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Badura K, Buławska D, Dąbek B, Witkowska A, Lisińska W, Radzioch E, Skwira S, Młynarska E, Rysz J, Franczyk B. Primary Electrical Heart Disease-Principles of Pathophysiology and Genetics. Int J Mol Sci 2024; 25:1826. [PMID: 38339103 PMCID: PMC10855675 DOI: 10.3390/ijms25031826] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/27/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024] Open
Abstract
Primary electrical heart diseases, often considered channelopathies, are inherited genetic abnormalities of cardiomyocyte electrical behavior carrying the risk of malignant arrhythmias leading to sudden cardiac death (SCD). Approximately 54% of sudden, unexpected deaths in individuals under the age of 35 do not exhibit signs of structural heart disease during autopsy, suggesting the potential significance of channelopathies in this group of age. Channelopathies constitute a highly heterogenous group comprising various diseases such as long QT syndrome (LQTS), short QT syndrome (SQTS), idiopathic ventricular fibrillation (IVF), Brugada syndrome (BrS), catecholaminergic polymorphic ventricular tachycardia (CPVT), and early repolarization syndromes (ERS). Although new advances in the diagnostic process of channelopathies have been made, the link between a disease and sudden cardiac death remains not fully explained. Evolving data in electrophysiology and genetic testing suggest previously described diseases as complex with multiple underlying genes and a high variety of factors associated with SCD in channelopathies. This review summarizes available, well-established information about channelopathy pathogenesis, genetic basics, and molecular aspects relative to principles of the pathophysiology of arrhythmia. In addition, general information about diagnostic approaches and management is presented. Analyzing principles of channelopathies and their underlying causes improves the understanding of genetic and molecular basics that may assist general research and improve SCD prevention.
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Affiliation(s)
- Krzysztof Badura
- Department of Nephrocardiology, Medical University of Lodz, Ul. Zeromskiego 113, 90-549 Lodz, Poland (S.S.)
| | - Dominika Buławska
- Department of Nephrocardiology, Medical University of Lodz, Ul. Zeromskiego 113, 90-549 Lodz, Poland (S.S.)
| | - Bartłomiej Dąbek
- Department of Nephrocardiology, Medical University of Lodz, Ul. Zeromskiego 113, 90-549 Lodz, Poland (S.S.)
| | - Alicja Witkowska
- Department of Nephrocardiology, Medical University of Lodz, Ul. Zeromskiego 113, 90-549 Lodz, Poland (S.S.)
| | - Wiktoria Lisińska
- Department of Nephrocardiology, Medical University of Lodz, Ul. Zeromskiego 113, 90-549 Lodz, Poland (S.S.)
| | - Ewa Radzioch
- Department of Nephrocardiology, Medical University of Lodz, Ul. Zeromskiego 113, 90-549 Lodz, Poland (S.S.)
| | - Sylwia Skwira
- Department of Nephrocardiology, Medical University of Lodz, Ul. Zeromskiego 113, 90-549 Lodz, Poland (S.S.)
| | - Ewelina Młynarska
- Department of Nephrocardiology, Medical University of Lodz, Ul. Zeromskiego 113, 90-549 Lodz, Poland (S.S.)
| | - Jacek Rysz
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, Ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Beata Franczyk
- Department of Nephrocardiology, Medical University of Lodz, Ul. Zeromskiego 113, 90-549 Lodz, Poland (S.S.)
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Vacher E, Gourraud JB, Probst V. When to ablate in Brugada and early repolarization syndromes. Expert Rev Cardiovasc Ther 2024; 22:19-26. [PMID: 38427316 DOI: 10.1080/14779072.2024.2326549] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 02/29/2024] [Indexed: 03/02/2024]
Abstract
INTRODUCTION Mapping advances have expanded both the feasibility and benefits of ablation as a therapeutic approach, including in the treatment of two heart conditions that contribute to sudden cardiac death in young people: Brugada syndrome (BrS) and early repolarization syndrome (ERS). Although these conditions share a number of similarities, debates persist regarding the underlying pathophysiology and origin of the ventricular arrhythmias associated with them. AREAS COVERED By synthesizing available data (PubMed), including current recommendations, pathophysiological insights and case reports, patient registries, our aim is to elucidate and establish the nuanced role of radiofrequency ablation (RFA) in therapeutic management. EXPERT OPINION RFA is a particularly promising approach in BrS, with a proven long-term benefit. Concerning ERS, RFA seems to be interesting at the price of more complex procedures with more nuanced results.
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Affiliation(s)
- Eloi Vacher
- Centre Hospitalier Universitaire d'Angers, Service de Cardiologie, Angers, France
| | - Jean Baptiste Gourraud
- Centre Hospitalier Universitaire de Nantes, Institut du Thorax, Service de Cardiologie, Nantes, France
| | - Vincent Probst
- Centre Hospitalier Universitaire de Nantes, Institut du Thorax, Service de Cardiologie, Nantes, France
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Nogami A, Komatsu Y, Talib AK, Phanthawimol W, Naeemah QJ, Haruna T, Morishima I. Purkinje-Related Ventricular Tachycardia and Ventricular Fibrillation: Solved and Unsolved Questions. JACC Clin Electrophysiol 2023; 9:2172-2196. [PMID: 37498247 DOI: 10.1016/j.jacep.2023.05.040] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/05/2023] [Accepted: 05/24/2023] [Indexed: 07/28/2023]
Abstract
Of the monomorphic ventricular tachycardias, there are 4 specific tachycardias related to the Purkinje system: 1) idiopathic verapamil-sensitive fascicular ventricular tachycardia (FVT); 2) non-re-entrant FVT; 3) bundle branch re-entry and interfascicular re-entry; and 4) Purkinje-mediated VT in structural heart disease. Verapamil-sensitive FVT is classified into 4 types according to the location of the circuit: 1) left posterior type; 2) left anterior type; 3) left upper septal type;and 4) reverse type. And, in the left anterior and posterior types, there are septal and papillary muscle subtypes. Although macro-re-entry has been reported to be the mechanism underlying verapamil-sensitive FVT, recording the entire circuit is challenging. One possible reason is that the Purkinje-muscle junction may penetrate the myocardial layer as a part of the circuit. The Purkinje network may thus play an important role in the initiation and maintenance of ventricular fibrillation. Further, it has been reported that the development and the abnormalities of the Purkinje system are associated with the arrhythmogenesis of ventricular fibrillation. Furthermore, it has been reported that catheter ablation of trigger ventricular premature complexes, and/or "de-networking" of the Purkinje system, can be used as electrical bailout therapy. There is a hypothesis that the intramural Purkinje system is involved in the generation of J waves. Nevertheless, as there are still unresolved issues that must be debated and accurately analyzed, this review aims to discuss the solved and unsolved questions related to Purkinje-related arrhythmias.
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Affiliation(s)
- Akihiko Nogami
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan; Institute of Arrhythmia, Tokyo Heart Rhythm Hospital, Tokyo, Japan.
| | - Yuki Komatsu
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Ahmed Karim Talib
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan; Faculty of Medicine, University of Kufa, Najaf, Iraq
| | - Wipat Phanthawimol
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan; Cardiac Electrophysiology Unit, Division of Cardiology, Central Chest Institute of Thailand, Nonthaburi, Thailand
| | - Qasim J Naeemah
- Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan; Faculty of Medicine, University of Kufa, Najaf, Iraq
| | - Tetsuya Haruna
- Cardiovascular Center, Medical Research Institute Kitano Hospital, Osaka, Japan
| | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
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Khachatryan A, Chow RD, Harutyunyan H, Tamazyan V. Early Repolarization Augmentation Mimicking Pseudo-Infarction in a Patient With Diabetic Ketoacidosis and Normokalemia. Cureus 2023; 15:e41546. [PMID: 37426398 PMCID: PMC10329200 DOI: 10.7759/cureus.41546] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 07/11/2023] Open
Abstract
Early repolarization (ER) changes, characterized by J point elevation with or without ST-segment elevation, are dynamic in their presentation and can be exacerbated by factors such as hypothermia, hypercalcemia, vagotonia, and certain medications. There is limited research regarding the mechanism of these changes and the dynamic changes of ER secondary to diabetic ketoacidosis (DKA). This case report highlights the augmentation of early repolarization changes resembling ST-segment elevation myocardial infarction (STEMI) in a patient with DKA that resolved with the treatment of acidosis. The misinterpretation of ER changes on electrocardiogram (ECG) as STEMI or pericarditis may result in the inappropriate utilization of resources, increased patient risk, and elevated morbidity and mortality. Recognition of the potential of DKA to cause ER changes can potentially avoid these unfavorable outcomes.
