikato Clinical School, Faculty of Medicine and Health Science, The University of Auckland, Hamilton, New Zealand
| | - Arthur A M Wilde
- Amsterdam University Medical Center, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam, the Netherlands
| | | | | | | | - Elijah R Behr
- Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Institute, St George's, University of London, and St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Sumeet S Chugh
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Martina C Cornel
- Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Clinical Genetics, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | | | - Jodie Ingles
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, Australia
| | | | - Jyh-Ming Jimmy Juang
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Stefan Kääb
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany
| | | | - Andrew D Krahn
- The University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Heather MacLeod
- Data Coordinating Center for the Sudden Death in the Young Case Registry, Okemos, Michigan, USA
| | | | - Koonlawee Nademanee
- Chulalongkorn University, Faculty of Medicine, and Pacific Rim Electrophysiology Research Institute at Bumrungrad Hospital, Bangkok, Thailand
| | | | - Elizabeth V Saarel
- Cleveland Clinic Lerner College of Cardiology at Case Western Reserve University, Cleveland, Ohio, and St Luke's Medical Center, Boise, Idaho, USA
| | - Luciana Sacilotto
- Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, Australia
| | - Mary N Sheppard
- Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Institute, St George's, University of London, and St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Jonathan R Skinner
- Cardiac Inherited Disease Group, Starship Hospital, Auckland, New Zealand
| | - Jacob Tfelt-Hansen
- Department of Forensic Medicine, Faculty of Medical Sciences, Rigshospitalet, Copenhagen, Denmark
| | - Dao Wu Wang
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Kwenandar F, Japar KV, Damay V, Hariyanto TI, Tanaka M, Lugito NPH, Kurniawan A. Coronavirus disease 2019 and cardiovascular system: A narrative review. IJC HEART & VASCULATURE 2020; 29:100557. [PMID: 32550259 PMCID: PMC7266760 DOI: 10.1016/j.ijcha.2020.100557] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 06/01/2020] [Indexed: 02/08/2023]
Abstract
At the end of 2019, a viral pneumonia disease called coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV2), emerged in Wuhan, China. This novel disease rapidly spread at an alarming rate that as a result, it has now been declared pandemic by the World Health Organization. Although this infective disease is mostly characterized by respiratory tract symptoms, increasing numbers of evidence had shown considerable amounts of patients with cardiovascular involvements and these were associated with higher mortality among COVID-19 patients. Cardiac involvement as a possible late phenomenon of the viral respiratory infection is an issue that should be anticipated in patients with COVID-19. Cardiovascular manifestation in COVID-19 patients include myocardial injury (MI), arrhythmias, cardiac arrests, heart failure and coagulation abnormality, ranging from 7.2% up to 33%. The mechanism of cardiac involvement in COVID-19 patients involves direct injury to myocardial cells mediated by angiotensin-converting enzyme 2 (ACE2) receptors as suggested by some studies, while the other studies suggest that systemic inflammation causing indirect myocyte injury may also play a role. Combination of proper triage, close monitoring, and avoidance of some drugs that have cardiovascular toxicity are important in the management of cardiovascular system involvement in COVID-19 patients. The involvement of the cardiovascular system in COVID-19 patients is prevalent, variable, and debilitating. Therefore, it requires our attention and comprehensive management.
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Key Words
- ACE2
- ACE2, Angiotensin Converting Enzyme-2
- ARDS, Acute respiratory distress syndrome
- CFR, Case-fatality rate
- CK-MB, Creatine Kinase Myocardial Band
- COVID-19
- COVID-19, Coronavirus Disease 2019
- CPVT, Catecholaminergic polymorphic ventricular tachycardia
- CVD, Cardiovascular disease
- Cardiovascular
- Coronavirus
- DIC, Disseminated intravascular coagulation
- FDP, Fibrin degradation products
- Hs-cTnI, High-sensitive cardiac troponin I
- LV, Left Ventricle
- MI, Myocardial Infarction
- NT-proBNP, N-terminal prohormone of brain natriuretic peptide
- PCI, Percutaneous coronary intervention
- SARS-CoV-2
- SARS-CoV-2, Severe Acute Respiratory Syndrome Coronavirus 2
- TnT, Troponin T
- VTE, Venous thromboembolism
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Affiliation(s)
- Felix Kwenandar
- Faculty of Medicine, Pelita Harapan University, Banten, Indonesia
| | | | - Vika Damay
- Faculty of Medicine, Pelita Harapan University, Banten, Indonesia
| | | | - Michael Tanaka
- Faculty of Medicine, Pelita Harapan University, Department of Cardiology, Siloam Hospital Lippo Village, Karawaci, Banten, Indonesia
| | - Nata Pratama Hardjo Lugito
- Faculty of Medicine, Pelita Harapan University, Department of Internal Medicine, Siloam Hospital Lippo Village, Karawaci, Banten, Indonesia
| | - Andree Kurniawan
- Faculty of Medicine, Pelita Harapan University, Department of Internal Medicine, Siloam Hospital Lippo Village, Karawaci, Banten, Indonesia
- Corresponding author at: Department of Internal Medicine, Pelita Harapan University, Boulevard Jendral Sudirman street, Karawaci, Tangerang, Banten 15811, Indonesia.
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Cunningham T, Roston TM, Franciosi S, Liu MC, Atallah J, Escudero CA, Udupa S, Roberts JD, Dhillon S, Dallaire F, Fournier A, Fatah M, Hamilton R, Sanatani S. Initially unexplained cardiac arrest in children and adolescents: A national experience from the Canadian Pediatric Heart Rhythm Network. Heart Rhythm 2020; 17:975-981. [DOI: 10.1016/j.hrthm.2020.01.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 01/29/2020] [Indexed: 02/01/2023]
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10
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Wu CI, Postema PG, Arbelo E, Behr ER, Bezzina CR, Napolitano C, Robyns T, Probst V, Schulze-Bahr E, Remme CA, Wilde AAM. SARS-CoV-2, COVID-19, and inherited arrhythmia syndromes. Heart Rhythm 2020; 17:1456-1462. [PMID: 32244059 PMCID: PMC7156157 DOI: 10.1016/j.hrthm.2020.03.024] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 03/28/2020] [Indexed: 01/08/2023]
Abstract
Ever since the first case was reported at the end of 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the associated coronavirus disease 2019 (COVID-19) has become a serious threat to public health globally in short time. At this point in time, there is no proven effective therapy. The interactions with concomitant disease are largely unknown, and that may be particularly pertinent to inherited arrhythmia syndrome. An arrhythmogenic effect of COVID-19 can be expected, potentially contributing to disease outcome. This may be of importance for patients with an increased risk of cardiac arrhythmias, either secondary to acquired conditions or comorbidities or consequent to inherited syndromes. Management of patients with inherited arrhythmia syndromes such as long QT syndrome, Brugada syndrome, short QT syndrome, and catecholaminergic polymorphic ventricular tachycardia in the setting of the COVID-19 pandemic may prove particularly challenging. Depending on the inherited defect involved, these patients may be susceptible to proarrhythmic effects of COVID-19–related issues such as fever, stress, electrolyte disturbances, and use of antiviral drugs. Here, we describe the potential COVID-19–associated risks and therapeutic considerations for patients with distinct inherited arrhythmia syndromes and provide recommendations, pending local possibilities, for their monitoring and management during this pandemic.
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Affiliation(s)
- Cheng-I Wu
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, The Netherlands; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart); Heart Rhythm Center, Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Pieter G Postema
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, The Netherlands; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart)
| | - Elena Arbelo
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Elijah R Behr
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart); Cardiology Clinical Academic Group, St George's University of London and St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Connie R Bezzina
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, The Netherlands; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart)
| | - Carlo Napolitano
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart); Molecular Cardiology and Medicine Division, Istituti Clinici Scientifici Maugeri, IRCCS, Pavia, Italy
| | - Tomas Robyns
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart); Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Vincent Probst
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart); l'Institut du thorax, Service de Cardiologie du CHU de Nantes, Hopital Nord, Nantes Cedex, France
| | - Eric Schulze-Bahr
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart); Institute for Genetics of Heart Diseases (IfGH), Division of Cardiovascular Medicine, University Hospital Münster, Münster, Germany
| | - Carol Ann Remme
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, The Netherlands; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart)
| | - Arthur A M Wilde
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, The Netherlands; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart).
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Giudicessi JR, Ackerman MJ. Exercise testing oversights underlie missed and delayed diagnosis of catecholaminergic polymorphic ventricular tachycardia in young sudden cardiac arrest survivors. Heart Rhythm 2019; 16:1232-1239. [DOI: 10.1016/j.hrthm.2019.02.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Indexed: 12/31/2022]
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12
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Bui PV, Haas NL, Herrman NWC, Macias M, Hoch V, Schaeffer W, Wallace C. Epinephrine Administered for Anaphylaxis Unmasking a Type 1 Brugada Pattern on Electrocardiogram. J Emerg Med 2019; 56:444-447. [PMID: 30755346 DOI: 10.1016/j.jemermed.2018.12.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 12/18/2018] [Accepted: 12/24/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Brugada pattern on electrocardiography (ECG) can manifest as type 1 (coved pattern) and type 2 (saddleback pattern). Brugada syndrome represents an ECG with Brugada pattern in a patient with symptoms or clinical factors, including syncope, cardiac arrest, ventricular dysrhythmias, and family history. Brugada syndrome is caused by a genetic channelopathy, but the Brugada pattern may be drug-induced. Epinephrine-induced Brugada pattern has not been reported previously. CASE REPORT A 63-year-old man developed anaphylaxis secondary to a bee sting, had a transient loss of consciousness, and self-administered intramuscular epinephrine. He subsequently presented to the emergency department and was found to have a type 1 Brugada pattern on ECG that resolved during observation. A historic ECG was reviewed that demonstrated a baseline type 2 Brugada pattern. His anaphylaxis was managed with steroids and antihistamines. He was observed without subsequent dysrhythmic events on telemetry or any further symptoms. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The differential diagnosis for syncope includes dysrhythmia, such as Brugada syndrome. Among other possible drugs, epinephrine may induce a type 1 Brugada pattern. Patients with Brugada pattern on ECG should be referred immediately to electrophysiology for consideration of implantation of a cardioverter-defibrillator device, given the association of Brugada pattern with sudden cardiac arrest and ventricular dysrhythmias.
