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Nosetti L, Zaffanello M, Lombardi C, Gerosa A, Piacentini G, Abramo M, Agosti M. Early Screening for Long QT Syndrome and Cardiac Anomalies in Infants: A Comprehensive Study. Clin Pract 2024; 14:1038-1053. [PMID: 38921260 PMCID: PMC11203353 DOI: 10.3390/clinpract14030082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 03/26/2024] [Accepted: 05/30/2024] [Indexed: 06/27/2024] Open
Abstract
(1) Background: Sudden Infant Death Syndrome (SIDS) represents sudden and unexplained deaths during the sleep of infants under one year of age, despite thorough investigation. Screening for a prolonged QTc interval, a marker for Long QT Syndrome (LQTS), should be conducted on all newborns to reduce the incidence of SIDS. Neonatal electrocardiograms (ECGs) could identify congenital heart defects (CHDs) early, especially those not detected at birth. Infants with prolonged QTc intervals typically undergo genetic analysis for Long QT Syndrome. (2) Methods: The study involved infants aged 20-40 days, born with no apparent clinical signs of heart disease, with initial ECG screening. Infants with prenatal diagnoses or signs/symptoms of CHDs identified immediately after birth, as well as infants who had previously had an ECG or echocardiogram for other medical reasons, were excluded from the study. We used statistical software (SPSS version 22.0) to analyze the data. (3) Results: Of the 42,200 infants involved, 2245 were enrolled, with 39.9% being males. Following this initial screening, 164 children (37.8% males) with prolonged QTc intervals underwent further evaluation. Out of these 164 children, 27 children were confirmed to have LQTS. However, only 18 children were finally investigated for genetic mutations, and mutations were identified in 11 tests. The most common mutations were LQT1 (54.5%), LQT2 (36.4%), and LQT3 (1 patient). Treatment options included propranolol (39.8%), nadolol (22.2%), inderal (11.1%), metoprolol (11.1%), and no treatment (16.7%). The most common abnormalities were focal right bundle branch block (54.5%), left axis deviation (9.2%), and nonspecific ventricular repolarization abnormalities (7.1%). Multiple anomalies were found in 0.47% of children with focal right bundle branch block. Structural abnormalities were associated with specific features in 267 patients (11.9%), primarily isolated patent foramen ovale (PFO) at 61.4%. (4) Conclusions: This screening approach has demonstrated effectiveness in the early identification of LQTS and other cardiac rhythm anomalies, with additional identification of mutations and/or prolonged QTc intervals in family members. Identifying other ECG abnormalities and congenital heart malformations further enhances the benefits of the screening.
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Affiliation(s)
- Luana Nosetti
- Pediatric Sleep Disorders Center, Division of Pediatrics, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (L.N.)
| | - Marco Zaffanello
- Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, 37100 Verona, Italy
| | - Carolina Lombardi
- Sleep Disorders Center, Department of Cardiology Istituto Auxologico, IRCCS, 20149 Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy
| | - Alessandra Gerosa
- Pediatric Sleep Disorders Center, Division of Pediatrics, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (L.N.)
| | - Giorgio Piacentini
- Department of Surgery, Dentistry, Pediatrics and Gynecology, University of Verona, 37100 Verona, Italy
| | - Michele Abramo
- Pediatric Sleep Disorders Center, Division of Pediatrics, “F. Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy; (L.N.)