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Affiliation(s)
- Aleksan Khachatryan
- Department of Internal Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, USA
| | - Robert D Chow
- Department of Internal Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, USA
| | - Hakob Harutyunyan
- Department of Internal Medicine, Maimonides Medical Center, New York, USA
| | - Vahagn Tamazyan
- Department of Internal Medicine, Maimonides Medical Center, New York, USA
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Zeng B, Zhang X, Schimpf R, Powers A, Glikson M, Antzelevitch C, Hu D, Barajas-Martinez H. Functional identification of hot-spot mutations in cardiac calcium channel genes associated with the J wave syndromes. Philos Trans R Soc Lond B Biol Sci 2023; 378:20220286. [PMID: 37122210 PMCID: PMC10150203 DOI: 10.1098/rstb.2022.0286] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023] Open
Abstract
J wave syndrome (JWS) is an inherited cardiac channelopathy associated with malignant ventricular arrhythmias and sudden cardiac death (SCD), which comprises early repolarization syndrome and Brugada syndrome. Here, we explore the association between variants in the L-type calcium channel gene subunits, α1C (CACNA1C) and β2b (CACNB2b), and the JWS phenotype. Using next-generation genetic sequencing of 402 JWS probands and their family members, we identified a CACNA1C-G37R (p.Gly37Arg) mutation in five individuals in four families, two of which had a family history of SCD as well as a CACNB2b-S143F (p.Ser143Phe) mutation in seven individuals in three families, two of which had a family history of SCD. The variants were located in exon 2 in CACNA1C and exon 5 in CACNB2b; both were in highly conserved amino acid residues. Whole-cell patch-clamp results showed that compared with the wild-type group, calcium current density of CACNB2b-S143F and CACNA1C-G37R were significantly lower displaying a dominant-negative effect. Our findings provide further support for the hypothesis that variants in CACNA1C and CACNB2b are associated with JWS. The results suggest that mutations in these two genes lead to loss-of-function of the cardiac calcium channel current warranting their inclusion in genetic screening protocols. This article is part of the theme issue 'The heartbeat: its molecular basis and physiological mechanisms'.
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Affiliation(s)
- Bin Zeng
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, People's Republic of China
- Hubei Key Laboratory of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, People's Republic of China
| | - Xiang Zhang
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, People's Republic of China
- Hubei Key Laboratory of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, People's Republic of China
| | - Rainer Schimpf
- Cardiology Practice Clinic, Ludwig-Guttmann-Str. 11, Ludwigshafen, Ludwigshafen-Neustadt, 67071, Germany
| | - Andrew Powers
- Department of Biology, University at Albany, State University of New York, Albany, NY, 12222, USA
| | - Michael Glikson
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Hebrew University Faculty of Medicine, Jerusalem, 91031, Israel
| | - Charles Antzelevitch
- Lankenau Institute for Medical Research, and Lankenau Heart Institute, Wynnwood, Pennsylvania, PA, 19096, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Dan Hu
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, People's Republic of China
- Hubei Key Laboratory of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, People's Republic of China
| | - Hector Barajas-Martinez
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, People's Republic of China
- Hubei Key Laboratory of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, 430060, People's Republic of China
- Lankenau Institute for Medical Research, and Lankenau Heart Institute, Wynnwood, Pennsylvania, PA, 19096, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, 19107, USA
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Zhou X, Ren L, Huang J, Zhang Y, Cai Y, Pu J. Novel SCN5A frame‑shift mutation underlying in patient with idiopathic ventricular fibrillation manifested with J wave in inferior lead and prolonged S‑wave in precordial lead. Exp Ther Med 2023; 25:287. [PMID: 37206574 PMCID: PMC10189605 DOI: 10.3892/etm.2023.11986] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 02/01/2023] [Indexed: 05/21/2023] Open
Abstract
Mutations in the SCN5A gene has been recognized as resulting in a series of life-threatening arrhythmias. However, it also causes idiopathic ventricular fibrillation (IVF) with J wave in inferior leads and prolonged S-wave upstroke in precordial leads, which has not been previously reported. The present study aimed to study the mechanisms of a patient with IVF manifested with J wave in inferior leads and prolonged S-wave upstroke in precordial leads. The electrocardiograms (ECG) of the proband were recorded and genetic testing was conducted. Patch-clamp and immunocytochemical studies were performed in heterologously transfected 293 cells. The VF attacks was documented in a 55-year-old male proband with syncope episodes. 12-lead ECG shown the transient J wave in the inferior leads and prolonged S-wave upstroke in precordial V1-V3 leads in the same timeframe. Genetic analysis revealed a novel 1 base deletion (G) at position 839 in exon 2 in SCN5A gene (C280S*fs61), which causes a severe truncation of the sodium channel. The functional study revealed that in 293 cells transfected with mutant channel, no sodium current could be recorded even though the immunocytochemical experiment confirmed the truncated sodium channel existed in cytosol. The kinetics of the wild-type (WT) channel were not altered when co-transfected with C280S*fs61 mutant which suggested a haploinsufficiency effect of sodium channel in the cells. The present study identified a novel C280Sfs*61 mutation that caused the 'loss of function' of the sodium channel by haploinsufficiency mechanism. The reduced sodium channel function in the heart may cause conduction delay that may underlie the manifestation of J wave and prolonged S-wave upstroke associated with IVF.
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Affiliation(s)
- Xiaoqian Zhou
- Department of Cardiology, Shanghai East Hospital, Tongji University, Shanghai 100123, P.R. China
| | - Lan Ren
- Department of Cardiology, Beijing Jishuitan Hospital, Beijing 100035, P.R. China
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100037, P.R. China
| | - Jian Huang
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100037, P.R. China
| | - Yinhui Zhang
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100037, P.R. China
| | - Ying Cai
- Department of Cardiology, Shanghai East Hospital, Tongji University, Shanghai 100123, P.R. China
- Correspondence to: Professor Jielin Pu and Professor Ying Cai, Department of Cardiology, Shanghai East Hospital, Tongji University, 1800 Yuntai Road, Pudong, Shanghai 100123, P.R. China
| | - Jielin Pu
- Department of Cardiology, Shanghai East Hospital, Tongji University, Shanghai 100123, P.R. China
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing 100037, P.R. China
- Correspondence to: Professor Jielin Pu and Professor Ying Cai, Department of Cardiology, Shanghai East Hospital, Tongji University, 1800 Yuntai Road, Pudong, Shanghai 100123, P.R. China
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Ahammed MR, Ananya FN. Association of Cardiac Electrical Disorders With KCND3 Gene Mutation. Cureus 2023; 15:e34597. [PMID: 36883079 PMCID: PMC9985904 DOI: 10.7759/cureus.34597] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2023] [Indexed: 02/05/2023] Open
Abstract
Globally, cardiac channelopathies leading to electrical disorders are responsible for a significant number of sudden cardiac deaths without structural heart disease. Many genes encoding different ion channels in the heart were identified and their impairment was found to be associated with life-threatening cardiac abnormalities. KCND3, one of the genes expressed both in the heart and brain, is reported to have an association with Brugada syndrome, early-onset atrial fibrillation, early repolarization syndrome, and sudden unexplained death syndrome. KCND3 genetic screening could be a promising tool for functional studies for an understanding of the pathogenesis and genetic determinants of the above-mentioned electrical disorders.