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Affiliation(s)
- Peter V Bui
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan
| | - Nathan L Haas
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan
| | | | - Matthew Macias
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan
| | - Victoria Hoch
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan
| | - William Schaeffer
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan
| | - Christopher Wallace
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan
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Abstract
OBJECTIVES To raise awareness among pediatric intensive care specialists of catecholaminergic polymorphic ventricular tachycardia; an uncommon cause of polymorphic ventricular tachycardia and ventricular fibrillation arrest in children and young adults where epinephrine (adrenaline), even when given according to international protocols, can be counter-productive and life-threatening. We review three cases of cardiac arrest in children, later proven to be catecholaminergic polymorphic ventricular tachycardia related, where delay in recognition of this condition resulted in significantly longer resuscitation efforts, more interventions, and a longer time to return of spontaneous circulation. DESIGN Retrospective case series. SETTING Tertiary children's hospital. PATIENTS AND RESULTS Three previously well children 4, 5, and 10 years old presented with cardiac arrest triggered by light activity, partial water immersion, and running, respectively. Initial resuscitation was bystander cardiopulmonary resuscitation and community defibrillation in all three cases. Electrocardiograms revealed multifocal ventricular ectopy, and in two (4 and 10 yr old), this correlated with repeated administration of epinephrine during repeated ventricular tachycardia and ventricular fibrillation cardiac arrest resuscitation cycles. This ultimately resolved immediately (at 78 and 140 min, respectively) with IV opiates once catecholaminergic polymorphic ventricular tachycardia was suspected. During recovery, on extracorporeal membrane oxygenation, epinephrine challenge in two children induced polymorphic ventricular tachycardia, bidirectional ventricular tachycardia, and ventricular fibrillation, which was cardioverted with flecainide in the 4-year-old. The third case was recognized early as catecholaminergic polymorphic ventricular tachycardia and was managed by avoiding epinephrine and using opiates and general anesthesia after the initial (single) cardioversion, and had a much better clinical course, without recourse to extracorporeal membrane oxygenation. All three carried de novo RyR2 (cardiac ryanodine) mutations. CONCLUSIONS Those involved in resuscitation of young people should be aware of catecholaminergic polymorphic ventricular tachycardia and be suspicious of persistent ventricular ectopy, polymorphic, or bidirectional ventricular tachycardia during resuscitation. Appropriate management is avoidance of epinephrine, administration of general anesthesia, IV opiates, and consideration of flecainide.
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Danielsen TK, Manotheepan R, Sadredini M, Leren IS, Edwards AG, Vincent KP, Lehnart SE, Sejersted OM, Sjaastad I, Haugaa KH, Stokke MK. Arrhythmia initiation in catecholaminergic polymorphic ventricular tachycardia type 1 depends on both heart rate and sympathetic stimulation. PLoS One 2018; 13:e0207100. [PMID: 30399185 PMCID: PMC6219810 DOI: 10.1371/journal.pone.0207100] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 10/24/2018] [Indexed: 11/20/2022] Open
Abstract
Aims Catecholaminergic polymorphic ventricular tachycardia type 1 (CPVT1) predisposes to ventricular tachyarrhythmias (VTs) during high heart rates due to physical or psychological stress. The essential role of catecholaminergic effects on ventricular cardiomyocytes in this situation is well documented, but the importance of heart rate per se for arrhythmia initiation in CPVT1 is largely unexplored. Methods and results Sixteen CPVT1 patients performed a bicycle stress-test. Occurrence of VT triggers, i.e. premature ventricular complexes (PVC), depended on high heart rate, with individual thresholds. Atrial pacing above the individual PVC threshold in three patients did not induce PVCs. The underlying mechanism for the clinical observation was explored using cardiomyocytes from mice with the RyR2-R2474S (RyR2-RS) mutation, which exhibit exercise-induced VTs. While rapid pacing increased the number of Ca2+ waves in both RyR2-RS and wild-type (p<0.05), β-adrenoceptor (βAR) stimulation induced more Ca2+ waves in RyR2-RS (p<0.05). Notably, Ca2+ waves occurred despite decreased sarcoplasmic reticulum (SR) Ca2+ content in RyR2-RS (p<0.05), suggesting increased cytosolic RyR2 Ca2+ sensitivity. A computational model of mouse ventricular cardiomyocyte electrophysiology reproduced the cellular CPVT1 phenotype when RyR2 Ca2+ sensitivity was increased. Importantly, diastolic fluctuations in phosphorylation of RyR2 and SR Ca2+ content determined Ca2+ wave initiation. These factors were modulated towards increased propensity for arrhythmia initiation by increased pacing rates, but even more by βAR stimulation. Conclusion In CPVT1, VT propensity depends on individual heart rate thresholds for PVCs. Through converging data from clinical exercise stress-testing, cellular studies and computational modelling, we confirm the heart rate-independent pro-arrhythmic effects of βAR stimulation in CPVT1, but also identify an independent and synergistic contribution from effects of high heart rate.
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Affiliation(s)
- Tore K. Danielsen
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway
- K.G. Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway
| | - Ravinea Manotheepan
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway
- K.G. Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway
| | - Mani Sadredini
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway
- K.G. Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway
| | - Ida S. Leren
- Center for Cardiological Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway and University of Oslo, Oslo, Norway
| | - Andrew G. Edwards
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway
- Simula Research Laboratory, Oslo, Norway
| | | | - Stephan E. Lehnart
- Heart Research Center Göttingen, Department of Cardiology and Pulmonology, University Medical Center Göttingen, Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Ole M. Sejersted
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway
- K.G. Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway
| | - Ivar Sjaastad
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway
- K.G. Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway
| | - Kristina H. Haugaa
- Center for Cardiological Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway and University of Oslo, Oslo, Norway
- Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, University of Oslo, Oslo, Norway
| | - Mathis K. Stokke
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway
- K.G. Jebsen Center for Cardiac Research, University of Oslo, Oslo, Norway
- Center for Cardiological Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway and University of Oslo, Oslo, Norway
- * E-mail:
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15
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Waldmann V, Bougouin W, Karam N, Dumas F, Sharifzadehgan A, Gandjbakhch E, Algalarrondo V, Narayanan K, Zhao A, Amet D, Jost D, Geri G, Lamhaut L, Beganton F, Ludes B, Bruneval P, Plu I, Hidden-Lucet F, Albuisson J, Lavergne T, Piot O, Alonso C, Leenhardt A, Lellouche N, Extramiana F, Cariou A, Jouven X, Marijon E. Characteristics and clinical assessment of unexplained sudden cardiac arrest in the real-world setting: focus on idiopathic ventricular fibrillation. Eur Heart J 2018; 39:1981-1987. [PMID: 29566157 PMCID: PMC5982722 DOI: 10.1093/eurheartj/ehy098] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 11/30/2017] [Accepted: 02/13/2018] [Indexed: 12/22/2022] Open
Abstract
Aims Recent studies have shown that in more than half of apparently unexplained sudden cardiac arrests (SCA), a specific aetiology can be unmasked by a careful evaluation. The characteristics and the extent to which such cases undergo a systematic thorough investigation in real-life practice are unknown. Methods and results Data were analysed from an ongoing study, collecting all cases of out-of-hospital cardiac arrest in Paris area. Investigations performed during the index hospitalization or planned after discharge were gathered to evaluate the completeness of assessment of unexplained SCA. Between 2011 and 2016, among the 18 622 out-of-hospital cardiac arrests, 717 survivors (at hospital discharge) fulfilled the definition of cardiac SCA. Of those, 88 (12.3%) remained unexplained after electrocardiogram, echocardiography, and coronary angiography. Cardiac magnetic resonance imaging yielded the diagnosis in 25 (3.5%) cases, other investigations accounted for 14 (2.4%) additional diagnoses, and 49 (6.8%) patients were labelled as idiopathic ventricular fibrillation (IVF) (48.7 ± 15 years, 69.4% male). Among those labelled IVF, only 8 (16.3%) cases benefited from a complete workup (including pharmacological testing). Younger patients [odds ratio (OR) 6.00, 95% confidence interval (CI) 1.80-22.26] and those admitted to university centres (OR 3.60, 95% CI 1.12-12.45) were more thoroughly investigated. Genetic testing and family screening were initiated in only 9 (18.4%) and 12 (24.5%) cases, respectively. Conclusion Our findings suggest that complete investigations are carried out in a very low proportion of unexplained SCA. Standardized, systematic approaches need to be implemented to ensure that opportunities for specific therapies and preventive strategies (including relatives) are not missed.
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Affiliation(s)
- Victor Waldmann
- Cardiology Department, European Georges Pompidou Hospital, 20-40 Rue Leblanc, 75908 Paris Cedex 15, France
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 Rue Leblanc, 75798 Paris Cedex 15, France
- Faculty of Medicine, Paris Descartes University, 12 Rue de l'Ecole de Médecine, 75006 Paris, France
| | - Wulfran Bougouin
- Cardiology Department, European Georges Pompidou Hospital, 20-40 Rue Leblanc, 75908 Paris Cedex 15, France
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 Rue Leblanc, 75798 Paris Cedex 15, France
- Faculty of Medicine, Paris Descartes University, 12 Rue de l'Ecole de Médecine, 75006 Paris, France
| | - Nicole Karam
- Cardiology Department, European Georges Pompidou Hospital, 20-40 Rue Leblanc, 75908 Paris Cedex 15, France
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 Rue Leblanc, 75798 Paris Cedex 15, France
- Faculty of Medicine, Paris Descartes University, 12 Rue de l'Ecole de Médecine, 75006 Paris, France
| | - Florence Dumas
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 Rue Leblanc, 75798 Paris Cedex 15, France
- Faculty of Medicine, Paris Descartes University, 12 Rue de l'Ecole de Médecine, 75006 Paris, France
- Emergency Department, Cochin Hospital, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Ardalan Sharifzadehgan
- Cardiology Department, European Georges Pompidou Hospital, 20-40 Rue Leblanc, 75908 Paris Cedex 15, France
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 Rue Leblanc, 75798 Paris Cedex 15, France
| | - Estelle Gandjbakhch
- Cardiology Department, La Pitié Salpêtrière University Hospital, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
- Groupe Parisien Universitaire de Rythmologie (G.P.U.R.)
| | - Vincent Algalarrondo
- Groupe Parisien Universitaire de Rythmologie (G.P.U.R.)
- Cardiology Department, Antoine-Béclère Hospital, 157 Rue de la Porte de Trivaux, 92140 Clamart, France
| | - Kumar Narayanan
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 Rue Leblanc, 75798 Paris Cedex 15, France
- Cardiology Department, Maxcure Hospitals, Behind Cyber Towers, Hitec City, 500081 Hyderabad, India
| | - Alexandre Zhao
- Cardiology Department, European Georges Pompidou Hospital, 20-40 Rue Leblanc, 75908 Paris Cedex 15, France
| | - Denis Amet
- Cardiology Department, European Georges Pompidou Hospital, 20-40 Rue Leblanc, 75908 Paris Cedex 15, France
| | - Daniel Jost
- Paris Firefighters Brigade, 1 Place Jules Renard, 75017 Paris, France
| | - Guillaume Geri
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 Rue Leblanc, 75798 Paris Cedex 15, France
- Intensive Care Unit, Ambroise Paré Hospital, 9 Avenue Charles de Gaulle, 92100 Boulogne Billancourt, France
| | - Lionel Lamhaut
- SAMU de Paris, Necker Hospital, 149 rue Sèvres, 75015 Paris, France
| | - Frankie Beganton
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 Rue Leblanc, 75798 Paris Cedex 15, France
| | - Bertrand Ludes
- Forensic Medical Institute, 2 Voie Mazas, 75012 Paris, France
| | - Patrick Bruneval
- Pathology Department, European Georges Pompidou Hospital, 20-40 Rue Leblanc, 75908 Paris Cedex 15, France
| | - Isabelle Plu
- Pathology Department, La Pitié Salpêtrière University Hospital, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - Françoise Hidden-Lucet
- Cardiology Department, La Pitié Salpêtrière University Hospital, 47-83 Boulevard de l'Hôpital, 75013 Paris, France
| | - Juliette Albuisson
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 Rue Leblanc, 75798 Paris Cedex 15, France
- Faculty of Medicine, Paris Descartes University, 12 Rue de l'Ecole de Médecine, 75006 Paris, France
- Genetic Department, European Georges Pompidou Hospital, 20-40 Rue Leblanc, 75908 Paris Cedex 15, France
| | - Thomas Lavergne
- Cardiology Department, European Georges Pompidou Hospital, 20-40 Rue Leblanc, 75908 Paris Cedex 15, France
- Faculty of Medicine, Paris Descartes University, 12 Rue de l'Ecole de Médecine, 75006 Paris, France
| | - Olivier Piot
- Cardiology Department, Centre Cardiologique du Nord, 32-36 Rue des Moulins Gémeaux, 93200 Saint-Denis, France
| | - Christine Alonso
- Cardiology Department, Clinique Ambroise Paré, 25-27 Boulevard Victor Hugo, 92200 Neuilly-sur-Seine, France
| | - Antoine Leenhardt
- Cardiology Department, Bichat-Claude-Bernard Hospital, 46 Rue Henri Huchard, 75877 Paris, France
| | - Nicolas Lellouche
- Groupe Parisien Universitaire de Rythmologie (G.P.U.R.)