| | - Massimo Agosti
- Woman and Child Department, Varese Hospital, Insubria University, Via Ravasi 2, 21100 Varese, Italy;
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2
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Fogaça-da-Mata M, Martínez-Barrios E, Jiménez-Montañés L, Cruzalegui J, Chipa-Ccasani F, Greco A, Cesar S, Díez-Escuté N, Cerralbo P, Zschaeck I, Clavero Adell M, Ayerza-Casas A, Palanca-Arias D, López M, Campuzano O, Brugada J, Sarquella-Brugada G. Brugada Syndrome and Pulmonary Atresia with Intact Interventricular Septum: Fortuitous Finding or New Genetic Connection? Genes (Basel) 2024; 15:638. [PMID: 38790267 PMCID: PMC11121103 DOI: 10.3390/genes15050638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024] Open
Abstract
Brugada syndrome is a rare arrhythmogenic syndrome associated mainly with pathogenic variants in the SCN5A gene. Right ventricle outflow tract fibrosis has been reported in some cases of patients diagnosed with Brugada syndrome. Pulmonary atresia with an intact ventricular septum is characterized by the lack of a functional pulmonary valve, due to the underdevelopment of the right ventricle outflow tract. We report, for the first time, a 4-year-old boy with pulmonary atresia with an intact ventricular septum who harbored a pathogenic de novo variant in SCN5A, and the ajmaline test unmasked a type-1 Brugada pattern. We suggest that deleterious variants in the SCN5A gene could be implicated in pulmonary atresia with an intact ventricular septum embryogenesis, leading to overlapping phenotypes.
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Affiliation(s)
- Miguel Fogaça-da-Mata
- Arrhythmia, Inherited Cardiac Diseases and Sudden Death Unit, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, Esplugues de Llobregat, 08950 Barcelona, Spain; (M.F.-d.-M.); (E.M.-B.); (J.C.); (F.C.-C.); (A.G.); (S.C.); (N.D.-E.); (P.C.); (I.Z.)
- Pediatric Cardiology Unit, Hospital de Santa Cruz, Centro Hospitalar Lisboa Ocidental, 1449-005 Lisbon, Portugal
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), 1105 AZ Amsterdam, The Netherlands
| | - Estefanía Martínez-Barrios
- Arrhythmia, Inherited Cardiac Diseases and Sudden Death Unit, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, Esplugues de Llobregat, 08950 Barcelona, Spain; (M.F.-d.-M.); (E.M.-B.); (J.C.); (F.C.-C.); (A.G.); (S.C.); (N.D.-E.); (P.C.); (I.Z.)
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), 1105 AZ Amsterdam, The Netherlands
- Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Institut de Recerca Sant Joan de Déu, Santa Rosa 39–57, Esplugues de Llobregat, 08950 Barcelona, Spain
- Medical Science Department, School of Medicine, Universitat de Girona, 17003 Girona, Spain;
| | - Lorenzo Jiménez-Montañés
- Pediatric Cardiology Unit, University Hospital Miguel Servet, 50009 Zaragoza, Spain; (L.J.-M.); (M.C.A.); (A.A.-C.); (D.P.-A.); (M.L.)
| | - José Cruzalegui
- Arrhythmia, Inherited Cardiac Diseases and Sudden Death Unit, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, Esplugues de Llobregat, 08950 Barcelona, Spain; (M.F.-d.-M.); (E.M.-B.); (J.C.); (F.C.-C.); (A.G.); (S.C.); (N.D.-E.); (P.C.); (I.Z.)
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), 1105 AZ Amsterdam, The Netherlands
- Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Institut de Recerca Sant Joan de Déu, Santa Rosa 39–57, Esplugues de Llobregat, 08950 Barcelona, Spain
| | - Fredy Chipa-Ccasani
- Arrhythmia, Inherited Cardiac Diseases and Sudden Death Unit, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, Esplugues de Llobregat, 08950 Barcelona, Spain; (M.F.-d.-M.); (E.M.-B.); (J.C.); (F.C.-C.); (A.G.); (S.C.); (N.D.-E.); (P.C.); (I.Z.)
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), 1105 AZ Amsterdam, The Netherlands
- Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Institut de Recerca Sant Joan de Déu, Santa Rosa 39–57, Esplugues de Llobregat, 08950 Barcelona, Spain
| | - Andrea Greco
- Arrhythmia, Inherited Cardiac Diseases and Sudden Death Unit, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, Esplugues de Llobregat, 08950 Barcelona, Spain; (M.F.-d.-M.); (E.M.-B.); (J.C.); (F.C.-C.); (A.G.); (S.C.); (N.D.-E.); (P.C.); (I.Z.)