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Affiliation(s)
- Md Ripon Ahammed
- Internal Medicine, Icahn School of Medicine at Mount Sinai, Queens Hospital Center, New York, USA
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Ye D, Zhou W, Hamrick SK, Tester DJ, Kim CSJ, Barajas-Martinez H, Hu D, Giudicessi JR, Antzelevitch C, Ackerman MJ. Acacetin, a Potent Transient Outward Current Blocker, May Be a Novel Therapeutic for KCND3-Encoded Kv4.3 Gain-of-Function-Associated J-Wave Syndromes. Circ Genom Precis Med 2022; 15:e003238. [PMID: 35861988 PMCID: PMC9588492 DOI: 10.1161/circgen.120.003238] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 04/18/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND The transient outward current (Ito) that mediates early (phase 1) repolarization is conducted by the KCND3-encoded Kv4.3 pore-forming α-subunit. KCND3 gain-of-function mutations have been reported previously as a pathogenic substrate for J wave syndromes (JWS), including the Brugada syndrome and early repolarization syndrome, as well as autopsy-negative sudden unexplained death (SUD). Acacetin, a natural flavone, is a potent Ito current blocker. Acacetin may be a novel therapeutic for KCND3-mediated J wave syndrome. METHODS KCND3-V392I was identified in an 18-year-old male with J wave syndrome/early repolarization syndrome, and a history of cardiac arrest including ventricular tachycardia/ventricular fibrillation and atrial fibrillation/atrial flutter. Pathogenic KCND3 mutation was engineered by site-directed mutagenesis and co-expressed with wild-type KChIP2 in TSA201 cells. Gene-edited/variant-corrected isogenic control and patient-specific pluripotent stem cell-derived cardiomyocytes (iPSC-CMs) from the p. Val392Ile-KCND3-positive patient were generated. Ito currents and action potentials were recorded before and after treatment with Acacetin using the whole cell patch-clamp and multielectrode array technique. Western blot and immunocytochemistry were performed to investigate KCND3 expression. RESULTS KCND3-V392I demonstrated a marked gain-of-function phenotype, increasing peak Ito current density by 92.2% (P<0.05 versus KCND3-WT). KCND3 expression was significantly increased in KCND3-V392I-derived iPSC-CMs (P<0.05 versus isogenic control). While KCND3-WT revealed an IC50 of 7.2±1.0 µmol/L for acacetin effect, 30 µmol/L acacetin dramatically inhibited KCND3-V392I peak Ito current density by 96.2% (P<0.05 versus before Acacetin). Ito was also increased by 60.9% in Kv4.3-V392I iPSC-CM (P<0.05 versus isogenic control iPSC-CM). Ten micromoles per liter acacetin, a concentration approaching its IC50 value, inhibited Ito by ≈50% in patient-derived iPSC-CMs and reduced the accentuated action potential notch displayed in KCND3-V392I-derived iPSC-CMs. CONCLUSIONS This preclinical study provides pharmacological and functional evidence to suggest that Acacetin may be a novel therapeutic for patients with KCND3 gain-of-function-associated J wave syndrome by inhibiting Ito and abolishing the accentuated action potential notch in patient-derived iPSC-CMs.
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Affiliation(s)
- Dan Ye
- Department of Molecular Pharmacology & Experimental Therapeutics (Windland Smith Rice Sudden Death Genomics Laboratory); Department of Cardiovascular Medicine/Division of Heart Rhythm Services (Windland Smith Rice Genetic Heart Rhythm Clinic); Department of Pediatric and Adolescent Medicine/Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN
| | - Wei Zhou
- Department of Molecular Pharmacology & Experimental Therapeutics (Windland Smith Rice Sudden Death Genomics Laboratory); Department of Cardiovascular Medicine/Division of Heart Rhythm Services (Windland Smith Rice Genetic Heart Rhythm Clinic); Department of Pediatric and Adolescent Medicine/Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN
| | - Samantha K. Hamrick
- Department of Molecular Pharmacology & Experimental Therapeutics (Windland Smith Rice Sudden Death Genomics Laboratory); Department of Cardiovascular Medicine/Division of Heart Rhythm Services (Windland Smith Rice Genetic Heart Rhythm Clinic); Department of Pediatric and Adolescent Medicine/Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN
| | - David J Tester
- Department of Molecular Pharmacology & Experimental Therapeutics (Windland Smith Rice Sudden Death Genomics Laboratory); Department of Cardiovascular Medicine/Division of Heart Rhythm Services (Windland Smith Rice Genetic Heart Rhythm Clinic); Department of Pediatric and Adolescent Medicine/Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN
| | - CS John Kim
- Department of Molecular Pharmacology & Experimental Therapeutics (Windland Smith Rice Sudden Death Genomics Laboratory); Department of Cardiovascular Medicine/Division of Heart Rhythm Services (Windland Smith Rice Genetic Heart Rhythm Clinic); Department of Pediatric and Adolescent Medicine/Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN
| | | | - Dan Hu
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, China
| | - John R. Giudicessi
- Department of Molecular Pharmacology & Experimental Therapeutics (Windland Smith Rice Sudden Death Genomics Laboratory); Department of Cardiovascular Medicine/Division of Heart Rhythm Services (Windland Smith Rice Genetic Heart Rhythm Clinic); Department of Pediatric and Adolescent Medicine/Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN
| | | | - Michael J. Ackerman
- Department of Molecular Pharmacology & Experimental Therapeutics (Windland Smith Rice Sudden Death Genomics Laboratory); Department of Cardiovascular Medicine/Division of Heart Rhythm Services (Windland Smith Rice Genetic Heart Rhythm Clinic); Department of Pediatric and Adolescent Medicine/Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN
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Tondas AE, Batubara EAD, Sari NY, Marcantoni I, Burattini L. Microvolt T-wave alternans in early repolarization syndrome associated with ventricular arrhythmias: A case report. Ann Noninvasive Electrocardiol 2022; 28:e13005. [PMID: 36114698 PMCID: PMC9833357 DOI: 10.1111/anec.13005] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 08/23/2022] [Indexed: 01/20/2023] Open
Abstract
Despite early repolarization (ER) syndrome being usually considered benign, its association with severe/malignant ventricular arrhythmias (VA) was also reported. Microvolt T-wave alternans (MTWA) is an electrocardiographic marker for the development of VA, but its role in ER syndrome remains unknown. A 90-second 6-lead electrocardiogram from an ER syndrome patient, acquired with the Kardia recorder, was analyzed by the enhanced adaptive matched filter for MTWA quantification. On average, MTWA was 50 μV, higher than what was previously observed on healthy subjects using the same method. In our ER syndrome patient, MTWA plays a potential role in VA development in ER syndrome.
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Affiliation(s)
- Alexander Edo Tondas
- Department of Cardiology and Vascular MedicineDr. Mohammad Hoesin General HospitalPalembangIndonesia
| | | | - Novi Yanti Sari
- Department of Cardiology and Vascular MedicineDr. Mohammad Hoesin General HospitalPalembangIndonesia
| | - Ilaria Marcantoni
- Department of Information EngineeringUniversità Politecnica delle MarcheAnconaItaly
| | - Laura Burattini
- Department of Information EngineeringUniversità Politecnica delle MarcheAnconaItaly
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Takahashi M, Kondo H, Yonezu K, Shinohara T, Nakagawa M, Takahashi N. Atrial Fibrillation-triggered Ventricular Fibrillation in a Patient with Early Repolarization Syndrome. Intern Med 2022; 61:1973-1976. [PMID: 34776496 PMCID: PMC9334228 DOI: 10.2169/internalmedicine.8716-21] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 54-year-old man with early repolarization syndrome (ERS) implanted with an implantable cardioverter-defibrillator (ICD) developed persistent atrial fibrillation (AF) three years after the implantation. Similarly, the remote monitoring system begun frequently detecting ventricular fibrillation (VF) and polymorphic ventricular tachycardia (PVT). Longer RR intervals were repeatedly observed just before the initiation of PVT/VF. Catheter ablation for AF successfully diminished both the PVT and VF events.