- Cardiology Department, University Hospital Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Fabrice Extramiana
- Groupe Parisien Universitaire de Rythmologie (G.P.U.R.)
- Cardiology Department, Bichat-Claude-Bernard Hospital, 46 Rue Henri Huchard, 75877 Paris, France
| | - Alain Cariou
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 Rue Leblanc, 75798 Paris Cedex 15, France
- Faculty of Medicine, Paris Descartes University, 12 Rue de l'Ecole de Médecine, 75006 Paris, France
- Intensive Care Unit, Cochin Hospital, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France
| | - Xavier Jouven
- Cardiology Department, European Georges Pompidou Hospital, 20-40 Rue Leblanc, 75908 Paris Cedex 15, France
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 Rue Leblanc, 75798 Paris Cedex 15, France
- Faculty of Medicine, Paris Descartes University, 12 Rue de l'Ecole de Médecine, 75006 Paris, France
| | - Eloi Marijon
- Cardiology Department, European Georges Pompidou Hospital, 20-40 Rue Leblanc, 75908 Paris Cedex 15, France
- Paris-Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), 56 Rue Leblanc, 75798 Paris Cedex 15, France
- Faculty of Medicine, Paris Descartes University, 12 Rue de l'Ecole de Médecine, 75006 Paris, France
- Groupe Parisien Universitaire de Rythmologie (G.P.U.R.)
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16
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Mellor G, Laksman ZWM, Tadros R, Roberts JD, Gerull B, Simpson CS, Klein GJ, Champagne J, Talajic M, Gardner M, Steinberg C, Arbour L, Birnie DH, Angaran P, Leather R, Sanatani S, Chauhan VS, Seifer C, Healey JS, Krahn AD. Genetic Testing in the Evaluation of Unexplained Cardiac Arrest: From the CASPER (Cardiac Arrest Survivors With Preserved Ejection Fraction Registry). ACTA ACUST UNITED AC 2018; 10:CIRCGENETICS.116.001686. [PMID: 28600387 DOI: 10.1161/circgenetics.116.001686] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 03/27/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Unexplained cardiac arrest may be because of an inherited arrhythmia syndrome. The role of genetic testing in cardiac arrest survivors without a definite clinical phenotype is unclear. METHODS AND RESULTS The CASPER (Cardiac Arrest Survivors with Preserved Ejection Fraction Registry) is a large registry of cardiac arrest survivors where initial assessment reveals normal coronary arteries, left ventricular function, and resting ECG. Of 375 cardiac arrest survivors in CASPER from 2006 to 2015, 174 underwent genetic testing. Patients were classified as phenotype-positive (n=72) or phenotype-negative (n=102). Genetic testing was performed at treating physicians' discretion in line with contemporary guidelines and availability. All genetic variants identified from original laboratory reports were reassessed by the investigators in line with modern criteria. Pathogenic variants were identified in 29 (17%) patients (60% channelopathy-associated and 40% cardiomyopathy-associated genes) and 70 variants of unknown significance were identified in 32 (18%) patients. Prior syncope (odds ratio, 4.0; 95% confidence interval, 1.6-9.7) and a family history of sudden death (odds ratio, 3.2; 95% confidence interval, 1.1-9.4) were independently associated with the presence of a pathogenic variant. In phenotype-negative patients, broad multiphenotype genetic testing led to higher yields (21% versus 8%; P=0.04) but was associated with more variants of unknown significance (55% versus 5%; P<0.01). CONCLUSIONS Genetic testing identifies a pathogenic variant in a significant proportion of unexplained cardiac arrest survivors. Prior syncope and family history of sudden death are predictors of a positive genetic test. Both arrhythmia and cardiomyopathy genes are implicated. Broad, multiphenotype testing revealed the highest frequency of pathogenic variants in phenotype-negative patients. CLINICAL TRIAL REGISTRATION https://www.clinicaltrials.gov. Unique Identifier: NCT00292032.
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17
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Jiménez-Jáimez J, Alcalde Martínez V, Jiménez Fernández M, Bermúdez Jiménez F, Rodríguez Vázquez del Rey MDM, Perin F, Oyonarte Ramírez JM, López Fernández S, de la Torre I, García Orta R, González Molina M, Cabrerizo EM, Álvarez Abril B, Álvarez M, Macías Ruiz R, Correa C, Tercedor L. Diagnóstico clínico y genético de la muerte súbita cardiaca de origen no isquémico. Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2017.01.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Clinical and Genetic Diagnosis of Nonischemic Sudden Cardiac Death. ACTA ACUST UNITED AC 2017; 70:808-816. [PMID: 28566242 DOI: 10.1016/j.rec.2017.04.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 01/16/2017] [Indexed: 11/20/2022]
Abstract
INTRODUCTION AND OBJECTIVES Nonischemic sudden cardiac death (SCD) is predominantly caused by cardiomyopathies and channelopathies. There are many diagnostic tests, including some complex techniques. Our aim was to analyze the diagnostic yield of a systematic diagnostic protocol in a specialized unit. METHODS The study included 56 families with at least 1 index case of SCD (resuscitated or not). Survivors were studied with electrocardiogram, advanced cardiac imaging, exercise testing, familial study, genetic testing and, in some cases, pharmacological testing. Families with deceased probands were studied using the postmortem findings, familial evaluation, and molecular autopsy with next-generation sequencing (NGS). RESULTS A positive diagnosis was obtained in 80.4% of the cases, with no differences between survivors and nonsurvivors (P=.53). Cardiac channelopathies were more prevalent among survivors than nonsurvivors (66.6% vs 40%, P=.03). Among the 30 deceased probands, the definitive diagnosis was given by autopsy in 7. A diagnosis of cardiomyopathy tended to be associated with a higher event rate in the family. Genetic testing with NGS was performed in 42 index cases, with a positive result in 28 (66.6%), with no differences between survivors and nonsurvivors (P=.21). CONCLUSIONS There is a strong likelihood of reaching a diagnosis in SCD after a rigorous protocol, with a more prevalent diagnosis of channelopathy among survivors and a worse familial prognosis in cardiomyopathies. Genetic testing with NGS is useful and its value is increasing with respect to the Sanger method.
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Balla C, Ali H, Cappato R. Ventricular tachycardia as the first manifestation of disease: an element with different clinical settings. J Cardiovasc Med (Hagerstown) 2017; 18 Suppl 1:e77-e82. [PMID: 28151771 DOI: 10.2459/jcm.0000000000000452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Cristina Balla
- aArrhythmia and Electrophysiology Research Center, IRCCS Humanitas Research Hospital, Rozzano, Milan bArrhythmia and Electrophysiology Unit II, Humanitas Gavazzeni Clinics, Bergamo cDepartment of Cardiology, SS. ma Annunziata Hospital, Azienda Unità Sanitaria Locale Ferrara, Cento, Ferrara, Italy
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20
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Paludan-Müller C, Ahlberg G, Ghouse J, Herfelt C, Svendsen JH, Haunsø S, Kanters JK, Olesen MS. Integration of 60,000 exomes and ACMG guidelines question the role of Catecholaminergic Polymorphic Ventricular Tachycardia-associated variants. Clin Genet 2016; 91:63-72. [PMID: 27538377 DOI: 10.1111/cge.12847] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Revised: 08/12/2016] [Accepted: 08/15/2016] [Indexed: 01/13/2023]
Abstract
Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT) is a highly lethal cardiac arrhythmia disease occurring during exercise or psychological stress. CPVT has an estimated prevalence of 1:10,000 and has mainly been associated with variants in calcium-regulating genes. Identification of potential false-positive pathogenic variants was conducted by searching the Exome Aggregation Consortium (ExAC) database (n = 60,706) for variants reported to be associated with CPVT. The pathogenicity of the interrogated variants was assessed using guidelines from the American College of Medical Genetics and Genomics (ACMG) and in silico prediction tools. Of 246 variants 38 (15%) variants previously associated with CPVT were identified in the ExAC database. We predicted the CPVT prevalence to be 1:132. The ACMG standards classified 29% of ExAC variants as pathogenic or likely pathogenic. The in silico predictions showed a reduced probability of disease-causing effect for the variants identified in the exome database (p < 0.001). We have observed a large overrepresentation of previously CPVT-associated variants in a large exome database. Based on the frequency of CPVT in the general population, it is less likely that the previously proposed variants are associated with a highly penetrant monogenic form of the disease.
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Affiliation(s)
- C Paludan-Müller
- Danish National Research Foundation Centre for Cardiac Arrhythmia, Department of Biomedical Sciences, University of Copenhagen, Denmark.,Laboratory for Molecular Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - G Ahlberg
- Danish National Research Foundation Centre for Cardiac Arrhythmia, Department of Biomedical Sciences, University of Copenhagen, Denmark.,Laboratory for Molecular Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - J Ghouse
- Danish National Research Foundation Centre for Cardiac Arrhythmia, Department of Biomedical Sciences, University of Copenhagen, Denmark.,Laboratory for Molecular Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - C Herfelt
- Danish National Research Foundation Centre for Cardiac Arrhythmia, Department of Biomedical Sciences, University of Copenhagen, Denmark.,Laboratory for Molecular Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - J H Svendsen
- Danish National Research Foundation Centre for Cardiac Arrhythmia, Department of Biomedical Sciences, University of Copenhagen, Denmark.,Laboratory for Molecular Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health Sciences, Copenhagen, Denmark
| | - S Haunsø
- Danish National Research Foundation Centre for Cardiac Arrhythmia, Department of Biomedical Sciences, University of Copenhagen, Denmark.,Laboratory for Molecular Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health Sciences, Copenhagen, Denmark
| | - J K Kanters
- Laboratory of Experimental Cardiology, Department of Biomedicine, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiology, Herlev and Gentofte University Hospitals, Copenhagen, Denmark
| | - M S Olesen
- Danish National Research Foundation Centre for Cardiac Arrhythmia, Department of Biomedical Sciences, University of Copenhagen, Denmark.,Laboratory for Molecular Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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21
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Steinberg C, Padfield GJ, Champagne J, Sanatani S, Angaran P, Andrade JG, Roberts JD, Healey JS, Chauhan VS, Birnie DH, Janzen M, Gerull B, Klein GJ, Leather R, Simpson CS, Seifer C, Talajic M, Gardner M, Krahn AD. Cardiac Abnormalities in First-Degree Relatives of Unexplained Cardiac Arrest Victims. Circ Arrhythm Electrophysiol 2016; 9:CIRCEP.115.004274. [DOI: 10.1161/circep.115.004274] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 08/02/2016] [Indexed: 01/06/2023]
Abstract
Background—
Unexplained cardiac arrest (UCA) may be explained by inherited arrhythmia syndromes. The Cardiac Arrest Survivors With Preserved Ejection Fraction Registry prospectively assessed first-degree relatives of UCA or sudden unexplained death victims to screen for cardiac abnormalities.
