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Vasireddi SK, Draksler TZ, Bouman A, Kummeling J, Wheeler M, Reuter C, Srivastava S, Harris J, Fisher PG, Narayan SM, Wang PJ, Badhwar N, Kleefstra T, Perez MV. Arrhythmias including atrial fibrillation and congenital heart disease in Kleefstra syndrome: a possible epigenetic link. Europace 2023; 26:euae003. [PMID: 38195854 PMCID: PMC10803030 DOI: 10.1093/europace/euae003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/09/2023] [Accepted: 12/19/2023] [Indexed: 01/11/2024] Open
Abstract
AIMS Kleefstra syndrome (KS), often diagnosed in early childhood, is a rare genetic disorder due to haploinsufficiency of EHMT1 and is characterized by neuromuscular and intellectual developmental abnormalities. Although congenital heart disease (CHD) is common, the prevalence of arrhythmias and CHD subtypes in KS is unknown. METHODS AND RESULTS Inspired by a novel case series of KS patients with atrial tachyarrhythmias in the USA, we evaluate the two largest known KS registries for arrhythmias and CHD: Radboudumc (50 patients) based on health record review at Radboud University Medical Center in the Netherlands and GenIDA (163 patients) based on worldwide surveys of patient families. Three KS patients (aged 17-25 years) presented with atrial tachyarrhythmias without manifest CHD. In the international KS registries, the median [interquartile range (IQR)] age was considerably younger: GenIDA/Radboudumc at 10/13.5 (12/13) years, respectively. Both registries had a 40% prevalence of cardiovascular abnormalities, the majority being CHD, including septal defects, vascular malformations, and valvular disease. Interestingly, 4 (8%) patients in the Radboudumc registry reported arrhythmias without CHD, including one atrial fibrillation (AF), two with supraventricular tachycardias, and one with non-sustained ventricular tachycardia. The GenIDA registry reported one patient with AF and another with chronic ectopic atrial tachycardia (AT). In total, atrial tachyarrhythmias were noted in six young KS patients (6/213 or 3%) with at least four (three AF and one AT) without structural heart disease. CONCLUSION In addition to a high prevalence of CHD, evolving data reveal early-onset atrial tachyarrhythmias in young KS patients, including AF, even in the absence of structural heart disease.
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Affiliation(s)
- Sunil K Vasireddi
- Division of Cardiovascular Medicine, Cardiac Arrhythmia Center, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA
- Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Tanja Zdolsek Draksler
- Centre for Knowledge Transfer in Information Technologies, Jozef Stefan Institute, Ljubljana, Slovenia
- IDefine Europe, Ljubljana, Slovenia
| | - Arianne Bouman
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Joost Kummeling
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Matthew Wheeler
- Division of Cardiovascular Medicine, Cardiac Arrhythmia Center, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA
- Stanford Center for Inherited Cardiovascular Diseases, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA
- Stanford Center for Undiagnosed Diseases, Falk Cardiovascular Research Center, Stanford University, 870 Quarry Road, Palo Alto, CA 94305, USA
| | - Chloe Reuter
- Stanford Center for Inherited Cardiovascular Diseases, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA
- Stanford Center for Undiagnosed Diseases, Falk Cardiovascular Research Center, Stanford University, 870 Quarry Road, Palo Alto, CA 94305, USA
| | - Siddharth Srivastava
- Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Jacqueline Harris
- Department of Neurology and Neurogenetics, Kennedy Krieger Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Paul G Fisher
- Department of Neurology, Lucile Packard Children’s Hospital, Stanford University, Stanford, CA, USA
| | - Sanjiv M Narayan
- Division of Cardiovascular Medicine, Cardiac Arrhythmia Center, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Paul J Wang
- Division of Cardiovascular Medicine, Cardiac Arrhythmia Center, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Nitish Badhwar
- Division of Cardiovascular Medicine, Cardiac Arrhythmia Center, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA
| | - Tjitske Kleefstra
- Department of Human Genetics, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
- Centre of Excellence for Neuropsychiatry, Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands
| | - Marco V Perez
- Division of Cardiovascular Medicine, Cardiac Arrhythmia Center, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA
- Stanford Center for Inherited Cardiovascular Diseases, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA
- Stanford Center for Undiagnosed Diseases, Falk Cardiovascular Research Center, Stanford University, 870 Quarry Road, Palo Alto, CA 94305, USA
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