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Affiliation(s)
- Masaki Takahashi
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Japan
| | - Hidekazu Kondo
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Japan
| | - Keisuke Yonezu
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Japan
| | - Tetsuji Shinohara
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Japan
| | - Mikiko Nakagawa
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Japan
| | - Naohiko Takahashi
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Japan
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Zhang Y, Jiang H, Li XM. Cardiocerebral channelopathy caused by KCND3 mutation in a child: A case report. Front Pediatr 2022; 10:1019122. [PMID: 36518774 PMCID: PMC9742191 DOI: 10.3389/fped.2022.1019122] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 11/11/2022] [Indexed: 11/29/2022] Open
Abstract
Early repolarization syndrome is rare in children. Mutation of genes encoding ion channels could display mixed electrophysiological phenotype of Kv4.3 including both cardiac phenotype (early repolarization syndrome, atrial fibrillation) and cerebral phenotype (epilepsy, intellectual disability). This situation is rare and was named as cardiocerebral channelopathy. Here, we report a case of an 11-year-old-girl with cardiocerebral channelopathy caused by KCND3 mutation, who was successfully treated with oral quinidine, metoprolol and implantable cardioverter-defibrillator. Clinicians should be vigilant on the risk of cardiogenic syncope and sudden cardiac death in a patient with epilepsy, intellectual disability and early repolarization pattern.
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Affiliation(s)
- Yi Zhang
- Department of Pediatric Cardiology, Heart Center, The First Hospital of Tsinghua University (Beijing Huaxin Hospital), Beijing, China
| | - He Jiang
- Department of Pediatric Cardiology, Heart Center, The First Hospital of Tsinghua University (Beijing Huaxin Hospital), Beijing, China
| | - Xiao-Mei Li
- Department of Pediatric Cardiology, Heart Center, The First Hospital of Tsinghua University (Beijing Huaxin Hospital), Beijing, China
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12
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Affiliation(s)
- Elijah R Behr
- Institute of Molecular and Clinical Sciences, St. George's, University of London, St. George's University Hospitals, NHS Foundation Trust, London, United Kingdom; Mayo Clinic Healthcare, London, United Kingdom.
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13
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Chen X, Barajas-Martínez H, Xia H, Zhang Z, Chen G, Yang B, Jiang H, Antzelevitch C, Hu D. Clinical and Functional Genetic Characterization of the Role of Cardiac Calcium Channel Variants in the Early Repolarization Syndrome. Front Cardiovasc Med 2021; 8:680819. [PMID: 34222376 PMCID: PMC8249565 DOI: 10.3389/fcvm.2021.680819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Early repolarization syndrome (ERS) is an inherited sudden cardiac death (SCD) syndrome. The present study investigates the role of genetic variants in cardiac calcium-channel genes in the pathogenesis of ERS and probes the underlying mechanisms. Methods: Polymerase chain reaction-based next-generation sequencing was carried out using a targeted gene approach. Unrelated ERS probands carrying calcium-channel variants were evaluated clinically and compared with matched healthy controls. Wild-type (WT) and mutant CACNA1C genes were coexpressed with CACNB2b and CACNA2D1 in HEK293 cells and studied using whole-cell patch-clamp techniques and confocal fluorescence microscope. Results: Among 104 ERS probands, 16 carried pathogenic variants in calcium-channel genes (32.2 ± 14.6 years old, 87.5% male). The symptoms at diagnosis included syncope (56.3%), ventricular tachycardia/fibrillation (62.5%), and SCD (56.3%). Three cases (18.8%) had a family history of SCD or syncope. Eight patients (50.0%) had a single calcium gene rare variant. The other half carried rare variants in other ERS-susceptible genes. Compared with controls, the heart rate was slower (72.7 ± 8.9 vs. 65.6 ± 16.1 beats/min, * p < 0.05), QTc interval was shorter (408.2 ± 21.4 vs. 386.8 ± 16.9 ms, ** p < 0.01), and Tp-e/QT was longer (0.22 ± 0.05 vs. 0.28 ± 0.04, *** p < 0.001) in single calcium mutation carriers. Electrophysiological analysis of one mutation, CACNA1C-P817S (c.2449C>T), revealed that the density of whole-cell calcium current (I Ca) was reduced by ~84.61% compared to WT (-3.17 ± 2.53 vs. -20.59 ± 3.60 pA/pF, n = 11 and 15, respectively, ** p < 0.01). Heterozygous expression of mutant channels was associated with a 51.35% reduction of I Ca. Steady-state inactivation was shifted to more negative potentials and significantly accelerated as well. Confocal microscopy revealed trafficking impairment of CACNA1C-P817S (peripheral/central intensity: 0.94 ± 0.10 in WT vs. 0.33 ± 0.12 in P817S, n = 10 and 9, respectively, ** p < 0.01). Conclusions: ERS associated with loss-of-function (LOF) genetic defects in genes encoding the cardiac calcium channel represents a unique clinical entity characterized by decreased heart rate and QTc, as well as increased transmural dispersion of repolarization. In the case of CACNA1C-P817S, impaired trafficking of the channel to the membrane contributes to the LOF.
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Affiliation(s)
- Xiu Chen
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Hector Barajas-Martínez
- Lankenau Institute for Medical Research, Lankenau Heart Institute, Wynnewood, PA, United States.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Hao Xia
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Zhonghe Zhang
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Ganxiao Chen
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Bo Yang
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Hong Jiang
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
| | - Charles Antzelevitch
- Lankenau Institute for Medical Research, Lankenau Heart Institute, Wynnewood, PA, United States.,Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - Dan Hu
- Department of Cardiology and Cardiovascular Research Institute, Renmin Hospital of Wuhan University, Wuhan, China.,Hubei Key Laboratory of Cardiology, Wuhan, China
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14
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Nakajima T, Tamura S, Kurabayashi M, Kaneko Y. Towards Mutation-Specific Precision Medicine in Atypical Clinical Phenotypes of Inherited Arrhythmia Syndromes. Int J Mol Sci 2021; 22:ijms22083930. [PMID: 33920294 PMCID: PMC8069124 DOI: 10.3390/ijms22083930] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 04/08/2021] [Indexed: 12/19/2022] Open
Abstract
Most causal genes for inherited arrhythmia syndromes (IASs) encode cardiac ion channel-related proteins. Genotype-phenotype studies and functional analyses of mutant genes, using heterologous expression systems and animal models, have revealed the pathophysiology of IASs and enabled, in part, the establishment of causal gene-specific precision medicine. Additionally, the utilization of induced pluripotent stem cell (iPSC) technology have provided further insights into the pathophysiology of IASs and novel promising therapeutic strategies, especially in long QT syndrome. It is now known that there are atypical clinical phenotypes of IASs associated with specific mutations that have unique electrophysiological properties, which raises a possibility of mutation-specific precision medicine. In particular, patients with Brugada syndrome harboring an SCN5A R1632C mutation exhibit exercise-induced cardiac events, which may be caused by a marked activity-dependent loss of R1632C-Nav1.5 availability due to a marked delay of recovery from inactivation. This suggests that the use of isoproterenol should be avoided. Conversely, the efficacy of β-blocker needs to be examined. Patients harboring a KCND3 V392I mutation exhibit both cardiac (early repolarization syndrome and paroxysmal atrial fibrillation) and cerebral (epilepsy) phenotypes, which may be associated with a unique mixed electrophysiological property of V392I-Kv4.3. Since the epileptic phenotype appears to manifest prior to cardiac events in this mutation carrier, identifying KCND3 mutations in patients with epilepsy and providing optimal therapy will help prevent sudden unexpected death in epilepsy. Further studies using the iPSC technology may provide novel insights into the pathophysiology of atypical clinical phenotypes of IASs and the development of mutation-specific precision medicine.
