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Carrick RT, De Marco C, Gasperetti A, Bosman LP, Gourraud JB, Trancuccio A, Mazzanti A, Murray B, Pendleton C, Tichnell C, Tandri H, Zeppenfeld K, Wilde AAM, Davies B, Seifer C, Roberts JD, Healey JS, MacIntyre C, Alqarawi W, Tadros R, Cutler MJ, Targetti M, Calò L, Vitali F, Bertini M, Compagnucci P, Casella M, Dello Russo A, Cappelletto C, De Luca A, Stolfo D, Duru F, Jensen HK, Svensson A, Dahlberg P, Hasselberg NE, Di Marco A, Jordà P, Arbelo E, Moreno Weidmann Z, Borowiec K, Delinière A, Biernacka EK, van Tintelen JP, Platonov PG, Olivotto I, Saguner AM, Haugaa KH, Cox M, Tondo C, Merlo M, Krahn AD, te Riele ASJM, Wu KC, Calkins H, James CA, Cadrin-Tourigny J. Implantable cardioverter defibrillator use in arrhythmogenic right ventricular cardiomyopathy in North America and Europe. Eur Heart J 2024; 45:538-548. [PMID: 38195003 PMCID: PMC11024811 DOI: 10.1093/eurheartj/ehad799] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 09/14/2023] [Accepted: 11/21/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND AND AIMS Implantable cardioverter-defibrillators (ICDs) are critical for preventing sudden cardiac death (SCD) in arrhythmogenic right ventricular cardiomyopathy (ARVC). This study aims to identify cross-continental differences in utilization of primary prevention ICDs and survival free from sustained ventricular arrhythmia (VA) in ARVC. METHODS This was a retrospective analysis of ARVC patients without prior VA enrolled in clinical registries from 11 countries throughout Europe and North America. Patients were classified according to whether they received treatment in North America or Europe and were further stratified by baseline predicted VA risk into low- (<10%/5 years), intermediate- (10%-25%/5 years), and high-risk (>25%/5 years) groups. Differences in ICD implantation and survival free from sustained VA events (including appropriate ICD therapy) were assessed. RESULTS One thousand ninety-eight patients were followed for a median of 5.1 years; 554 (50.5%) received a primary prevention ICD, and 286 (26.0%) experienced a first VA event. After adjusting for baseline risk factors, North Americans were more than three times as likely to receive ICDs {hazard ratio (HR) 3.1 [95% confidence interval (CI) 2.5, 3.8]} but had only mildly increased risk for incident sustained VA [HR 1.4 (95% CI 1.1, 1.8)]. North Americans without ICDs were at higher risk for incident sustained VA [HR 2.1 (95% CI 1.3, 3.4)] than Europeans. CONCLUSIONS North American ARVC patients were substantially more likely than Europeans to receive primary prevention ICDs across all arrhythmic risk strata. A lower rate of ICD implantation in Europe was not associated with a higher rate of VA events in those without ICDs.
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MESH Headings
- Humans
- Defibrillators, Implantable/adverse effects
- Arrhythmogenic Right Ventricular Dysplasia/complications
- Arrhythmogenic Right Ventricular Dysplasia/epidemiology
- Arrhythmogenic Right Ventricular Dysplasia/therapy
- Retrospective Studies
- Arrhythmias, Cardiac/epidemiology
- Arrhythmias, Cardiac/therapy
- Arrhythmias, Cardiac/etiology
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/prevention & control
- Death, Sudden, Cardiac/etiology
- Risk Factors
- North America/epidemiology
- Europe/epidemiology
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Affiliation(s)
- Richard T Carrick
- Heart and Vascular Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Corrado De Marco
- Cardiovascular Genetics Centre, Montreal Heart Institute, Université de Montréal, 5000 rue Bélanger, Montréal, Québec H1T 1C8, Canada
| | - Alessio Gasperetti
- Heart and Vascular Institute, Johns Hopkins University, Baltimore, MD, USA
- Division of Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Laurens P Bosman
- Division of Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart)
| | - Jean-Baptiste Gourraud
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart)
- Department of Cardiology, Centre Hospitalier Universitaire Nantes, Nantes, France
| | | | - Andrea Mazzanti
- Molecular Cardiology, Istituti Clinici Scientifici Maugeri (IRCCS), Pavia, Italy
| | - Brittney Murray
- Heart and Vascular Institute, Johns Hopkins University, Baltimore, MD, USA
| | | | - Crystal Tichnell
- Heart and Vascular Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Harikrishna Tandri
- Heart and Vascular Institute, Johns Hopkins University, Baltimore, MD, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Arthur A M Wilde