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), 1105 AZ Amsterdam, The Netherlands
- Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Institut de Recerca Sant Joan de Déu, Santa Rosa 39–57, Esplugues de Llobregat, 08950 Barcelona, Spain
| | - Sergi Cesar
- Arrhythmia, Inherited Cardiac Diseases and Sudden Death Unit, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, Esplugues de Llobregat, 08950 Barcelona, Spain; (M.F.-d.-M.); (E.M.-B.); (J.C.); (F.C.-C.); (A.G.); (S.C.); (N.D.-E.); (P.C.); (I.Z.)
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), 1105 AZ Amsterdam, The Netherlands
- Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Institut de Recerca Sant Joan de Déu, Santa Rosa 39–57, Esplugues de Llobregat, 08950 Barcelona, Spain
| | - Núria Díez-Escuté
- Arrhythmia, Inherited Cardiac Diseases and Sudden Death Unit, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, Esplugues de Llobregat, 08950 Barcelona, Spain; (M.F.-d.-M.); (E.M.-B.); (J.C.); (F.C.-C.); (A.G.); (S.C.); (N.D.-E.); (P.C.); (I.Z.)
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), 1105 AZ Amsterdam, The Netherlands
- Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Institut de Recerca Sant Joan de Déu, Santa Rosa 39–57, Esplugues de Llobregat, 08950 Barcelona, Spain
| | - Patricia Cerralbo
- Arrhythmia, Inherited Cardiac Diseases and Sudden Death Unit, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, Esplugues de Llobregat, 08950 Barcelona, Spain; (M.F.-d.-M.); (E.M.-B.); (J.C.); (F.C.-C.); (A.G.); (S.C.); (N.D.-E.); (P.C.); (I.Z.)
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), 1105 AZ Amsterdam, The Netherlands
- Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Institut de Recerca Sant Joan de Déu, Santa Rosa 39–57, Esplugues de Llobregat, 08950 Barcelona, Spain
| | - Irene Zschaeck
- Arrhythmia, Inherited Cardiac Diseases and Sudden Death Unit, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, Esplugues de Llobregat, 08950 Barcelona, Spain; (M.F.-d.-M.); (E.M.-B.); (J.C.); (F.C.-C.); (A.G.); (S.C.); (N.D.-E.); (P.C.); (I.Z.)
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), 1105 AZ Amsterdam, The Netherlands
- Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Institut de Recerca Sant Joan de Déu, Santa Rosa 39–57, Esplugues de Llobregat, 08950 Barcelona, Spain
| | - Marcos Clavero Adell
- Pediatric Cardiology Unit, University Hospital Miguel Servet, 50009 Zaragoza, Spain; (L.J.-M.); (M.C.A.); (A.A.-C.); (D.P.-A.); (M.L.)
| | - Ariadna Ayerza-Casas
- Pediatric Cardiology Unit, University Hospital Miguel Servet, 50009 Zaragoza, Spain; (L.J.-M.); (M.C.A.); (A.A.-C.); (D.P.-A.); (M.L.)
| | - Daniel Palanca-Arias
- Pediatric Cardiology Unit, University Hospital Miguel Servet, 50009 Zaragoza, Spain; (L.J.-M.); (M.C.A.); (A.A.-C.); (D.P.-A.); (M.L.)
| | - Marta López
- Pediatric Cardiology Unit, University Hospital Miguel Servet, 50009 Zaragoza, Spain; (L.J.-M.); (M.C.A.); (A.A.-C.); (D.P.-A.); (M.L.)