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15
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Coronel R, Potse M, Haïssaguerre M, Derval N, Rivaud MR, Meijborg VMF, Cluitmans M, Hocini M, Boukens BJ. Why Ablation of Sites With Purkinje Activation Is Antiarrhythmic: The Interplay Between Fast Activation and Arrhythmogenesis. Front Physiol 2021; 12:648396. [PMID: 33833689 PMCID: PMC8021688 DOI: 10.3389/fphys.2021.648396] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 03/03/2021] [Indexed: 12/27/2022] Open
Abstract
Ablation of sites showing Purkinje activity is antiarrhythmic in some patients with idiopathic ventricular fibrillation (iVF). The mechanism for the therapeutic success of ablation is not fully understood. We propose that deeper penetrance of the Purkinje network allows faster activation of the ventricles and is proarrhythmic in the presence of steep repolarization gradients. Reduction of Purkinje penetrance, or its indirect reducing effect on apparent propagation velocity may be a therapeutic target in patients with iVF.
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Affiliation(s)
- Ruben Coronel
- Department of Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France
| | - Mark Potse
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France.,UMR5251 Institut de mathématiques de Bordeaux, Talence, France.,Carmen Team, Inria Bordeaux - Sud-Ouest, Talence, France
| | - Michel Haïssaguerre
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France
| | - Nicolas Derval
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France
| | - Mathilde R Rivaud
- Department of Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Veronique M F Meijborg
- Department of Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Matthijs Cluitmans
- Department of Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Mélèze Hocini
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France
| | - Bastiaan J Boukens
- Department of Medical Biology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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16
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Martini N, Testolina M, Toffanin GL, Arancio R, De Mattia L, Cannas S, Morani G, Martini B. Role of Provocable Brugada ECG Pattern in The Correct Risk Stratification for Major Arrhythmic Events. J Clin Med 2021; 10:jcm10051025. [PMID: 33801474 PMCID: PMC7958847 DOI: 10.3390/jcm10051025] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/15/2021] [Accepted: 02/23/2021] [Indexed: 11/26/2022] Open
Abstract
The so-called Brugada syndrome (BS), first called precordial early repolarization syndrome (PERS), is characterized by the association of a fascinating electrocardiographic pattern, namely an aspect resembling right bundle branch block with a coved and sometime upsloping ST segment elevation in the precordial leads, and major ventricular arrhythmic events that could rarely lead to sudden death. Its electrogenesis has been related to a conduction delay mostly, but not only, located on the right ventricular outflow tract (RVOT), probably due to a progressive fibrosis of the conduction system. Many tests have been proposed to identify people at risk of sudden death and, among all, ajmaline challenge, thanks to its ability to enhance latent conduction defects, became so popular, even if its role is still controversial as it is neither specific nor sensitive enough to guide further invasive investigations and managements. Interestingly, a type 1 pattern has also been induced in many other cardiac diseases or systemic diseases with a cardiac involvement, such as long QT syndrome (LQTS), arrhythmogenic right ventricular cardiomyopathy (ARVC), hypertrophic cardiomyopathy (HCM) and myotonic dystrophy, without any clear arrhythmic risk profile. Evidence-based studies clearly showed that a positive ajmaline test does not provide any additional information on the risk stratification for major ventricular arrhythmic events on asymptomatic individuals with a non-diagnostic Brugada ECG pattern.
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Affiliation(s)
- Nicolò Martini
- Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy;
| | - Martina Testolina
- Cardiac Unit, Alto Vicentino Hospital, 36014 Santorso, Italy; (M.T.); (G.L.T.); (S.C.); (G.M.)
| | - Gian Luca Toffanin
- Cardiac Unit, Alto Vicentino Hospital, 36014 Santorso, Italy; (M.T.); (G.L.T.); (S.C.); (G.M.)
| | - Rocco Arancio
- Cardiac Unit, Ospedale Umberto Primo, 96100 Siracusa, Italy;
| | | | - Sergio Cannas
- Cardiac Unit, Alto Vicentino Hospital, 36014 Santorso, Italy; (M.T.); (G.L.T.); (S.C.); (G.M.)
| | - Giovanni Morani
- Cardiac Unit, Alto Vicentino Hospital, 36014 Santorso, Italy; (M.T.); (G.L.T.); (S.C.); (G.M.)
| | - Bortolo Martini
- Cardiac Unit, Alto Vicentino Hospital, 36014 Santorso, Italy; (M.T.); (G.L.T.); (S.C.); (G.M.)
- Correspondence:
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17
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Lindow T, Pahlm O, Khoshnood A, Nyman I, Manna D, Engblom H, Lassen AT, Ekelund U. Electrocardiographic changes in the differentiation of ischemic and non-ischemic ST elevation. SCAND CARDIOVASC J 2019; 54:100-107. [PMID: 31885293 DOI: 10.1080/14017431.2019.1705383] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Identification of true STEMI among patients with different ST-elevation etiology may be improved by considering reciprocal ST depression, ST depression in aVR and chest-lead PR depression.
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Affiliation(s)
- Thomas Lindow
- Department of Clinical Physiology, Växjö Central Hospital, Växjö, Sweden.,Department of Research and Development, Region Kronoberg, Sweden.,Clinical Physiology, Skane University Hospital, Clinical Sciences, Lund University, Lund, Sweden
| | - Olle Pahlm
- Department of Research and Development, Region Kronoberg, Sweden
| | - Ardavan Khoshnood
- Emergency Medicine, Skane University Hospital, Clinical Sciences, Lund University, Lund, Sweden
| | - Ingvar Nyman
- Department of Clinical Physiology, Växjö Central Hospital, Växjö, Sweden
| | - Daniel Manna
- Department of Clinical Physiology, Växjö Central Hospital, Växjö, Sweden
| | - Henrik Engblom
- Department of Research and Development, Region Kronoberg, Sweden
| | | | - Ulf Ekelund
- Emergency Medicine, Skane University Hospital, Clinical Sciences, Lund University, Lund, Sweden
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18
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Kesarwani M. Out-of-Hospital Cardiac Arrest Due to a Concealed Diagnosis. JACC Case Rep 2019; 1:339-342. [PMID: 34316821 PMCID: PMC8289128 DOI: 10.1016/j.jaccas.2019.07.019] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/15/2019] [Accepted: 07/17/2019] [Indexed: 06/13/2023]
Abstract
This case outlines the dynamic and often concealed electrocardiographic findings associated with Brugada syndrome and explores its important relationship with early repolarization syndrome as part of a spectrum of inherited J-wave syndromes. (Level of Difficulty: Beginner.).
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Affiliation(s)
- Manoj Kesarwani
- Address for correspondence: Dr. Manoj Kesarwani, Ellison Ambulatory Care Center, 4860 Y Street, Suite 2820, Sacramento, California 95817.
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19
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Nauchi M, Sakai T, Sugisaki Y, Ito Y. Revelation of early repolarization by eliminating accessory pathway in manifest Wolff-Parkinson-White syndrome: A case report. J Arrhythm 2019; 35:300-302. [PMID: 31007798 PMCID: PMC6457479 DOI: 10.1002/joa3.12166] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 12/19/2018] [Accepted: 01/10/2019] [Indexed: 11/10/2022] Open
Abstract
A 23-year-old male with manifest Wolff-Parkinson-White syndrome presented with a first occurrence of ventricular fibrillation (VF). Initially, we anticipated the occurrence of atrial fibrillation, causing rapid antegrade conduction over the accessory pathway and, thus, resulting in hemodynamic deterioration. Electrophysiological study revealed that the atrioventricular accessory pathway was located at the mid-septum. After eliminating the pathway, a J-point elevation was revealed in the inferior and lateral leads. In addition, program ventricular stimulation induced VF, and the administration of isoproterenol suppressed VF. In our case, VF occurrence can be attributed to early repolarization syndrome and ventricular preexcitation-modified J-point elevation.