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart)
- Amsterdam UMC, Heart Center Department of Cardiology, Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, University of Amsterdam, Amsterdam, The Netherlands
| | - Brianna Davies
- Center for Cardiac Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Colette Seifer
- St.Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jason D Roberts
- Hamilton Health Sciences, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada
| | - Jeff S Healey
- Hamilton Health Sciences, Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Ciorsti MacIntyre
- Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Wael Alqarawi
- Department of Cardiac Sciences, College of Medicine, King Saudi University, Riyadh, Saudi Arabia
- Division of Cardiology, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Canada
| | - Rafik Tadros
- Cardiovascular Genetics Centre, Montreal Heart Institute, Université de Montréal, 5000 rue Bélanger, Montréal, Québec H1T 1C8, Canada
| | - Michael J Cutler
- Intermountain Medical Center, Intermountain Medical Center Heart Institute, Murray, UT, USA
| | - Mattia Targetti
- Cardiomyopathy Unit, Careggi Hospital and Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Leonardo Calò
- Division of Cardiology, Policlinico Casilino, Rome, Italy
| | - Francesco Vitali
- Cardiology Unit, Sant’Anna University Hospital, University of Ferrara, Ferrara, Italy
| | - Matteo Bertini
- Cardiology Unit, Sant’Anna University Hospital, University of Ferrara, Ferrara, Italy
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti, Ancona, Italy
| | - Michela Casella
- Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti, Ancona, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, University Hospital Ospedali Riuniti, Ancona, Italy
| | - Chiara Cappelletto
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart)
- Division of Cardiology, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, Trieste, Italy
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
| | - Antonio De Luca
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart)
- Division of Cardiology, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, Trieste, Italy
| | - Davide Stolfo
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart)
- Division of Cardiology, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, Trieste, Italy
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
| | - Firat Duru
- Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland
| | - Henrik K Jensen
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart)
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Aarhus N, Denmark
| | - Anneli Svensson
- Department of Cardiology, Linköping University Hospital, Linköping, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Pia Dahlberg
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Nina E Hasselberg
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, University of Oslo, Oslo, Norway
| | - Andrea Di Marco
- Arrhythmia Unit, Department ofCardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
- BioHeartCardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Paloma Jordà
- Cardiovascular Genetics Centre, Montreal Heart Institute, Université de Montréal, 5000 rue Bélanger, Montréal, Québec H1T 1C8, Canada
- Arrhythmia Section, Department of Cardiology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Elena Arbelo
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart)
- Arrhythmia Section, Department of Cardiology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | | | - Karolina Borowiec
- Department of Congenital Heart Diseases, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland
- Outpatient Department of Genetic Arrhythmias, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - Antoine Delinière
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart)
- Department of Cardiology, National Reference Center for Inherited Arrhythmias of Lyon, Louis Pradel Cardiovascular Hospital, Hospices Civils de Lyon, Lyon, France
- University of Lyon, Claude Bernard Lyon 1 University, MeLiS, CNRS UMR 5284, INSERM U1314, Institut NeuroMyoGène, Lyon, France
| | - Elżbieta K Biernacka
- Department of Congenital Heart Diseases, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland
- Outpatient Department of Genetic Arrhythmias, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland
| | - J Peter van Tintelen
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart)
- Department of Genetics, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Pyotr G Platonov