| | - Oscar Campuzano
- Medical Science Department, School of Medicine, Universitat de Girona, 17003 Girona, Spain;
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, 28029 Madrid, Spain;
- Cardiovascular Genetics Center, University of Girona—IDIBGI, 17190 Girona, Spain
| | - Josep Brugada
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares, 28029 Madrid, Spain;
- Arrhythmias Unit, Hospital Clinic de Barcelona, Universitat de Barcelona, 08036 Barcelona, Spain
| | - Georgia Sarquella-Brugada
- Arrhythmia, Inherited Cardiac Diseases and Sudden Death Unit, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu 2, Esplugues de Llobregat, 08950 Barcelona, Spain; (M.F.-d.-M.); (E.M.-B.); (J.C.); (F.C.-C.); (A.G.); (S.C.); (N.D.-E.); (P.C.); (I.Z.)
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart), 1105 AZ Amsterdam, The Netherlands
- Arrítmies Pediàtriques, Cardiologia Genètica i Mort Sobtada, Institut de Recerca Sant Joan de Déu, Santa Rosa 39–57, Esplugues de Llobregat, 08950 Barcelona, Spain
- Medical Science Department, School of Medicine, Universitat de Girona, 17003 Girona, Spain;
- Department of Surgery and Medico-Surgical Specialties, School of Medicine and Health Sciences, Universitat de Barcelona, 08036 Barcelona, Spain
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Caruso E, Farruggio S, Guccione P. Calmodulin mutation in long QT syndrome 15 associated with congenital heart defects further complicated by a functional 2:1 atrioventricular block: Management from foetal life to postpartum. Indian Pacing Electrophysiol J 2024; 24:150-154. [PMID: 38281621 PMCID: PMC11143731 DOI: 10.1016/j.ipej.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 12/27/2023] [Accepted: 01/17/2024] [Indexed: 01/30/2024] Open
Abstract
We report a long QT syndrome 15 whose diagnosis was suspected during foetal life and confirmed at birth and was associated with congenital heart disease. Genetic testing revealed a rare mutation associated with the CALM2 gene. At 23 weeks of gestation, severe foetal sinus bradycardia (∼100 bpm) was detected. In the third trimester, the foetus developed severe right ventricular hypertrophy. At birth, the electrocardiogram showed a long QT interval of 640 ms, and after 1 hour, the newborn showed functional 2:1 atrioventricular block at ventricular rate of 50 bpm. After further pharmacological therapies, epicardial wires were surgically implanted for transient pacing in VVI mode at 90 bpm. Echocardiogram showed aneurysmatic left atrial appendage, dilated right segments, hypertrophied right ventricle, ostium secundum type atrial septal defect, and muscular ventricular septal defect. At two weeks of postpartum, a permanent dual-chamber pacemaker was implanted in the DDD mode and the patient was discharged with a prescription of beta-blockers and calcium therapy.
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Affiliation(s)
- Elio Caruso
- Mediterranean Pediatric Cardiology Center "Bambino Gesù", San Vincenzo Hospital, Taormina, ME, Italy
| | - Silvia Farruggio
- Mediterranean Pediatric Cardiology Center "Bambino Gesù", San Vincenzo Hospital, Taormina, ME, Italy.