Methods and Results—
Around 398 first-degree family members (186 UCA, 212 sudden unexplained death victims’ relatives; mean age, 44±17 years) underwent extensive cardiac workup, including ECG, signal averaged ECG, exercise testing, cardiac imaging, Holter-monitoring, and selective provocative drug testing with epinephrine or procainamide. Genetic testing was performed when a mutation was identified in the UCA survivor or when the diagnostic workup revealed a phenotype suggestive of a specific inherited arrhythmia syndrome. The diagnostic strength was classified as definite, probable, or possible based on previously published definitions. Cardiac abnormalities were detected in 120 of 398 patients (30.2%) with 67 of 398 having a definite or probable diagnosis (17%), including Long-QT syndrome (13%), catecholaminergic polymorphic ventricular tachycardia (4%), arrhythmogenic right ventricular cardiomyopathy (4%), and Brugada syndrome (3%). The detection yield was similar for family members of UCA and sudden unexplained death victims (31% versus 27%;
P
=0.59). Genetic testing was performed more often in family members of UCA patients (29% versus 20%;
P
=0.03). Disease-causing mutations were identified in 20 of 398 relatives (5%). The most common pathogenic mutations were RyR2 (2%), SCN5A (1%), and KNCQ1 (0.8%).
Conclusions—
Cardiac screening revealed abnormalities in 30% of first-degree relatives of UCA or sudden unexplained death victims, with a clear working diagnosis in 17%. Long-QT, arrhythmogenic right ventricular cardiomyopathy, and catecholaminergic polymorphic ventricular tachycardia were the most common diagnoses. Systematic cascade screening and genetic testing in asymptomatic individuals will lead to preventive lifestyle and medical interventions with potential to prevent sudden cardiac death.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00292032.
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Affiliation(s)
| | | | | | | | - Paul Angaran
- For the author affiliations, please see the Appendix
| | | | | | | | | | | | - Mikyla Janzen
- For the author affiliations, please see the Appendix
| | - Brenda Gerull
- For the author affiliations, please see the Appendix
| | | | | | | | | | - Mario Talajic
- For the author affiliations, please see the Appendix
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22
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Krahn AD, Healey JS, Gerull B, Angaran P, Chakrabarti S, Sanatani S, Arbour L, Laksman ZWM, Carroll SL, Seifer C, Green M, Roberts JD, Talajic M, Hamilton R, Gardner M. The Canadian Arrhythmogenic Right Ventricular Cardiomyopathy Registry: Rationale, Design, and Preliminary Recruitment. Can J Cardiol 2016; 32:1396-1401. [PMID: 27474350 DOI: 10.1016/j.cjca.2016.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 03/31/2016] [Accepted: 04/11/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a complex and clinically heterogeneous arrhythmic condition. Incomplete penetrance and variable expressivity are particularly evident in ARVC, making clinical decision-making challenging. METHODS Pediatric and adult cardiologists, geneticists, genetic counsellors, ethicists, nurses, and qualitative researchers are collaborating to create the Canadian ARVC registry using a web-based clinical database. Biological samples will be banked and systematic analysis will be performed to examine potentially causative mutations, variants, and biomarkers. Outcomes will include syncope, ventricular arrhythmias, defibrillator therapies, heart failure, and mortality. RESULTS Preliminary recruitment has enrolled 365 participants (aged 42.7 ± 17.1 years; 50% women), including 129 probands and 236 family members. Previous cardiac arrest occurred in 28 (8%) participants, syncope occurred in 43 (12%) participants, and 46% of probands had a family history of sudden death. Overall yield of genetic testing was 36% for a disease-causing mutation and 20% for a variant of unknown significance. Target enrollment is 1000 affected patients and 500 unaffected family member controls over 7 years. The cross-sectional and longitudinal data collected in this manner will allow a robust assessment of the natural history and clinical course of genetic subtypes. CONCLUSIONS The Canadian ARVC Registry will create a population-based cohort of patients and their families to inform clinical decisions regarding patients with ARVC.
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Affiliation(s)
- Andrew D Krahn
- Heart Rhythm Vancouver, Vancouver, British Columbia, Canada; Heart Rhythm Vancouver, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Jeffrey S Healey
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Brenda Gerull
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Paul Angaran
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Santabhanu Chakrabarti
- Heart Rhythm Vancouver, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Laura Arbour
- Department of Medical Genetics, University of British Columbia, Victoria, British Columbia, Canada
| | - Zachary W M Laksman
- Heart Rhythm Vancouver, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sandra L Carroll
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Colette Seifer
- St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Martin Green
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | | | | | - Martin Gardner
- QEII Health Sciences Center, Halifax, Nova Scotia, Canada
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23
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Herman ARM, Cheung C, Gerull B, Simpson CS, Birnie DH, Klein GJ, Champagne J, Healey JS, Gibbs K, Talajic M, Gardner M, Bennett MT, Steinberg C, Janzen M, Gollob MH, Angaran P, Yee R, Leather R, Chakrabarti S, Sanatani S, Chauhan VS, Krahn AD. Outcome of Apparently Unexplained Cardiac Arrest: Results From Investigation and Follow-Up of the Prospective Cardiac Arrest Survivors With Preserved Ejection Fraction Registry. Circ Arrhythm Electrophysiol 2016; 9:e003619. [PMID: 26783233 DOI: 10.1161/circep.115.003619] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Cardiac Arrest Survivors with Preserved Ejection Fraction Registry (CASPER) enrolls patients with apparently unexplained cardiac arrest and no evident cardiac disease to identify the pathogenesis of cardiac arrest through systematic clinical testing. Exercise testing, drug provocation, advanced cardiac imaging, and genetic testing may be useful when a cause is not apparent. METHODS AND RESULTS The first 200 survivors of unexplained cardiac arrest from 14 centers across Canada were evaluated to determine the results of investigation and follow-up (age, 48.6±14.7 years, 41% female). Patients were free of evidence of coronary artery disease, left ventricular dysfunction, or evident repolarization syndromes. Advanced testing determined a diagnosis in 34% of patients at baseline, with a diagnosis emerging during follow-up in 7% of patients. Of those who were diagnosed, 28 (35%) had an underlying structural condition and 53 (65%) had a primary electric disease. During a mean follow-up of 3.15±2.34 years, 23% of patients had either a shock or an appropriate antitachycardia pacing from their implantable cardioverter defibrillator, or both. The implantable cardioverter defibrillator appropriate intervention rate was 8.4% at 1 year and 18.1% at 3 years, with no clear difference between diagnosed and undiagnosed subjects, or between those diagnosed with a primary electric versus structural pathogenesis. CONCLUSIONS Obtaining a diagnosis in previously unexplained cardiac arrest patients requires systematic clinical testing and regular follow-up to unmask the cause. Nearly half of apparently unexplained cardiac arrest patients ultimately received a diagnosis, allowing for improved treatment and family screening. A substantial proportion of patients received appropriate implantable cardioverter defibrillator therapy during medium-term follow-up. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00292032.
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Affiliation(s)
- Adam R M Herman
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Christopher Cheung
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Brenda Gerull
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Christopher S Simpson
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - David H Birnie
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - George J Klein
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Jean Champagne
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Jeffrey S Healey
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Karen Gibbs
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Mario Talajic
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Martin Gardner
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Matthew T Bennett
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Christian Steinberg
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Mikyla Janzen
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Michael H Gollob
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Paul Angaran
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Raymond Yee
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Richard Leather
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Santabhanu Chakrabarti
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Shubhayan Sanatani
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Vijay S Chauhan
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.)
| | - Andrew D Krahn
- From the Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada (A.R.M.H., C.C., K.G., M.T.B., C.S., M.J., S.C., A.D.K.); Department of Cardiovascular Sciences, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada (B.G.); Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada (C.S.S.); University of Ottawa Heart Institute, Ottawa, ON, Canada (D.H.B.); Division of Cardiology, Department of Medicine, Western University, London, ON, Canada (G.J.K., R.Y.); Department of Medicine, Quebec Heart and Lung Institute, Quebec City, QC, Canada (J.C.); Division of Cardiology, Department of Medicine, Population Health Research Institute, Hamilton, ON, Canada (J.S.H.); Department of Medicine, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada (M.T.); Division of Cardiology, Department of Medicine, QEII Health Sciences Center, Halifax, NS, Canada (M.G.); Division of Cardiology, Department of Medicine, University Health Network, Toronto, ON, Canada (M.H.G., V.S.C.); Division of Cardiology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada (P.A.); Division of Cardiology, Department of Medicine, Royal Jubilee Hospital, Victoria, BC, Canada (R.L.); and Division of Cardiology, Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada (S.S.).
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Jiménez-Jáimez J, Palomino Doza J, Ortega Á, Macías-Ruiz R, Perin F, Rodríguez-Vázquez del Rey MM, Ortiz-Genga M, Monserrat L, Barriales-Villa R, Blanca E, Álvarez M, Tercedor L. Calmodulin 2 Mutation N98S Is Associated with Unexplained Cardiac Arrest in Infants Due to Low Clinical Penetrance Electrical Disorders. PLoS One 2016; 11:e0153851. [PMID: 27100291 PMCID: PMC4839566 DOI: 10.1371/journal.pone.0153851] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 04/05/2016] [Indexed: 01/08/2023] Open
Abstract
Background Calmodulin 1, 2 and 3 (CALM) mutations have been found to cause cardiac arrest in children at a very early age. The underlying aetiology described is long QT syndrome (LQTS), catecholaminergic polymorphic ventricular tachycardia (CPVT) and idiopathic ventricular fibrillation (IVF). Little phenotypical data about CALM2 mutations is available. Objectives The aim of this paper is to describe the clinical manifestations of the Asn98Ser mutation in CALM2 in two unrelated children in southern Spain with apparently unexplained cardiac arrest/death. Methods Two unrelated children aged 4 and 7, who were born to healthy parents, were studied. Both presented with sudden cardiac arrest. The first was resuscitated after a VF episode, and the second died suddenly. In both cases the baseline QTc interval was within normal limits. Peripheral blood DNA was available to perform targeted gene sequencing. Results The surviving 4-year-old girl had a positive epinephrine test for LQTS, and polymorphic ventricular ectopic beats were seen on a previous 24-hour Holter recording from the deceased 7-year-old boy, suggestive of a possible underlying CPVT phenotype. A p.Asn98Ser mutation in CALM2 was detected in both cases. This affected a highly conserved across species residue, and the location in the protein was adjacent to critical calcium binding loops in the calmodulin carboxyl-terminal domain, predicting a high pathogenic effect. Conclusions Human calmodulin 2 mutation p.Asn98Ser is associated with sudden cardiac death in childhood with a variable clinical penetrance. Our results provide new phenotypical information about clinical behaviour of this mutation.