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Careggi Hospital and Meyer Children’s Hospital IRCCS, Florence, Italy
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center Zurich, Zurich, Switzerland
| | - Kristina H Haugaa
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, University of Oslo, Oslo, Norway
| | - Moniek Cox
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing, Centro Cardiologico Monzino, IRCCS, University of Milan, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Marco Merlo
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart)
- Division of Cardiology, Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, Trieste, Italy
| | - Andrew D Krahn
- Center for Cardiac Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anneline S J M te Riele
- Division of Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart (ERN GUARD-Heart)
| | - Katherine C Wu
- Heart and Vascular Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Hugh Calkins
- Heart and Vascular Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Cynthia A James
- Heart and Vascular Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Julia Cadrin-Tourigny
- Cardiovascular Genetics Centre, Montreal Heart Institute, Université de Montréal, 5000 rue Bélanger, Montréal, Québec H1T 1C8, Canada
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2
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Nelson D, Seifer C, Khoo C. Recurrent loss of pacemaker capture following premature ventricular contractions. HeartRhythm Case Rep 2023; 9:869-872. [PMID: 38204827 PMCID: PMC10774534 DOI: 10.1016/j.hrcr.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Affiliation(s)
- David Nelson
- Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Colette Seifer
- Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Clarence Khoo
- Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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3
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Alqarawi W, Tadros R, Roberts JD, Cheung CC, Green MS, Burwash IG, Steinberg C, Healey JS, Khan H, McIntyre C, Cadrin-Touringy J, Laksman ZWM, Simpson CS, Sanatani S, Gardner M, Angaran P, Ilhan E, Talajic M, Arbour L, Leather R, Seifer C, Joza J, Lee F, Lau L, Nair G, Wells G, Krahn AD. The Prevalence and Characteristics of Arrhythmic Mitral Valve Prolapse in Patients With Unexplained Cardiac Arrest. JACC Clin Electrophysiol 2023; 9:2494-2503. [PMID: 37804262 DOI: 10.1016/j.jacep.2023.08.017] [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: 04/10/2023] [Revised: 07/25/2023] [Accepted: 08/02/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND There is growing evidence that mitral valve prolapse (MVP) is associated with otherwise unexplained cardiac arrest (UCA). However, reports are hindered by the absence of a systematic ascertainment of alternative diagnoses. OBJECTIVES This study reports the prevalence and characteristics of MVP in a large cohort of patients with UCA. METHODS Patients were enrolled following an UCA, defined as cardiac arrest with no coronary artery disease, preserved left ventricular ejection fraction, and no apparent explanation on electrocardiogram. A comprehensive evaluation was performed, and patients were diagnosed with idiopathic ventricular fibrillation (IVF) if no cause was found. Echocardiography reports were reviewed for MVP. Patients with MVP were divided into 2 groups: those with IVF (AMVP) and those with an alternative diagnosis (nonarrhythmic MVP). Patient characteristics were then compared. The long-term outcomes of AMVP were reported. RESULTS Among 571 with an initially UCA, 34 patients had MVP (6%). The prevalence of definite MVP was significantly higher in patients with IVF than those with an alternative diagnosis (24 of 366 [6.6%] vs 5 of 205 [2.4%]; P = 0.03). Bileaflet prolapse was significantly associated with AMVP (18 of 23 [78%] vs 1 of 8 [12.5%]; P = 0.001; OR: 25.2). The proportion of patients with AMVP who received appropriate implantable cardioverter-defibrillator therapies over a median follow-up of 42 months was 21.1% (4 of 19). CONCLUSIONS MVP is associated with otherwise UCA (IVF), with a prevalence of 6.6%. Bileaflet prolapse appears to be a feature of AMVP, although future studies need to ascertain its independent association. A significant proportion of patients with AMVP received appropriate implantable cardioverter-defibrillator therapies during follow-up.
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Affiliation(s)
- Wael Alqarawi
- Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Division of Cardiology, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada.