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Affiliation(s)
- Masahiro Nauchi
- Saiseikai Yokohamashi Tobu HospitalYokohama‐City, KanagawaJapan
| | - Tsuyoshi Sakai
- Saiseikai Yokohamashi Tobu HospitalYokohama‐City, KanagawaJapan
| | - Yuuta Sugisaki
- Saiseikai Yokohamashi Tobu HospitalYokohama‐City, KanagawaJapan
| | - Yoshiaki Ito
- Saiseikai Yokohamashi Tobu HospitalYokohama‐City, KanagawaJapan
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20
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Bourier F, Denis A, Cheniti G, Lam A, Vlachos K, Takigawa M, Kitamura T, Frontera A, Duchateau J, Pambrun T, Klotz N, Derval N, Sacher F, Jais P, Haissaguerre M, Hocini M. Early Repolarization Syndrome: Diagnostic and Therapeutic Approach. Front Cardiovasc Med 2018; 5:169. [PMID: 30542653 PMCID: PMC6278243 DOI: 10.3389/fcvm.2018.00169] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 11/05/2018] [Indexed: 12/11/2022] Open
Abstract
An early repolarization pattern can be observed in 1% up to 13% of the overall population. Whereas, this pattern was associated with a benign outcome for many years, several more recent studies demonstrated an association between early repolarization and sudden cardiac death, so-called early repolarization syndrome. In early repolarization syndrome patients, current imbalances between epi- and endo-cardial layers result in dispersion of de- and repolarization. As a consequence, J waves or ST segment elevations can be observed on these patients' surface ECGs as manifestations of those current imbalances. Whereas, an early repolarization pattern is relatively frequently found on surface ECGs in the overall population, the majority of individuals presenting with an early repolarization pattern will remain asymptomatic and the isolated presence of an early repolarization pattern does not require further intervention. The mismatch between frequently found early repolarization patterns in the overall population, low incidences of sudden cardiac deaths related to early repolarization syndrome, but fatal, grave consequences in affected patients remains a clinical challenge. More precise tools for risk stratification and identification of this minority of patients, who will experience events, remain a clinical need. This review summarizes the epidemiologic, pathophysiologic and diagnostic background and presents therapeutic options of early repolarization syndrome.
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Affiliation(s)
- Felix Bourier
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Arnaud Denis
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,Electrophysiology and Heart Modeling Institute, IHU Liryc, Pessac, France
| | - Ghassen Cheniti
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,Electrophysiology and Heart Modeling Institute, IHU Liryc, Pessac, France
| | - Anna Lam
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Konstantinos Vlachos
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Masateru Takigawa
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,Electrophysiology and Heart Modeling Institute, IHU Liryc, Pessac, France
| | - Takeshi Kitamura
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Antonio Frontera
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France
| | - Josselin Duchateau
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,Electrophysiology and Heart Modeling Institute, IHU Liryc, Pessac, France.,Centre de Recherche Cardio-thoracique de Bordeaux, U1045, Université de Bordeaux, Bordeaux, France
| | - Thomas Pambrun
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,Electrophysiology and Heart Modeling Institute, IHU Liryc, Pessac, France
| | - Nicolas Klotz
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,Electrophysiology and Heart Modeling Institute, IHU Liryc, Pessac, France
| | - Nicolas Derval
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,Electrophysiology and Heart Modeling Institute, IHU Liryc, Pessac, France
| | - Frédéric Sacher
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,Electrophysiology and Heart Modeling Institute, IHU Liryc, Pessac, France.,Centre de Recherche Cardio-thoracique de Bordeaux, U1045, Université de Bordeaux, Bordeaux, France
| | - Pierre Jais
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,Electrophysiology and Heart Modeling Institute, IHU Liryc, Pessac, France.,Centre de Recherche Cardio-thoracique de Bordeaux, U1045, Université de Bordeaux, Bordeaux, France
| | - Michel Haissaguerre
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,Electrophysiology and Heart Modeling Institute, IHU Liryc, Pessac, France.,Centre de Recherche Cardio-thoracique de Bordeaux, U1045, Université de Bordeaux, Bordeaux, France
| | - Mélèze Hocini
- Electrophysiology and Ablation Unit, Bordeaux University Hospital (CHU), Pessac, France.,Electrophysiology and Heart Modeling Institute, IHU Liryc, Pessac, France.,Centre de Recherche Cardio-thoracique de Bordeaux, U1045, Université de Bordeaux, Bordeaux, France
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21
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Yao H, Fan J, Cheng YJ, Chen XM, Ji CC, Liu LJ, Zheng ZH, Wu SH. SCN1Bβ mutations that affect their association with Kv4.3 underlie early repolarization syndrome. J Cell Mol Med 2018; 22:5639-5647. [PMID: 30160358 PMCID: PMC6201368 DOI: 10.1111/jcmm.13839] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 07/13/2018] [Indexed: 12/12/2022] Open
Abstract
Background Abnormal cardiac ion channels current, including transient outward potassium current (Ito), is associated with early repolarization syndrome (ERS). Previous studies showed that mutations in SCN1Bβ both to increase the Ito current and to decrease the sodium current. Yet its role in ERS remains unknown. Objective To determine the role of mutations in the SCN1Bβ subunits in ERS. Methods We screened for mutations in the SCN1B genes from four families with ERS. Wild‐type and mutant SCN1Bβ genes were co‐expressed with wild‐type KCND3 in human embryonic kidney cells (HEK293). Whole‐cell patch‐clamp technique and co‐immunoprecipitation were used to study the electrophysiological properties and explore the underlying mechanisms. Results S248R and R250T mutations in SCN1Bβ were detected in 4 families’ probands. Neither S248R nor R250T mutation had significant influence on the sodium channel current density (INa) when co‐expressed with SCN5A/WT. Co‐expression of KCND3/WT and SCN1Bβ/S248R or SCN1Bβ/R250T increased the transient outward potassium current Ito by 27.44% and 199.89%, respectively (P < 0.05 and P < 0.01, respectively) when compared with SCN1Bβ/WT. Electrophysiological properties showed that S248R and R250T mutations decreased the steady‐state inactivation and recovery from inactivation of Ito channel. Co‐immunoprecipitation study demonstrated an increased association between SCN1Bβ mutations and Kv4.3 compared with SCN1Bβ/WT (P < 0.05 and P < 0.01, respectively). Conclusion The S248R and R250T mutations of SCN1Bβ gene caused gain‐of‐function of Ito by associated with Kv4.3, which maybe underlie the ERS phenotype of the probands.
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Affiliation(s)
- Hao Yao
- Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, and Key Laboratory on Assisted Circulation, NHC, Guangzhou, China
| | - Jun Fan
- Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, and Key Laboratory on Assisted Circulation, NHC, Guangzhou, China
| | - Yun-Jiu Cheng
- Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, and Key Laboratory on Assisted Circulation, NHC, Guangzhou, China
| | - Xu-Miao Chen
- Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, and Key Laboratory on Assisted Circulation, NHC, Guangzhou, China
| | - Cheng-Cheng Ji
- Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, and Key Laboratory on Assisted Circulation, NHC, Guangzhou, China
| | - Li-Juan Liu
- Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, and Key Laboratory on Assisted Circulation, NHC, Guangzhou, China
| | - Zi-Heng Zheng
- Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, and Key Laboratory on Assisted Circulation, NHC, Guangzhou, China
| | - Su-Hua Wu
- Department of Cardiology, the First Affiliated Hospital, Sun Yat-Sen University, and Key Laboratory on Assisted Circulation, NHC, Guangzhou, China
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22
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Di Diego JM, Antzelevitch C. J wave syndromes as a cause of malignant cardiac arrhythmias. Pacing Clin Electrophysiol 2018; 41:684-699. [PMID: 29870068 DOI: 10.1111/pace.13408] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 05/05/2018] [Indexed: 12/19/2022]
Abstract
The J wave syndromes, including the Brugada (BrS) and early repolarization (ERS) syndromes, are characterized by the manifestation of prominent J waves in the electrocardiogram appearing as an ST segment elevation and the development of life-threatening cardiac arrhythmias. BrS and ERS differ with respect to the magnitude and lead location of abnormal J waves and are thought to represent a continuous spectrum of phenotypic expression termed J wave syndromes. Despite over 25 years of intensive research, risk stratification and the approach to therapy of these two inherited cardiac arrhythmia syndromes are still rapidly evolving. Our objective in this review is to provide an integrated synopsis of the clinical characteristics, risk stratifiers, as well as the molecular, ionic, cellular, and genetic mechanisms underlying these two syndromes that have captured the interest and attention of the cardiology community over the past two decades.