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Affiliation(s)
- Juan Jiménez-Jáimez
- Cardiology Department, Complejo Hospitalario Universitario de Granada, Granada, Spain
- Instituto de Investigación Biosanitario de Granada, Granada, Spain
- * E-mail:
| | | | - Ángeles Ortega
- Paediatrics Department, Hospital de Torrecárdenas, Almería, Spain
| | - Rosa Macías-Ruiz
- Cardiology Department, Complejo Hospitalario Universitario de Granada, Granada, Spain
- Instituto de Investigación Biosanitario de Granada, Granada, Spain
| | - Francesca Perin
- Paediatrics Department, Complejo Hospitalario Universitario de Granada, Granada, Spain
| | | | | | | | | | - Enrique Blanca
- Paediatrics Department, Complejo Hospitalario Universitario de Granada, Granada, Spain
| | - Miguel Álvarez
- Cardiology Department, Complejo Hospitalario Universitario de Granada, Granada, Spain
- Instituto de Investigación Biosanitario de Granada, Granada, Spain
| | - Luis Tercedor
- Cardiology Department, Complejo Hospitalario Universitario de Granada, Granada, Spain
- Instituto de Investigación Biosanitario de Granada, Granada, Spain
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KANESHIRO TAKASHI, SUZUKI HITOSHI, NODERA MINORU, YAMADA SHINYA, KAMIOKA MASASHI, KAMIYAMA YOSHIYUKI, TAKEISHI YASUCHIKA. Mapping Strategy Associated with QRS Morphology for Catheter Ablation in Patients with Idiopathic Ventricular Outflow Tract Tachyarrhythmia. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:338-44. [DOI: 10.1111/pace.12810] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 12/22/2015] [Accepted: 01/01/2016] [Indexed: 11/27/2022]
Affiliation(s)
- TAKASHI KANESHIRO
- Department of Cardiology and Hematology; Fukushima Medical University; Fukushima Japan
| | - HITOSHI SUZUKI
- Department of Cardiology and Hematology; Fukushima Medical University; Fukushima Japan
- Department of Arrhythmia and Cardiac Pacing; Fukushima Medical University; Fukushima Japan
| | - MINORU NODERA
- Department of Cardiology and Hematology; Fukushima Medical University; Fukushima Japan
| | - SHINYA YAMADA
- Department of Cardiology and Hematology; Fukushima Medical University; Fukushima Japan
| | - MASASHI KAMIOKA
- Department of Cardiology and Hematology; Fukushima Medical University; Fukushima Japan
| | - YOSHIYUKI KAMIYAMA
- Department of Cardiology and Hematology; Fukushima Medical University; Fukushima Japan
| | - YASUCHIKA TAKEISHI
- Department of Cardiology and Hematology; Fukushima Medical University; Fukushima Japan
- Department of Arrhythmia and Cardiac Pacing; Fukushima Medical University; Fukushima Japan
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Jiménez-Jáimez J, de la Torre I, Peinado Peinado R, Zorio Grima E, Segura F, Moriña P, Sánchez Muñoz JJ, Mazuelos F, Cózar R, Gimeno JR, Picón Heras R, Monserrat L, Macías Ruiz R, Álvarez M, Tercedor L. Penetrancia familiar en la parada cardíaca en ausencia de cardiopatía aparente: observaciones del estudio FIVI-Gen. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.carcor.2015.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Siegers CEP, Visser M, Loh P, van der Heijden JF, Hassink RJ. Catecholaminergic polymorphic ventricular tachycardia (CPVT) initially diagnosed as idiopathic ventricular fibrillation: the importance of thorough diagnostic work-up and follow-up. Int J Cardiol 2015; 177:e81-3. [PMID: 25456695 DOI: 10.1016/j.ijcard.2014.10.005] [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] [Received: 09/30/2014] [Accepted: 10/01/2014] [Indexed: 10/24/2022]
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Diagnostic Approach to Unexplained Cardiac Arrest (from the FIVI-Gen Study). Am J Cardiol 2015; 116:894-9. [PMID: 26189708 DOI: 10.1016/j.amjcard.2015.06.030] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 06/14/2015] [Accepted: 06/14/2015] [Indexed: 01/12/2023]
Abstract
Unexplained cardiac arrest (UCA) can be caused by low-penetrance genetic disorders. The aim of this cross-sectional study is to assess the usefulness of a new diagnostic protocol: Thirty-five patients were recruited from 9 Spanish centers. Electrocardiogram, echocardiogram, and coronary catheterization were used to rule out electrical or structural heart disease in all subjects. Patients underwent pharmacologic tests with epinephrine and flecainide, followed by assessment of family members using electrocardiogram and echocardiogram, and next-generation genetic sequencing to analyze 126 genes if all the other test results were negative. A firm diagnosis of channelopathy required phenotypic proof of the condition in unmasking tests, the presence of a pathogenic variant consistent with the phenotype observed, and/or co-segregation of the mutation found in a family member's phenotype. A firm diagnosis was made in 18 cases. The diagnoses were 7 Brugada syndrome, 5 catecholaminergic polymorphic ventricular tachycardia, 3 long QT syndrome, 2 early repolarization syndrome, and 1 short QT syndrome. Pharmacologic testing was the most frequent method of diagnosis. In 5 cases, the diagnosis was made based on positive genetic testing without phenotypic alterations. In conclusion, this sequential diagnostic protocol allows diagnoses to be made in approximately half of the UCA cases. These diagnoses are low clinical penetrance channelopathies. If interpreted carefully, genetic tests can be a useful tool for diagnosing UCA without a phenotype.
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Mellor G, Behr ER. Sudden Unexplained Death - Treating the Family. Arrhythm Electrophysiol Rev 2014; 3:156-60. [PMID: 26835084 DOI: 10.15420/aer.2014.3.3.156] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 11/03/2014] [Indexed: 01/08/2023] Open
Abstract
Sudden unexplained death in the context of a normal heart at post-mortem and negative toxicological analysis is termed sudden arrhythmic death syndrome (SADS). SADS is often due to cardiac genetic disease, particularly channelopathies. Assessment of family members of SADS victims will reveal at least one affected individual in up to half of families. Specialist evaluation begins with an expert cardiac autopsy that improves diagnostic accuracy and minimises erroneous interpretation of minor pathological findings. Retention of appropriate material for post-mortem genetic testing, 'the molecular autopsy', is recommended as this may provide a genetic diagnosis in up to a third of cases. Clinical assessment of families initially comprises 12-lead ECG with high right ventricular leads, echocardiogram and exercise testing. Additional investigations include sodium channel blocker and epinephrine provocation tests. Families with a diagnosis should be managed as per guidelines. Those with negative investigations can generally be discharged unless they are young and/or symptomatic.
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Affiliation(s)
- Greg Mellor
- Clinical Research Fellow & Specialist Registrar Cardiology
| | - Elijah R Behr
- Reader in Cardiovascular Medicine & Honorary Consultant Cardiologist & Electrophysiologist Cardiac Research Centre, Institute of Cardiovascular and Cell Sciences, St. George's University of London, London
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Pedersen CT, Kay GN, Kalman J, Borggrefe M, Della-Bella P, Dickfeld T, Dorian P, Huikuri H, Kim YH, Knight B, Marchlinski F, Ross D, Sacher F, Sapp J, Shivkumar K, Soejima K, Tada H, Alexander ME, Triedman JK, Yamada T, Kirchhof P, Lip GY, Kuck KH, Mont L, Haines D, Indik J, Dimarco J, Exner D, Iesaka Y, Savelieva I. EHRA/HRS/APHRS expert consensus on ventricular arrhythmias. J Arrhythm 2014. [DOI: 10.1016/j.joa.2014.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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van der Werf C, Stiekema L, Tan HL, Hofman N, Alders M, van der Wal AC, van Langen IM, Wilde AA. Low rate of cardiac events in first-degree relatives of diagnosis-negative young sudden unexplained death syndrome victims during follow-up. Heart Rhythm 2014; 11:1728-32. [DOI: 10.1016/j.hrthm.2014.05.028] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Indexed: 01/23/2023]
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Pedersen CT, Kay GN, Kalman J, Borggrefe M, Della-Bella P, Dickfeld T, Dorian P, Huikuri H, Kim YH, Knight B, Marchlinski F, Ross D, Sacher F, Sapp J, Shivkumar K, Soejima K, Tada H, Alexander ME, Triedman JK, Yamada T, Kirchhof P, Lip GYH, Kuck KH, Mont L, Haines D, Indik J, Dimarco J, Exner D, Iesaka Y, Savelieva I. EHRA/HRS/APHRS expert consensus on ventricular arrhythmias. Europace 2014; 16:1257-83. [PMID: 25172618 DOI: 10.1093/europace/euu194] [Citation(s) in RCA: 136] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Choudhuri I, Pinninti M, Marwali MR, Sra J, Akhtar M. Polymorphic ventricular tachycardia--part II: the channelopathies. Curr Probl Cardiol 2014; 38:503-48. [PMID: 24262155 DOI: 10.1016/j.cpcardiol.2013.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
In this article, we explore the clinical and cellular phenomena of primary electrical diseases of the heart, that is, conditions purely related to ion channel dysfunction and not structural heart disease or reversible acquired causes. This growing classification of conditions, once considered together as "idiopathic ventricular fibrillation," continues to evolve and segregate into diseases that are phenotypically, molecularly, and genetically unique.
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Procainamide infusion in the evaluation of unexplained cardiac arrest: From the Cardiac Arrest Survivors with Preserved Ejection Fraction Registry (CASPER). Heart Rhythm 2014; 11:1047-54. [DOI: 10.1016/j.hrthm.2014.03.022] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Indexed: 12/31/2022]
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Herman A, Bennett MT, Chakrabarti S, Chakrabarti S, Krahn AD. Life threatening causes of syncope: channelopathies and cardiomyopathies. Auton Neurosci 2014; 184:53-9. [PMID: 24795161 DOI: 10.1016/j.autneu.2014.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 04/04/2014] [Accepted: 04/14/2014] [Indexed: 01/08/2023]
Abstract
Syncope is common, has a high recurrence rate and carries a risk of morbidity and, dependent on the cause, mortality. Although the majority of patients with syncope have a benign prognosis, syncope as a result of cardiomyopathy or channelopathy carries a poor prognosis. In addition, the identification of these disorders allows for the institution of treatments, which are effective at reducing the risk of both syncope and mortality. It is for these reasons that the identification of a cardiomyopathy or channelopathy in patients with syncope is crucial. This review article will describe the characteristics of common cardiomyopathies and channelopathies and their investigation.
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Affiliation(s)
- Adam Herman
- Division of Cardiology, University of British Columbia, Vancouver, BC, Canada
| | - Matthew T Bennett
- Division of Cardiology, University of British Columbia, Vancouver, BC, Canada
| | | | | | - Andrew D Krahn
- Division of Cardiology, University of British Columbia, Vancouver, BC, Canada.