| | - Rafik Tadros
- Cardiovascular Genetics Center, Montreal Heart Institute, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Jason D Roberts
- Population Health Research Institute, McMaster University, and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Christopher C Cheung
- Center for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Martin S Green
- Division of Cardiology, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Ian G Burwash
- Division of Cardiology, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Christian Steinberg
- Institut Universitaire de Cardiologie et Pneumologie de Québec, Laval University, Quebec City, Quebec, Canada
| | - Jeffrey S Healey
- Population Health Research Institute, McMaster University, and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Habib Khan
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada
| | | | - Julia Cadrin-Touringy
- Cardiovascular Genetics Center, Montreal Heart Institute, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Zachary W M Laksman
- Center for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Shubhayan Sanatani
- Division of Cardiology, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Martin Gardner
- Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Paul Angaran
- Cardiac Arrhythmia Service, St-Michael's Hospital, Toronto, Ontario, Canada
| | - Erkan Ilhan
- Division of Cardiology, Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Mario Talajic
- Cardiovascular Genetics Center, Montreal Heart Institute, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Laura Arbour
- Center for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Richard Leather
- Center for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Colette Seifer
- St-Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jacqueline Joza
- Division of Cardiology, McGill University Health Center, Montreal, Quebec, Canada
| | - Felicity Lee
- Division of Cardiology, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Lawrence Lau
- Division of Cardiology, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Girish Nair
- Division of Cardiology, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - George Wells
- Division of Cardiology, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Andrew D Krahn
- Center for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
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4
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Davies B, Allan KS, Carroll SL, Gibbs K, Roberts JD, MacIntyre C, Steinberg C, Tadros R, Dorian P, Healey JS, Gardner M, Laksman ZWM, Krahn AD, Fournier A, Seifer C, Lauck SB. Perceived self-efficacy and empowerment in patients at increased risk of sudden cardiac arrest. Front Cardiovasc Med 2023; 10:955060. [PMID: 37255708 PMCID: PMC10225561 DOI: 10.3389/fcvm.2023.955060] [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] [Received: 05/28/2022] [Accepted: 03/10/2023] [Indexed: 06/01/2023] Open
Abstract
Background The role of multidisciplinary clinics for psychosocial care is increasingly recognized for those living with inherited cardiac conditions (ICC). In Canada, access to healthcare providers differ between clinics. Little is known about the relationship between access to specialty care and a patient's ability to cope with, and manage their condition. Methods We leveraged the Hearts in Rhythm Organization (HiRO) to conduct a cross-sectional, community-based survey of individuals with ICC and their family members. We aimed to describe access to services, and explore the relationships between participants' characteristics, cardiac history and self-reported health status and self-efficacy (GSE: General Self-Efficacy Scale) and empowerment (GCOS-24: Genetic Counseling Outcome Scale). Results We collected 235 responses from Canadian participants in 10 provinces and territories. Overall, 63% of participants reported involvement of a genetic counsellor in their care. Access to genetic testing was associated with greater empowerment [mean GCOS-24: 121.14 (SD = 20.53) vs. 105.68 (SD = 21.69); p = 0.004]. Uncertain genetic test results were associated with lower perceived self-efficacy (mean GSE: uncertain = 28.85 vs. positive = 33.16, negative = 34.13; p = 0.01). Low global mental health scores correlated with both lower perceived self-efficacy and empowerment scores, with only 11% of affected participants reporting involvement of psychology services in their care. Conclusion Differences in resource accessibility, clinical history and self-reported health status impact the perceived self-efficacy and empowerment of patients with ICC. Future research evaluating interventions to improve patient outcomes is recommended.
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Affiliation(s)
- Brianna Davies
- Centre for Cardiovascular Innovation, St. Paul’s and Vancouver General Hospitals, University of British Columbia, Vancouver, BC, Canada
| | - Katherine S. Allan
- Division of Cardiology, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | - Sandra L. Carroll
- School of Nursing, Faculty of Health Science, Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Karen Gibbs