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Affiliation(s)
| | - Charles Antzelevitch
- Lankenau Institute for Medical Research, Wynnewood, PA, USA.,Lankenau Heart Institute, Wynnewood, PA, USA.,Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
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Kamakura T, Wada M, Ishibashi K, Inoue YY, Miyamoto K, Okamura H, Nagase S, Noda T, Aiba T, Yasuda S, Shimizu W, Kamakura S, Kusano K. Significance of Coronary Artery Spasm Diagnosis in Patients With Early Repolarization Syndrome. J Am Heart Assoc 2018; 7:JAHA.117.007942. [PMID: 29436392 PMCID: PMC5850201 DOI: 10.1161/jaha.117.007942] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previously described patients with early repolarization syndrome (ERS) may have experienced silent coronary artery spasm (CAS) because the diagnosis of CAS was mainly based on symptoms or coronary angiography findings, without performing a spasm provocation test. This study investigated the significance of CAS diagnosis and evaluated the incidence of silent CAS in patients with possible ERS (ie, idiopathic ventricular fibrillation [VF] and inferolateral J wave). METHODS AND RESULTS The study included 34 patients with idiopathic VF and inferolateral J wave. Thirteen patients (38%) were diagnosed as having CAS on the basis of coronary angiography with spasm provocation test (n=8) and documentation of spontaneous ST elevation (n=5). Of the 13 patients with CAS, 5 (38%) did not experience chest symptoms before and during VF, and were diagnosed as having silent CAS. The remaining 21 patients (62%), with a negative provocation test result and absence of chest symptoms, were considered to have ERS. During the 92 months of follow-up, patients with CAS receiving appropriate medical treatment with antianginal drugs showed a favorable outcome. In contrast, 4 of 21 patients with ERS (19%) had VF recurrences. The use of monotherapy or combination therapy, consisting of quinidine, cilostazol, and bepridil, in the 4 patients with ERS, was effective in suppressing VF. CONCLUSIONS Approximately 40% of patients with CAS with documented VF and inferolateral J wave did not experience chest symptoms at the first VF, and could have been misdiagnosed as having ERS. The use of the spasm provocation test is considered essential to differentiate patients for optimal medical treatment.
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Affiliation(s)
- Tsukasa Kamakura
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita Osaka, Japan
| | - Mitsuru Wada
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita Osaka, Japan
| | - Kohei Ishibashi
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita Osaka, Japan
| | - Yuko Y Inoue
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita Osaka, Japan
| | - Koji Miyamoto
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita Osaka, Japan
| | - Hideo Okamura
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita Osaka, Japan
| | - Satoshi Nagase
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita Osaka, Japan
| | - Takashi Noda
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita Osaka, Japan
| | - Takeshi Aiba
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita Osaka, Japan
| | - Satoshi Yasuda
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita Osaka, Japan
| | - Wataru Shimizu
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita Osaka, Japan.,Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Shiro Kamakura
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita Osaka, Japan
| | - Kengo Kusano
- Division of Arrhythmia and Electrophysiology, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita Osaka, Japan
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Latcu DG, Bun SS, Zarqane N, Saoudi N. Ablation of Left Ventricular Substrate in Early Repolarization Syndrome. J Cardiovasc Electrophysiol 2015; 27:490-1. [PMID: 26467677 DOI: 10.1111/jce.12857] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 10/01/2015] [Accepted: 10/08/2015] [Indexed: 11/29/2022]
Affiliation(s)
| | - Sok-Sithikun Bun
- Cardiologie, Centre Hospitalier Princesse Grace, Monaco, Monaco (Principalty)
| | - Naima Zarqane
- Cardiologie, Centre Hospitalier Princesse Grace, Monaco, Monaco (Principalty)
| | - Nadir Saoudi
- Cardiologie, Centre Hospitalier Princesse Grace, Monaco, Monaco (Principalty)
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Fuyuta M, Nakao S, Kitaura A, Iwamoto T, Hamasaki S, Iwasaki S, Kurita T. Preoperative Prevalence of J-Wave Syndrome Electrocardiographic Patterns and Their Association With Perioperative Cardiac Events. J Cardiothorac Vasc Anesth 2015; 29:1533-6. [PMID: 26432696 DOI: 10.1053/j.jvca.2015.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the preoperative prevalence of each type of J-wave syndrome electrocardiographic pattern and its association with perioperative cardiac events. DESIGN Retrospective study. SETTING Single hospital university study. PARTICIPANTS The study evaluated 930 patients who underwent gynecologic, abdominal, neurosurgical, orthopedic, and urologic surgeries. INTERVENTIONS Preoperative standard 12-lead electrocardiogram (ECG) monitoring was performed, and each type of J-wave syndrome ECG pattern-types 1, 2, and 3 and Brugada syndrome-type-was evaluated. Incidence of perioperative cardiac events was investigated up to 1 year postoperatively using an electronic medical record system. MEASUREMENTS AND MAIN RESULTS Data from 789 patients were included in the final study. Of these, 16 patients (2.0%) had J-wave syndrome: 7 patients (0.9%) had type-1 patterns; 5 patients (0.6%) had type-2 patterns; 2 patients (0.3%) had type-3 patterns; and 2 patients (0.3%) had Brugada syndrome-type ECG patterns. A J-point elevation≥0.2 mV, which is considered to be more dangerous, was found in only 2 patients with Brugada syndrome-type ECG patterns, both of whom suffered perioperative lethal arrhythmias. CONCLUSION Patients with J-wave syndrome ECG patterns, even dangerous patterns, are not necessarily associated with a higher risk of perioperative cardiac events. However, Brugada syndrome type ECG patterns should be carefully monitored.
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Affiliation(s)
- Masaki Fuyuta
- Department of Anesthesiology, Department of Internal Medicine, Kinki University Faculty of Medicine, Osaka, Japan
| | - Shinichi Nakao
- Department of Anesthesiology, Department of Internal Medicine, Kinki University Faculty of Medicine, Osaka, Japan.