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Genetic testing in heritable cardiac arrhythmia syndromes: differentiating pathogenic mutations from background genetic noise. Curr Opin Cardiol 2013; 28:63-71. [PMID: 23128497 DOI: 10.1097/hco.0b013e32835b0a41] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW In this review, we summarize the basic principles governing rare variant interpretation in the heritable cardiac arrhythmia syndromes, focusing on recent advances that have led to disease-specific approaches to the interpretation of positive genetic testing results. RECENT FINDINGS Elucidation of the genetic substrates underlying heritable cardiac arrhythmia syndromes has unearthed new arrhythmogenic mechanisms and given rise to a number of clinically meaningful genotype-phenotype correlations. As such, genetic testing for these disorders now carries important diagnostic, prognostic, and therapeutic implications. Recent large-scale systematic studies designed to explore the background genetic 'noise' rate associated with these genetic tests have provided important insights and enhanced how positive genetic testing results are interpreted for these potentially lethal, yet highly treatable, cardiovascular disorders. SUMMARY Clinically available genetic tests for heritable cardiac arrhythmia syndromes allow the identification of potentially at-risk family members and contribute to the risk-stratification and selection of therapeutic interventions in affected individuals. The systematic evaluation of the 'signal-to-noise' ratio associated with these genetic tests has proven critical and essential to assessing the probability that a given variant represents a rare pathogenic mutation or an equally rare, yet innocuous, genetic bystander.
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Jiménez-Jáimez J, Álvarez M, Algarra M, Macías Ruíz R, Peñas R, Valverde F, Tortajada G, Lorente JA, Melgares R, Tercedor L. Baja penetrancia clínica en sujetos portadores de mutación patogénica para las canalopatías cardiacas. Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2012.09.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Jiménez-Jáimez J, Álvarez M, Algarra M, Macías Ruíz R, Peñas R, Valverde F, Tortajada G, Lorente JA, Melgares R, Tercedor L. Low clinical penetrance in causal mutation carriers for cardiac channelopathies. ACTA ACUST UNITED AC 2012; 66:275-81. [PMID: 24775617 DOI: 10.1016/j.rec.2012.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Accepted: 09/20/2012] [Indexed: 01/20/2023]
Abstract
INTRODUCTION AND OBJECTIVES Cardiac channelopathies are genetic alterations that can cause sudden death. Long QT syndrome and Brugada syndrome are 2 such conditions. Both are diagnosed according to previously published criteria. Our objective was to determine the sensitivity of these criteria in a consecutive series of patients carrying the mutations that cause them. METHODS We enrolled 15 families and 31 causal mutation carriers with a high pathogenic probability of having long QT syndrome and Brugada syndrome. We conducted clinical and electrocardiographic studies to analyze the extent to which these patients fulfilled the diagnostic criteria. Statistical analysis was with SPSS 17.0. RESULTS Some 48.3% of the subjects met the criteria indicating a high probability of long QT syndrome or Brugada syndrome. Among those with the mutation for long QT syndrome, only 10 out of 21 had a Schwartz index score ≥ 4. Both the median Schwartz score and the cQT interval were lower in relatives than in probands. Of those with the mutation for Brugada syndrome, 60% failed to meet current diagnostic criteria, which were more frequently fulfilled in relatives. Pharmacological tests with epinephrine and flecainide helped establish the diagnosis in 2 mutation carriers with negative phenotype. CONCLUSIONS Current diagnostic criteria for long QT syndrome and Brugada syndrome had low sensitivity in our sample of genetic carriers. Genetic tests supported by pharmacological tests can increase diagnostic sensitivity, especially in asymptomatic relatives.
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Affiliation(s)
- Juan Jiménez-Jáimez
- Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain.
| | - Miguel Álvarez
- Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - María Algarra
- Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Rosa Macías Ruíz
- Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Rocío Peñas
- Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Francisca Valverde
- Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Gustavo Tortajada
- Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Jose Antonio Lorente
- Departamento de Medicina Legal y Toxicología, Universidad de Granada, GENYO-Centro Pfizer-Universidad de Granada-Junta de Andalucía de Genómica y Oncología, Granada, Spain
| | - Rafael Melgares
- Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Luis Tercedor
- Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain
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Abstract
Unexplained cardiac arrest is defined as a cardiac arrest in the absence of coronary artery disease and overt structural heart disease, present in 5%-10% of cardiac arrest survivors. A genetic contribution to cardiac arrest is more common in this population, most commonly attributed to an inherited ion channel abnormality leading to familial syncope and sudden death. The common causes are Long QT and Brugada syndrome, catecholaminergic ventricular tachycardia, idiopathic ventricular fibrillation, and early repolarization syndrome. Latent structural causes include inherited cardiomyopathy such as arrhythmogenic right ventricular cardiomyopathy. We review these causes in detail and a structured approach to the investigation of these patients, which provides a diagnosis in approximately half of these patients. This allows for the initiation of disease-specific treatments and enables family screening.
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Silva JNA, Silva JR. Updates on the inherited cardiac ion channelopathies: from cell to clinical. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2012; 14:473-89. [PMID: 22865245 DOI: 10.1007/s11936-012-0198-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OPINION STATEMENT The inherited channelopathies are a rare, heterogeneous group of diseases with widely variable clinical presentations and courses. Systematic clinical and experimental work has led to identification of disease-causing genetic mutations and their biophysical manifestation. The process by which the knowledge base is developed, from genetic mutation, to cardiac myocyte, to whole heart, and finally to clinical presentation, has dramatically expanded our understanding of these diseases. Most importantly, we can now begin to comprehend how small changes at the genetic level can dramatically influence a patient's clinical course.
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Affiliation(s)
- Jennifer N A Silva
- Department of Pediatrics, Washington University School of Medicine/Saint Louis Children's Hospital, Saint Louis, MO, USA,
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Krahn AD, Healey JS, Chauhan VS, Birnie DH, Champagne J, Sanatani S, Ahmad K, Ballantyne E, Gerull B, Yee R, Skanes AC, Gula LJ, Leong-Sit P, Klein GJ, Gollob MH, Simpson CS, Talajic M, Gardner M. Epinephrine Infusion in the Evaluation of Unexplained Cardiac Arrest and Familial Sudden Death. Circ Arrhythm Electrophysiol 2012; 5:933-40. [DOI: 10.1161/circep.112.973230] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Epinephrine infusion may unmask latent genetic conditions associated with cardiac arrest, including long-QT syndrome and catecholaminergic polymorphic ventricular tachycardia (VT).
Methods and Results—
Patients with unexplained cardiac arrest (normal left ventricular function and QT interval) and selected family members from the Cardiac Arrest Survivors with Preserved Ejection Fraction Registry (CASPER) registry underwent epinephrine challenge at doses of 0.05, 0.10, and 0.20 μg/kg per minute. A test was considered positive for long-QT syndrome if the absolute QT interval prolonged by ≥30 ms at 0.10 μg/kg per minute and borderline if QT prolongation was 1 to 29 ms. Catecholaminergic polymorphic VT was diagnosed if epinephrine provoked ≥3 beats of polymorphic or bidirectional VT and borderline if polymorphic couplets, premature ventricular contractions, or nonsustained monomorphic VT was induced. Epinephrine infusion was performed in 170 patients (age, 42±16 years; 49% men), including 98 patients with unexplained cardiac arrest. Testing was positive for long-QT syndrome in 31 patients (18%) and borderline in 24 patients (14%). Exercise testing provoked an abnormal QT response in 42% of tested patients with a positive epinephrine response. Testing for catecholaminergic polymorphic VT was positive in 7% and borderline in 5%. Targeted genetic testing of abnormal patients was positive in 17% of long-QT syndrome patients and 13% of catecholaminergic polymorphic VT patients.
Conclusions—
Epinephrine challenge provoked abnormalities in a substantial proportion of patients, most commonly a prolonged QT interval. Exercise and genetic testing replicated the diagnosis suggested by the epinephrine response in a small proportion of patients. Epinephrine infusion combined with exercise testing and targeted genetic testing is recommended in the workup of suspected familial sudden death syndromes.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00292032.
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Affiliation(s)
- Andrew D. Krahn
- From the University of British Columbia (A.D.K.), Vancouver, BC; Population Health Research Institute, McMaster University (J.S.H.), Hamilton, ON; University Health Network (V.S.C.), Toronto, Canada; University of Ottawa Heart Institute (D.H.B., M.H.G.), Ottawa, ON; Quebec Heart Institute (J.C.), Laval Hospital, Quebec City, PQ; BC Children’s Hospital (S.S.), Vancouver, British Columbia, Vancouver, BC; St Michael’s Hospital (K.A.), Toronto, Canada; University of Western Ontario (E.B., R.Y., A.C.S.,
| | - Jeffrey S. Healey
- From the University of British Columbia (A.D.K.), Vancouver, BC; Population Health Research Institute, McMaster University (J.S.H.), Hamilton, ON; University Health Network (V.S.C.), Toronto, Canada; University of Ottawa Heart Institute (D.H.B., M.H.G.), Ottawa, ON; Quebec Heart Institute (J.C.), Laval Hospital, Quebec City, PQ; BC Children’s Hospital (S.S.), Vancouver, British Columbia, Vancouver, BC; St Michael’s Hospital (K.A.), Toronto, Canada; University of Western Ontario (E.B., R.Y., A.C.S.,
| | - Vijay S. Chauhan
- From the University of British Columbia (A.D.K.), Vancouver, BC; Population Health Research Institute, McMaster University (J.S.H.), Hamilton, ON; University Health Network (V.S.C.), Toronto, Canada; University of Ottawa Heart Institute (D.H.B., M.H.G.), Ottawa, ON; Quebec Heart Institute (J.C.), Laval Hospital, Quebec City, PQ; BC Children’s Hospital (S.S.), Vancouver, British Columbia, Vancouver, BC; St Michael’s Hospital (K.A.), Toronto, Canada; University of Western Ontario (E.B., R.Y., A.C.S.,
| | - David H. Birnie