| | - Paolo Guccione
- Mediterranean Pediatric Cardiology Center "Bambino Gesù", San Vincenzo Hospital, Taormina, ME, Italy
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Martínez-Barrios E, Cesar S, Cruzalegui J, Hernandez C, Arbelo E, Fiol V, Brugada J, Brugada R, Campuzano O, Sarquella-Brugada G. Clinical Genetics of Inherited Arrhythmogenic Disease in the Pediatric Population. Biomedicines 2022; 10:106. [PMID: 35052786 PMCID: PMC8773373 DOI: 10.3390/biomedicines10010106] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 12/27/2021] [Accepted: 12/31/2021] [Indexed: 12/19/2022] Open
Abstract
Sudden death is a rare event in the pediatric population but with a social shock due to its presentation as the first symptom in previously healthy children. Comprehensive autopsy in pediatric cases identify an inconclusive cause in 40-50% of cases. In such cases, a diagnosis of sudden arrhythmic death syndrome is suggested as the main potential cause of death. Molecular autopsy identifies nearly 30% of cases under 16 years of age carrying a pathogenic/potentially pathogenic alteration in genes associated with any inherited arrhythmogenic disease. In the last few years, despite the increasing rate of post-mortem genetic diagnosis, many families still remain without a conclusive genetic cause of the unexpected death. Current challenges in genetic diagnosis are the establishment of a correct genotype-phenotype association between genes and inherited arrhythmogenic disease, as well as the classification of variants of uncertain significance. In this review, we provide an update on the state of the art in the genetic diagnosis of inherited arrhythmogenic disease in the pediatric population. We focus on emerging publications on gene curation for genotype-phenotype associations, cases of genetic overlap and advances in the classification of variants of uncertain significance. Our goal is to facilitate the translation of genetic diagnosis to the clinical area, helping risk stratification, treatment and the genetic counselling of families.
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Affiliation(s)
- Estefanía Martínez-Barrios
- Arrhythmias Unit, Hospital Sant Joan de Déu, University of Barcelona, 08007 Barcelona, Spain; (E.M.-B.); (S.C.); (J.C.); (C.H.); (V.F.); (J.B.)
| | - Sergi Cesar
- Arrhythmias Unit, Hospital Sant Joan de Déu, University of Barcelona, 08007 Barcelona, Spain; (E.M.-B.); (S.C.); (J.C.); (C.H.); (V.F.); (J.B.)
| | - José Cruzalegui
- Arrhythmias Unit, Hospital Sant Joan de Déu, University of Barcelona, 08007 Barcelona, Spain; (E.M.-B.); (S.C.); (J.C.); (C.H.); (V.F.); (J.B.)
| | - Clara Hernandez
- Arrhythmias Unit, Hospital Sant Joan de Déu, University of Barcelona, 08007 Barcelona, Spain; (E.M.-B.); (S.C.); (J.C.); (C.H.); (V.F.); (J.B.)
| | - Elena Arbelo
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain; (E.A.); (R.B.)
- Arrhythmias Unit, Hospital Clinic, University of Barcelona-IDIBAPS, 08036 Barcelona, Spain
| | - Victoria Fiol
- Arrhythmias Unit, Hospital Sant Joan de Déu, University of Barcelona, 08007 Barcelona, Spain; (E.M.-B.); (S.C.); (J.C.); (C.H.); (V.F.); (J.B.)
| | - Josep Brugada
- Arrhythmias Unit, Hospital Sant Joan de Déu, University of Barcelona, 08007 Barcelona, Spain; (E.M.-B.); (S.C.); (J.C.); (C.H.); (V.F.); (J.B.)
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain; (E.A.); (R.B.)
- Arrhythmias Unit, Hospital Clinic, University of Barcelona-IDIBAPS, 08036 Barcelona, Spain
| | - Ramon Brugada
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain; (E.A.); (R.B.)
- Medical Science Department, School of Medicine, University of Girona, 17004 Girona, Spain
- Cardiovascular Genetics Center, University of Girona-IDIBGI, 17190 Girona, Spain
- Cardiology Service, Hospital Josep Trueta, University of Girona, 17007 Girona, Spain
| | - Oscar Campuzano
- Centro de Investigación Biomédica en Red, Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain; (E.A.); (R.B.)
- Medical Science Department, School of Medicine, University of Girona, 17004 Girona, Spain
- Cardiovascular Genetics Center, University of Girona-IDIBGI, 17190 Girona, Spain
| | - Georgia Sarquella-Brugada
- Arrhythmias Unit, Hospital Sant Joan de Déu, University of Barcelona, 08007 Barcelona, Spain; (E.M.-B.); (S.C.); (J.C.); (C.H.); (V.F.); (J.B.)
- Medical Science Department, School of Medicine, University of Girona, 17004 Girona, Spain
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