- Centre for Cardiovascular Innovation, St. Paul’s and Vancouver General Hospitals, University of British Columbia, Vancouver, BC, Canada
| | - Jason D. Roberts
- Section of Cardiac Electrophysiology, Division of Cardiology, Department ofMedicine, Western University, London, ON, Canada
| | | | - Christian Steinberg
- Institut Universitaire de Cardiologie et Pneumologie de Québec, Laval University, Quebec City, QC, Canada
| | - Rafik Tadros
- Department of Medicine, Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada
| | - Paul Dorian
- Division of Cardiology, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada
| | - Jeff S. Healey
- School of Nursing, Faculty of Health Science, Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | | | - Zachary W. M. Laksman
- Centre for Cardiovascular Innovation, St. Paul’s and Vancouver General Hospitals, University of British Columbia, Vancouver, BC, Canada
| | - Andrew D. Krahn
- Centre for Cardiovascular Innovation, St. Paul’s and Vancouver General Hospitals, University of British Columbia, Vancouver, BC, Canada
| | - Anne Fournier
- Division of Pediatric Cardiology, CHU Sainte-Justine, Université de Montréal, Montreal,QC, Canada
| | - Colette Seifer
- Department of Internal Medicine, St Boniface Hospital, University of Manitoba, Winnipeg, MB, Canada
| | - Sandra B. Lauck
- Centre for Cardiovascular Innovation, St. Paul’s and Vancouver General Hospitals, University of British Columbia, Vancouver, BC, Canada
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5
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Rayani K, Davies B, Cheung M, Comber D, Roberts JD, Tadros R, Green MS, Healey JS, Simpson CS, Sanatani S, Steinberg C, MacIntyre C, Angaran P, Duff H, Hamilton R, Arbour L, Leather R, Seifer C, Fournier A, Atallah J, Kimber S, Makanjee B, Alqarawi W, Cadrin-Tourigny J, Joza J, Gardner M, Talajic M, Bagnall RD, Krahn AD, Laksman ZWM. Identification and in-silico characterization of splice-site variants from a large cardiogenetic national registry. Eur J Hum Genet 2023; 31:512-520. [PMID: 36138163 PMCID: PMC10172209 DOI: 10.1038/s41431-022-01193-9] [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: 03/26/2022] [Revised: 08/23/2022] [Accepted: 09/08/2022] [Indexed: 11/08/2022] Open
Abstract
Splice-site variants in cardiac genes may predispose carriers to potentially lethal arrhythmias. To investigate, we screened 1315 probands and first-degree relatives enrolled in the Canadian Hearts in Rhythm Organization (HiRO) registry. 10% (134/1315) of patients in the HiRO registry carry variants within 10 base-pairs of the intron-exon boundary with 78% (104/134) otherwise genotype negative. These 134 probands were carriers of 57 unique variants. For each variant, American College of Medical Genetics and Genomics (ACMG) classification was revisited based on consensus between nine in silico tools. Due in part to the in silico algorithms, seven variants were reclassified from the original report, with the majority (6/7) downgraded. Our analyses predicted 53% (30/57) of variants to be likely/pathogenic. For the 57 variants, an average of 9 tools were able to score variants within splice sites, while 6.5 tools responded for variants outside these sites. With likely/pathogenic classification considered a positive outcome, the ACMG classification was used to calculate sensitivity/specificity of each tool. Among these, Combined Annotation Dependent Depletion (CADD) had good sensitivity (93%) and the highest response rate (131/134, 98%), dbscSNV was also sensitive (97%), and SpliceAI was the most specific (64%) tool. Splice variants remain an important consideration in gene elusive inherited arrhythmia syndromes. Screening for intronic variants, even when restricted to the ±10 positions as performed here may improve genetic testing yield. We compare 9 freely available in silico tools and provide recommendations regarding their predictive capabilities. Moreover, we highlight several novel cardiomyopathy-associated variants which merit further study.
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Affiliation(s)
- Kaveh Rayani
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Brianna Davies
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Matthew Cheung
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Drake Comber
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jason D Roberts
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, ON, Canada
| | - Rafik Tadros
- Cardiovascular Genetics Center, Montreal Heart Institute, Montreal, QC, Canada
- Department of Medicine, Universite de Montreal, Montreal, QC, Canada
| | - Martin S Green
- Heart Institute, University of Ottawa, Ottawa, ON, Canada
| | | | | | | | - Christian Steinberg
- Institut Universitaire de Cardiologie et Pneumologie de Quebec, Laval University, Quebec City, QC, Canada
| | - Ciorsti MacIntyre
- Division of Cardiology, QEII Health Sciences Center, Halifax, NS, Canada
| | - Paul Angaran
- St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Henry Duff
- Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada
| | - Robert Hamilton