- From the University of British Columbia (A.D.K.), Vancouver, BC; Population Health Research Institute, McMaster University (J.S.H.), Hamilton, ON; University Health Network (V.S.C.), Toronto, Canada; University of Ottawa Heart Institute (D.H.B., M.H.G.), Ottawa, ON; Quebec Heart Institute (J.C.), Laval Hospital, Quebec City, PQ; BC Children’s Hospital (S.S.), Vancouver, British Columbia, Vancouver, BC; St Michael’s Hospital (K.A.), Toronto, Canada; University of Western Ontario (E.B., R.Y., A.C.S.,
| | - Jean Champagne
- From the University of British Columbia (A.D.K.), Vancouver, BC; Population Health Research Institute, McMaster University (J.S.H.), Hamilton, ON; University Health Network (V.S.C.), Toronto, Canada; University of Ottawa Heart Institute (D.H.B., M.H.G.), Ottawa, ON; Quebec Heart Institute (J.C.), Laval Hospital, Quebec City, PQ; BC Children’s Hospital (S.S.), Vancouver, British Columbia, Vancouver, BC; St Michael’s Hospital (K.A.), Toronto, Canada; University of Western Ontario (E.B., R.Y., A.C.S.,
| | - Shubhayan Sanatani
- From the University of British Columbia (A.D.K.), Vancouver, BC; Population Health Research Institute, McMaster University (J.S.H.), Hamilton, ON; University Health Network (V.S.C.), Toronto, Canada; University of Ottawa Heart Institute (D.H.B., M.H.G.), Ottawa, ON; Quebec Heart Institute (J.C.), Laval Hospital, Quebec City, PQ; BC Children’s Hospital (S.S.), Vancouver, British Columbia, Vancouver, BC; St Michael’s Hospital (K.A.), Toronto, Canada; University of Western Ontario (E.B., R.Y., A.C.S.,
| | - Kamran Ahmad
- From the University of British Columbia (A.D.K.), Vancouver, BC; Population Health Research Institute, McMaster University (J.S.H.), Hamilton, ON; University Health Network (V.S.C.), Toronto, Canada; University of Ottawa Heart Institute (D.H.B., M.H.G.), Ottawa, ON; Quebec Heart Institute (J.C.), Laval Hospital, Quebec City, PQ; BC Children’s Hospital (S.S.), Vancouver, British Columbia, Vancouver, BC; St Michael’s Hospital (K.A.), Toronto, Canada; University of Western Ontario (E.B., R.Y., A.C.S.,
| | - Emily Ballantyne
- From the University of British Columbia (A.D.K.), Vancouver, BC; Population Health Research Institute, McMaster University (J.S.H.), Hamilton, ON; University Health Network (V.S.C.), Toronto, Canada; University of Ottawa Heart Institute (D.H.B., M.H.G.), Ottawa, ON; Quebec Heart Institute (J.C.), Laval Hospital, Quebec City, PQ; BC Children’s Hospital (S.S.), Vancouver, British Columbia, Vancouver, BC; St Michael’s Hospital (K.A.), Toronto, Canada; University of Western Ontario (E.B., R.Y., A.C.S.,
| | - Brenda Gerull
- From the University of British Columbia (A.D.K.), Vancouver, BC; Population Health Research Institute, McMaster University (J.S.H.), Hamilton, ON; University Health Network (V.S.C.), Toronto, Canada; University of Ottawa Heart Institute (D.H.B., M.H.G.), Ottawa, ON; Quebec Heart Institute (J.C.), Laval Hospital, Quebec City, PQ; BC Children’s Hospital (S.S.), Vancouver, British Columbia, Vancouver, BC; St Michael’s Hospital (K.A.), Toronto, Canada; University of Western Ontario (E.B., R.Y., A.C.S.,
| | - Raymond Yee
- From the University of British Columbia (A.D.K.), Vancouver, BC; Population Health Research Institute, McMaster University (J.S.H.), Hamilton, ON; University Health Network (V.S.C.), Toronto, Canada; University of Ottawa Heart Institute (D.H.B., M.H.G.), Ottawa, ON; Quebec Heart Institute (J.C.), Laval Hospital, Quebec City, PQ; BC Children’s Hospital (S.S.), Vancouver, British Columbia, Vancouver, BC; St Michael’s Hospital (K.A.), Toronto, Canada; University of Western Ontario (E.B., R.Y., A.C.S.,
| | - Allan C. Skanes
- From the University of British Columbia (A.D.K.), Vancouver, BC; Population Health Research Institute, McMaster University (J.S.H.), Hamilton, ON; University Health Network (V.S.C.), Toronto, Canada; University of Ottawa Heart Institute (D.H.B., M.H.G.), Ottawa, ON; Quebec Heart Institute (J.C.), Laval Hospital, Quebec City, PQ; BC Children’s Hospital (S.S.), Vancouver, British Columbia, Vancouver, BC; St Michael’s Hospital (K.A.), Toronto, Canada; University of Western Ontario (E.B., R.Y., A.C.S.,
| | - Lorne J. Gula
- From the University of British Columbia (A.D.K.), Vancouver, BC; Population Health Research Institute, McMaster University (J.S.H.), Hamilton, ON; University Health Network (V.S.C.), Toronto, Canada; University of Ottawa Heart Institute (D.H.B., M.H.G.), Ottawa, ON; Quebec Heart Institute (J.C.), Laval Hospital, Quebec City, PQ; BC Children’s Hospital (S.S.), Vancouver, British Columbia, Vancouver, BC; St Michael’s Hospital (K.A.), Toronto, Canada; University of Western Ontario (E.B., R.Y., A.C.S.,
| | - Peter Leong-Sit
- From the University of British Columbia (A.D.K.), Vancouver, BC; Population Health Research Institute, McMaster University (J.S.H.), Hamilton, ON; University Health Network (V.S.C.), Toronto, Canada; University of Ottawa Heart Institute (D.H.B., M.H.G.), Ottawa, ON; Quebec Heart Institute (J.C.), Laval Hospital, Quebec City, PQ; BC Children’s Hospital (S.S.), Vancouver, British Columbia, Vancouver, BC; St Michael’s Hospital (K.A.), Toronto, Canada; University of Western Ontario (E.B., R.Y., A.C.S.,
| | - George J. Klein
- From the University of British Columbia (A.D.K.), Vancouver, BC; Population Health Research Institute, McMaster University (J.S.H.), Hamilton, ON; University Health Network (V.S.C.), Toronto, Canada; University of Ottawa Heart Institute (D.H.B., M.H.G.), Ottawa, ON; Quebec Heart Institute (J.C.), Laval Hospital, Quebec City, PQ; BC Children’s Hospital (S.S.), Vancouver, British Columbia, Vancouver, BC; St Michael’s Hospital (K.A.), Toronto, Canada; University of Western Ontario (E.B., R.Y., A.C.S.,
| | - Michael H. Gollob
- From the University of British Columbia (A.D.K.), Vancouver, BC; Population Health Research Institute, McMaster University (J.S.H.), Hamilton, ON; University Health Network (V.S.C.), Toronto, Canada; University of Ottawa Heart Institute (D.H.B., M.H.G.), Ottawa, ON; Quebec Heart Institute (J.C.), Laval Hospital, Quebec City, PQ; BC Children’s Hospital (S.S.), Vancouver, British Columbia, Vancouver, BC; St Michael’s Hospital (K.A.), Toronto, Canada; University of Western Ontario (E.B., R.Y., A.C.S.,
| | - Christopher S. Simpson
- From the University of British Columbia (A.D.K.), Vancouver, BC; Population Health Research Institute, McMaster University (J.S.H.), Hamilton, ON; University Health Network (V.S.C.), Toronto, Canada; University of Ottawa Heart Institute (D.H.B., M.H.G.), Ottawa, ON; Quebec Heart Institute (J.C.), Laval Hospital, Quebec City, PQ; BC Children’s Hospital (S.S.), Vancouver, British Columbia, Vancouver, BC; St Michael’s Hospital (K.A.), Toronto, Canada; University of Western Ontario (E.B., R.Y., A.C.S.,
| | - Mario Talajic
- From the University of British Columbia (A.D.K.), Vancouver, BC; Population Health Research Institute, McMaster University (J.S.H.), Hamilton, ON; University Health Network (V.S.C.), Toronto, Canada; University of Ottawa Heart Institute (D.H.B., M.H.G.), Ottawa, ON; Quebec Heart Institute (J.C.), Laval Hospital, Quebec City, PQ; BC Children’s Hospital (S.S.), Vancouver, British Columbia, Vancouver, BC; St Michael’s Hospital (K.A.), Toronto, Canada; University of Western Ontario (E.B., R.Y., A.C.S.,
| | - Martin Gardner
- From the University of British Columbia (A.D.K.), Vancouver, BC; Population Health Research Institute, McMaster University (J.S.H.), Hamilton, ON; University Health Network (V.S.C.), Toronto, Canada; University of Ottawa Heart Institute (D.H.B., M.H.G.), Ottawa, ON; Quebec Heart Institute (J.C.), Laval Hospital, Quebec City, PQ; BC Children’s Hospital (S.S.), Vancouver, British Columbia, Vancouver, BC; St Michael’s Hospital (K.A.), Toronto, Canada; University of Western Ontario (E.B., R.Y., A.C.S.,
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Catecholaminergic polymorphic ventricular tachycardia found in an adolescent after a methylenedioxymethamphetamine and marijuana-induced cardiac arrest. Crit Care Med 2012; 40:2223-6. [PMID: 22584762 DOI: 10.1097/ccm.0b013e318250a870] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To illustrate the challenges of managing patients with acute, undiagnosed arrhythmias through a case that demonstrates a possible association between catecholaminergic polymorphic ventricular tachycardia, a genetically determined severe arrhythmia disorder that often presents as either syncope or sudden death, and 3,4-Methylenedioxymethamphetamine ("Ecstasy") combined with marijuana, which are often considered safe drugs by users. DESIGN Case report. SETTING Pediatric intensive care unit. PATIENT A 15-yr-old male collapsed suddenly after ingesting an unknown substance and smoking marijuana. He was successfully resuscitated by first-responder chest compressions and rescue breaths along with a single 100-J shock by paramedics. He was intubated and transferred to a pediatric intensive care unit. Initial cardiac workup was negative but severe instability on vasopressors and a family history of intermittent palpitations and syncope in his brother raised suspicion for catecholaminergic polymorphic ventricular tachycardia. Identification of the unknown substance required coordination with a toxicology laboratory. INTERVENTIONS The patient had extremely labile cardiovascular responses to vasopressors. On day 5, his blood pressure was stable and he was extubated. A full cardiac workup, including a catheterization (preadmission to pediatric intensive care unit), electrocardiogram, cardiac magnetic resonance imaging were done to screen out most structural arrythmogenic diseases. A specific genetic test for catecholaminergic polymorphic ventricular tachycardia was sent. MEASUREMENTS AND MAIN RESULTS The patient's methylenedioxymethamphetamine blood level was 87 ng/mL approximately 12 hrs after ingestion. Given the 3-8 hr half-life of methylenedioxymethamphetamine, it is likely that levels were toxic at the time of ingestion (>110 ng/mL). Marijuana may have provided a synergistic critical catecholamine release to trigger an arrhythmia. Genetic testing showed a ryanodine receptor-2 mutation that was consistent with catecholaminergic polymorphic ventricular tachycardia. CONCLUSIONS While an initial cardiac workup for an acute, undiagnosed arrhythmia may be negative, family history may be a simple, essential component of patient management and disease diagnosis. This case demonstrates a possible association between methylenedioxymethamphetamine, marijuana, and catecholaminergic polymorphic ventricular tachycardia. All genetic and structural arrythmogenic disorders should be considered when working up a patient with presumed toxin-induced arrhythmias.
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Obeyesekere MN, Leong-Sit P, Gula LJ, Yee R, Skanes AC, Klein GJ, Krahn AD. The Evaluation of a Borderline Long QT Interval in an Asymptomatic Patient. Card Electrophysiol Clin 2012; 4:227-238. [PMID: 26939820 DOI: 10.1016/j.ccep.2012.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
QT prolongation on resting electrocardiography (ECG) is common, and the clinician is often challenged by the dilemma of excluding acquired causes and recognizing potential congenital long QT syndrome (LQTS). The hallmark of LQTS is an abnormally long QT interval. However, a normal or borderline long QT interval may be observed in up to 50% of patients with LQTS because of the intermittent nature of QT prolongation. This review presents an approach to evaluating the asymptomatic patient with a borderline long QT interval, which incorporates a comprehensive clinical assessment, rest and provocative ECG testing, and genetic testing when appropriate.