| | - Atsuhiro Kitaura
- Department of Anesthesiology, Department of Internal Medicine, Kinki University Faculty of Medicine, Osaka, Japan
| | - Tatsushige Iwamoto
- Department of Anesthesiology, Department of Internal Medicine, Kinki University Faculty of Medicine, Osaka, Japan
| | - Shinichi Hamasaki
- Department of Anesthesiology, Department of Internal Medicine, Kinki University Faculty of Medicine, Osaka, Japan
| | - Shouhei Iwasaki
- Department of Anesthesiology, Department of Internal Medicine, Kinki University Faculty of Medicine, Osaka, Japan
| | - Takashi Kurita
- Division of Cardiology, Department of Internal Medicine, Kinki University Faculty of Medicine, Osaka, Japan
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Talib AK, Sato N, Kawabata N, Sugiyama E, Sakamoto N, Tanabe Y, Fujino T, Takeuchi T, Saijo Y, Akasaka K, Kawamura Y, Hasebe N. Repolarization characteristics in early repolarization and brugada syndromes: insight into an overlapping mechanism of lethal arrhythmias. J Cardiovasc Electrophysiol 2014; 25:1376-84. [PMID: 25329037 DOI: 10.1111/jce.12566] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 09/21/2014] [Accepted: 10/14/2014] [Indexed: 01/12/2023]
Abstract
INTRODUCTION We reported impaired QT-rate dependence in early repolarization syndrome (ERS); however, contemporary data have shown peak incidence of sudden cardiac death (SCD) in ERS and Brugada syndrome (BrS) at mid-night and early morning. Taken together, we analyzed the nocturnal QT-rate dependence in both syndromes. METHODS AND RESULTS A total of 172 subjects were enrolled: 11 ERS, 11 BrS patients, 50 subjects with an uneventful ER pattern (ERP), and 100 non-J-wave control subjects. Ambulatory ECG-derived parameters (QT, QTc, and QT/RR slope) and day-night QT difference were analyzed and compared. Among the groups, there was no significant difference in the average QT or QTc; however, the 24-hour QT/RR slope was significantly smaller in ERS and BrS patients (0.103 ± 0.01 and 0.106 ± 0.01, respectively) than in the control group (0.156 ± 0.03, P < 0.001). Detailed analysis showed a lower day-night QT difference in ERS and BrS patients (19 ±18.7 and 24 ±14 milliseconds, respectively) than in the controls (40 ± 22 milliseconds, P = 0.007) with the lowest QT/RR slopes seen in the ERS and BrS groups from 0 to 3:00 am (QT/RR; 0.076 ± 0.02 vs. 0.092 ± 0.04 vs. 0.117 ± 0.04, for the ERS, BrS, and controls, respectively, P = 0.004) and from 3 to 6 am (QT/RR 0.074 ± 0.03 vs. 0.079 ± 0.02 vs. 0.118 ± 0.04, P < 0.001). CONCLUSION In a large population of age- and gender-matched groups, both ERS and BrS patients showed attenuated QT-rate dependence and impaired QT day-night modulation that may provide a baseline reentrant substrate. Importantly, QT/RR maladaptation was most evident at mid-night and early morning, which may explain the propensity of such patients to develop SCD during this critical period.
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Affiliation(s)
- Ahmed Karim Talib
- Department of Cardiology, Asahikawa Medical University, Asahikawa, Japan
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Vittoria Matassini M, Krahn AD, Gardner M, Champagne J, Sanatani S, Birnie DH, Gollob MH, Chauhan V, Simpson CS, Hamilton RM, Talajic M, Ahmad K, Gerull B, Chakrabarti S, Healey JS. Evolution of clinical diagnosis in patients presenting with unexplained cardiac arrest or syncope due to polymorphic ventricular tachycardia. Heart Rhythm 2013; 11:274-81. [PMID: 24239842 DOI: 10.1016/j.hrthm.2013.11.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND A systematic evaluation of patients with unexplained cardiac arrest (UCA) yields a diagnosis in 50% of the cases. However, evolution of clinical phenotype, identification of new disease-causing mutations, and description of new syndromes may revise the diagnosis. OBJECTIVE To assess the evolution in diagnosis among patients with initially UCA. METHODS Diagnoses were reviewed for all patients with UCA recruited from the Cardiac Arrest Survivors with Preserved Ejection Fraction Registry with at least 1 year of follow-up. RESULTS After comprehensive investigation of 68 patients (age 45.2 ± 14.9 years; 63% men), the initial diagnosis was as follows: idiopathic ventricular fibrillation (n = 34 [50%]), a primary arrhythmic disorder (n = 21 [31%]), and an occult structural cause (n = 13 [19%]). Patients were followed for 30 ± 17 months, during which time the diagnosis changed in 12 (18%) patients. A specific diagnosis emerged for 7 patients (21%) with an initial diagnosis of idiopathic ventricular fibrillation. A structural cardiomyopathy evolved in 2 patients with an initial diagnosis of primary electrical disorder, while the specific structural cardiomyopathy was revised for 1 patient. Two patients with an initial diagnosis of a primary arrhythmic disorder were subsequently considered to have a different primary arrhythmic disorder. A follow-up resting electrocardiogram was the test that most frequently changed the diagnosis (67% of the cases), followed by genetic testing (17%). CONCLUSIONS The reevaluation of patients presenting with UCA may lead to a change in diagnosis in up to 20%. This emphasizes the need to actively monitor the phenotype and also has implications for the treatment of these patients and the screening of their relatives.
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Affiliation(s)
- Maria Vittoria Matassini
- Population Health Research Institute, McMaster University, Hamilton, Canada; Polytechnic University of Marche, Ancona, Italy
| | - Andrew D Krahn
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Shubhayan Sanatani
- British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | | | | | - Vijay Chauhan
- University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Kam Ahmad
- St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Jeff S Healey
- Population Health Research Institute, McMaster University, Hamilton, Canada.
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Nakagawa K, Nagase S, Morita H, Ito H. Left ventricular epicardial electrogram recordings in idiopathic ventricular fibrillation with inferior and lateral early repolarization. Heart Rhythm 2013; 11:314-7. [PMID: 24184784 DOI: 10.1016/j.hrthm.2013.10.057] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Koji Nakagawa
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Satoshi Nagase
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
| | - Hiroshi Morita
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
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Abstract
An early repolarization (ER) pattern in the ECG, distinguished by J-point elevation, slurring of the terminal part of the QRS and ST-segment elevation has long been recognized and considered to be a benign electrocardiographic manifestation. Experimental studies conducted over a decade ago suggested that some cases of ER may be associated with malignant arrhythmias. Validation of this hypothesis was provided by recent studies demonstrating that an ER pattern in the inferior or inferolateral leads is associated with increased risk for life-threatening arrhythmias, termed ER syndrome (ERS). Because accentuated J waves characterize both Brugada syndrome (BS) and ERS, these syndromes have been grouped under the term "J wave syndromes". ERS and BS share similar ECG characteristics, clinical outcomes and risk factors, as well as a common arrhythmic platform related to amplification of I(to)-mediated J waves. Although BS and ERS differ with respect to the magnitude and lead location of abnormal J wave manifestation, they can be considered to represent a continuous spectrum of phenotypic expression. Although most subjects exhibiting an ER pattern are at minimal to no risk, mounting evidence suggests that careful attention should be paid to subjects with "high risk" ER. The challenge ahead is to be able to identify those at risk for sudden cardiac death. Here I review the clinical and genetic aspects as well as the cellular and molecular mechanisms underlying the J wave syndromes.
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Affiliation(s)
- Charles Antzelevitch
- Masonic Medical Research Laboratory, 2150 Bleecker Street, Utica, NY 13501, USA.
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Abstract
The J wave, also referred to as an Osborn wave, is a deflection immediately following the QRS complex of the surface ECG. When partially buried in the R wave, the J wave appears as J-point elevation or ST-segment elevation. Several lines of evidence have suggested that arrhythmias associated with an early repolarization pattern in the inferior or mid to lateral precordial leads, Brugada syndrome, or arrhythmias associated with hypothermia and the acute phase of ST-segment elevation myocardial infarction are mechanistically linked to abnormalities in the manifestation of the transient outward current (I(to))-mediated J wave. Although Brugada syndrome and early repolarization syndrome differ with respect to the magnitude and lead location of abnormal J-wave manifestation, they can be considered to represent a continuous spectrum of phenotypic expression that we propose be termed J-wave syndromes. This review summarizes our current state of knowledge concerning J-wave syndromes, bridging basic and clinical aspects. We propose to divide early repolarization syndrome into three subtypes: type 1, which displays an early repolarization pattern predominantly in the lateral precordial leads, is prevalent among healthy male athletes and is rarely seen in ventricular fibrillation survivors; type 2, which displays an early repolarization pattern predominantly in the inferior or inferolateral leads, is associated with a higher level of risk; and type 3, which displays an early repolarization pattern globally in the inferior, lateral, and right precordial leads, is associated with the highest level of risk for development of malignant arrhythmias and is often associated with ventricular fibrillation storms.
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