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Affiliation(s)
- Manoj N Obeyesekere
- Division of Cardiology, The University of Western Ontario, 339 Windermere Road, London, Ontario N6A 5A5, Canada
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45
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Spears DA, Suszko AM, Krahn AD, Selvaraj RJ, Ivanov J, Chauhan VS. Latent microvolt T-wave alternans in survivors of unexplained cardiac arrest unmasked by epinephrine challenge. Heart Rhythm 2012; 9:1076-82. [PMID: 22373794 DOI: 10.1016/j.hrthm.2012.02.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Indexed: 12/01/2022]
Abstract
BACKGROUND The arrhythmogenic substrate in survivors of unexplained cardiac arrest (UCA) has not been defined. OBJECTIVES To test the hypothesis that patients with UCA have latent repolarization abnormalities, in particular T-wave alternans (TWA), which may be unmasked with epinephrine (EPI) challenge. METHODS We prospectively studied 10 UCA survivors (46 ± 9 years) and 11 first-degree relatives (FDRs) of sudden death victims (37 ± 14 years). Patients with UCA underwent standard clinical testing, which was normal. FDRs had normal clinical history and testing. All subjects underwent an EPI infusion (0.05, 0.1, and 0.2 μg/(kg·min), 5 minutes each dose) while recording continuous digital 12-lead electrocardiograms. Corrected QT interval and QT variability index were evaluated at each EPI dose. TWA magnitude (V(alt)) was assessed at each dose by using the spectral method. Positive (+) TWA at each dose was defined as V(alt) > 0 with k ≥ 3 in 1 or more 128-beat segment in ≥2 electrocardiogram leads. A novel metric, TWA burden, reflecting V(alt) integrated over time (s), was also evaluated for each EPI dose. RESULTS There was no difference between UCA survivors and FDRs with respect to heart rate, QT, corrected QT interval, or QT variability index at baseline or during EPI. At baseline, +TWA was similar between UCA survivors and FDRs (10% vs 0%; P = NS). During EPI, +TWA was more prevalent in UCA survivors than in FDRs (80% vs 18%; P = .009). TWA burden was greater in UCA survivors than in FDRs during EPI 0.1 (P = .039) and EPI 0.2 μg/(kg·min) (P = .009). CONCLUSIONS UCA survivors are more likely to demonstrate latent TWA compared with FDRs, which becomes manifest with EPI. This novel finding provides evidence for an arrhythmogenic substrate in UCA survivors.
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Affiliation(s)
- Danna A Spears
- Division of Cardiology, University Health Network, Toronto, Ontario, Canada
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Kaneshiro T, Naruse Y, Nogami A, Tada H, Yoshida K, Sekiguchi Y, Murakoshi N, Kato Y, Horigome H, Kawamura M, Horie M, Aonuma K. Successful Catheter Ablation of Bidirectional Ventricular Premature Contractions Triggering Ventricular Fibrillation in Catecholaminergic Polymorphic Ventricular Tachycardia With
RyR2
Mutation. Circ Arrhythm Electrophysiol 2012; 5:e14-7. [DOI: 10.1161/circep.111.966549] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Takashi Kaneshiro
- From the Cardiovascular Division, Institute of Clinical Medicine (T.K., Y.N., H.T., K.Y., Y.S., N.M., K.A.) and Department of Child Health (Y.K., H.H.), Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan; Division of Heart Rhythm Management, Yokohama Rosai Hospital, Yokohama, Japan (A.N.); and Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Shiga, Japan (M.K., M.H.)
| | - Yoshihisa Naruse
- From the Cardiovascular Division, Institute of Clinical Medicine (T.K., Y.N., H.T., K.Y., Y.S., N.M., K.A.) and Department of Child Health (Y.K., H.H.), Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan; Division of Heart Rhythm Management, Yokohama Rosai Hospital, Yokohama, Japan (A.N.); and Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Shiga, Japan (M.K., M.H.)
| | - Akihiko Nogami
- From the Cardiovascular Division, Institute of Clinical Medicine (T.K., Y.N., H.T., K.Y., Y.S., N.M., K.A.) and Department of Child Health (Y.K., H.H.), Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan; Division of Heart Rhythm Management, Yokohama Rosai Hospital, Yokohama, Japan (A.N.); and Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Shiga, Japan (M.K., M.H.)
| | - Hiroshi Tada
- From the Cardiovascular Division, Institute of Clinical Medicine (T.K., Y.N., H.T., K.Y., Y.S., N.M., K.A.) and Department of Child Health (Y.K., H.H.), Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan; Division of Heart Rhythm Management, Yokohama Rosai Hospital, Yokohama, Japan (A.N.); and Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Shiga, Japan (M.K., M.H.)
| | - Kentaro Yoshida
- From the Cardiovascular Division, Institute of Clinical Medicine (T.K., Y.N., H.T., K.Y., Y.S., N.M., K.A.) and Department of Child Health (Y.K., H.H.), Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan; Division of Heart Rhythm Management, Yokohama Rosai Hospital, Yokohama, Japan (A.N.); and Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Shiga, Japan (M.K., M.H.)
| | - Yukio Sekiguchi
- From the Cardiovascular Division, Institute of Clinical Medicine (T.K., Y.N., H.T., K.Y., Y.S., N.M., K.A.) and Department of Child Health (Y.K., H.H.), Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan; Division of Heart Rhythm Management, Yokohama Rosai Hospital, Yokohama, Japan (A.N.); and Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Shiga, Japan (M.K., M.H.)
| | - Nobuyuki Murakoshi
- From the Cardiovascular Division, Institute of Clinical Medicine (T.K., Y.N., H.T., K.Y., Y.S., N.M., K.A.) and Department of Child Health (Y.K., H.H.), Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan; Division of Heart Rhythm Management, Yokohama Rosai Hospital, Yokohama, Japan (A.N.); and Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Shiga, Japan (M.K., M.H.)
| | - Yoshiaki Kato
- From the Cardiovascular Division, Institute of Clinical Medicine (T.K., Y.N., H.T., K.Y., Y.S., N.M., K.A.) and Department of Child Health (Y.K., H.H.), Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan; Division of Heart Rhythm Management, Yokohama Rosai Hospital, Yokohama, Japan (A.N.); and Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Shiga, Japan (M.K., M.H.)
| | - Hitoshi Horigome
- From the Cardiovascular Division, Institute of Clinical Medicine (T.K., Y.N., H.T., K.Y., Y.S., N.M., K.A.) and Department of Child Health (Y.K., H.H.), Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan; Division of Heart Rhythm Management, Yokohama Rosai Hospital, Yokohama, Japan (A.N.); and Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Shiga, Japan (M.K., M.H.)
| | - Mihoko Kawamura
- From the Cardiovascular Division, Institute of Clinical Medicine (T.K., Y.N., H.T., K.Y., Y.S., N.M., K.A.) and Department of Child Health (Y.K., H.H.), Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan; Division of Heart Rhythm Management, Yokohama Rosai Hospital, Yokohama, Japan (A.N.); and Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Shiga, Japan (M.K., M.H.)
| | - Minoru Horie
- From the Cardiovascular Division, Institute of Clinical Medicine (T.K., Y.N., H.T., K.Y., Y.S., N.M., K.A.) and Department of Child Health (Y.K., H.H.), Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan; Division of Heart Rhythm Management, Yokohama Rosai Hospital, Yokohama, Japan (A.N.); and Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Shiga, Japan (M.K., M.H.)
| | - Kazutaka Aonuma
- From the Cardiovascular Division, Institute of Clinical Medicine (T.K., Y.N., H.T., K.Y., Y.S., N.M., K.A.) and Department of Child Health (Y.K., H.H.), Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan; Division of Heart Rhythm Management, Yokohama Rosai Hospital, Yokohama, Japan (A.N.); and Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Shiga, Japan (M.K., M.H.)
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Ackerman MJ, Priori SG, Willems S, Berul C, Brugada R, Calkins H, Camm AJ, Ellinor PT, Gollob M, Hamilton R, Hershberger RE, Judge DP, Le Marec H, McKenna WJ, Schulze-Bahr E, Semsarian C, Towbin JA, Watkins H, Wilde A, Wolpert C, Zipes DP. HRS/EHRA expert consensus statement on the state of genetic testing for the channelopathies and cardiomyopathies this document was developed as a partnership between the Heart Rhythm Society (HRS) and the European Heart Rhythm Association (EHRA). Heart Rhythm 2012; 8:1308-39. [PMID: 21787999 DOI: 10.1016/j.hrthm.2011.05.020] [Citation(s) in RCA: 729] [Impact Index Per Article: 60.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Indexed: 10/18/2022]
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Ackerman MJ, Priori SG, Willems S, Berul C, Brugada R, Calkins H, Camm AJ, Ellinor PT, Gollob M, Hamilton R, Hershberger RE, Judge DP, Le Marec H, McKenna WJ, Schulze-Bahr E, Semsarian C, Towbin JA, Watkins H, Wilde A, Wolpert C, Zipes DP. HRS/EHRA expert consensus statement on the state of genetic testing for the channelopathies and cardiomyopathies: this document was developed as a partnership between the Heart Rhythm Society (HRS) and the European Heart Rhythm Association (EHRA). Europace 2011; 13:1077-109. [PMID: 21810866 DOI: 10.1093/europace/eur245] [Citation(s) in RCA: 560] [Impact Index Per Article: 43.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Obeyesekere MN, Klein GJ, Modi S, Leong-Sit P, Gula LJ, Yee R, Skanes AC, Krahn AD. How to Perform and Interpret Provocative Testing for the Diagnosis of Brugada Syndrome, Long-QT Syndrome, and Catecholaminergic Polymorphic Ventricular Tachycardia. Circ Arrhythm Electrophysiol 2011; 4:958-64. [DOI: 10.1161/circep.111.965947] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Manoj N. Obeyesekere
- From the University of Western Ontario, Division of Cardiology, London, Ontario, Canada
| | - George J. Klein
- From the University of Western Ontario, Division of Cardiology, London, Ontario, Canada
| | - Simon Modi
- From the University of Western Ontario, Division of Cardiology, London, Ontario, Canada
| | - Peter Leong-Sit
- From the University of Western Ontario, Division of Cardiology, London, Ontario, Canada
| | - Lorne J. Gula
- From the University of Western Ontario, Division of Cardiology, London, Ontario, Canada
| | - Raymond Yee
- From the University of Western Ontario, Division of Cardiology, London, Ontario, Canada
| | - Allan C. Skanes
- From the University of Western Ontario, Division of Cardiology, London, Ontario, Canada
| | - Andrew D. Krahn
- From the University of Western Ontario, Division of Cardiology, London, Ontario, Canada
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Abstract
Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare adrenergically mediated arrhythmogenic disorder classically induced by exercise or emotional stress and found in structurally normal hearts. It is an important cause of cardiac syncope and sudden death in childhood. Catecholaminergic polymorphic ventricular tachycardia is a genetic cardiac channelopathy with known mutations involving genes affecting intracellular calcium regulation. We present a case of a 14-year-old boy who had cardiopulmonary arrest after an emotionally induced episode of CPVT while attempting to invite a girl to the school dance. Review of his presenting cardiac rhythm, induction of concerning ventricular arrhythmias during an exercise stress test, and genetic testing confirmed the diagnosis of CPVT. He recovered fully and was treated with β-blocker therapy and placement of an implantable cardioverter-defibrillator. In this report, we discuss this rare but important entity, including its molecular foundation, clinical presentation, basics of diagnosis, therapeutic options, and implications of genetic testing for family members. We also compare CPVT to other notable cardiomyopathic and channelopathic causes of sudden death in youth including hypertrophic cardiomyopathy, arrhythmogenic right ventricular dysplasia, long QT syndrome, short QT syndrome, and Brugada syndrome.
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