- Division of Cardiology, The Hospital for Sick Children (SickKids), Toronto, ON, Canada
| | - Laura Arbour
- Division of Medical Genetics, Island Health, Victoria, BC, Canada
| | | | - Colette Seifer
- Section of Cardiology, Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Anne Fournier
- Division of Pediatric Cardiology, CHU Sainte-Justine, Universite de Montreal, Montreal, QC, Canada
| | - Joseph Atallah
- Division of Pediatric Cardiology, University of Alberta Stollery Children's Hospital, Edmonton, AB, Canada
| | - Shane Kimber
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Bhavanesh Makanjee
- Heart Health Institute, Scarborough Health Network, Scarborough, ON, Canada
| | - Wael Alqarawi
- Heart Institute, University of Ottawa, Ottawa, ON, Canada
| | - Julia Cadrin-Tourigny
- Cardiovascular Genetics Center, Montreal Heart Institute, Montreal, QC, Canada
- Department of Medicine, Universite de Montreal, Montreal, QC, Canada
| | - Jacqueline Joza
- Division of Cardiology, McGill University Health Centre, Montreal, QC, Canada
| | - Martin Gardner
- Division of Cardiology, QEII Health Sciences Center, Halifax, NS, Canada
| | - Mario Talajic
- Cardiovascular Genetics Center, Montreal Heart Institute, Montreal, QC, Canada
- Department of Medicine, Universite de Montreal, Montreal, QC, Canada
| | - Richard D Bagnall
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Andrew D Krahn
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Zachary W M Laksman
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
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6
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Janzen ML, Davies B, Laksman ZW, Roberts JD, Sanatani S, Steinberg C, Tadros R, Cadrin-Tourigny J, MacIntyre C, Atallah J, Fournier A, Green MS, Hamilton R, Khan HR, Kimber S, White S, Joza J, Makanjee B, Ilhan E, Lee D, Hansom S, Hadjis A, Arbour L, Leather R, Seifer C, Angaran P, Simpson CS, Healey JS, Gardner M, Talajic M, Krahn AD. Management of Inherited Arrhythmia Syndromes: a HiRO Consensus Handbook on Process of Care. CJC Open 2023; 5:268-284. [PMID: 37124966 PMCID: PMC10140751 DOI: 10.1016/j.cjco.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 02/14/2023] [Indexed: 02/27/2023] Open
Abstract
Inherited arrhythmia syndromes are rare genetic conditions that predispose seemingly healthy individuals to sudden cardiac arrest and death. The Hearts in Rhythm Organization is a multidisciplinary Canadian network of clinicians, researchers, patients, and families that aims to improve care for patients and families with inherited cardiac conditions, focused on those that confer predisposition to arrhythmia and sudden cardiac arrest and/or death. The field is rapidly evolving as research discoveries increase. A streamlined, practical guide for providers to diagnose and follow pediatric and adult patients with inherited cardiac conditions represents a useful tool to improve health system utilization, clinical management, and research related to these conditions. This review provides consensus care pathways for 7 conditions, including the 4 most common inherited cardiac conditions that confer predisposition to arrhythmia, with scenarios to guide investigation, diagnosis, risk stratification, and management. These conditions include Brugada syndrome, long QT syndrome, arrhythmogenic right ventricular cardiomyopathy and related arrhythmogenic cardiomyopathies, and catecholaminergic polymorphic ventricular tachycardia. In addition, an approach to investigating and managing sudden cardiac arrest, sudden unexpected death, and first-degree family members of affected individuals is provided. Referral to specialized cardiogenetic clinics should be considered in most cases. The intention of this review is to offer a framework for the process of care that is useful for both experts and nonexperts, and related allied disciplines such as hospital management, diagnostic services, coroners, and pathologists, in order to provide high-quality, multidisciplinary, standardized care.
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7
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Sheldon RS, Seifer C, Parkash R, Sandhu RK, Hamzeh R, Raj SR. Atomoxetine for suppression of vasovagal syncope. Clin Auton Res 2023; 33:23-28. [PMID: 36401665 DOI: 10.1007/s10286-022-00905-x] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 10/26/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Vasovagal syncope (VVS) is a common clinical condition with few effective medical therapies. The study aimed to evaluate the effectiveness of atomoxetine in suppressing syncope in patients with recurrent VVS. METHODS This was a retrospective, open-label, observational case series of 12 patients taking atomoxetine for suppression of recurrent vasovagal syncope. We compared syncope frequency in the 1 year before atomoxetine and while subjects were taking atomoxetine. We used novel applications of the Poisson distribution to describe the results as a collection of n = 1 studies. RESULTS There were 12 subjects, eight female, with a mean age 47 ± 22 years and a mean Calgary Syncope Symptom Score of 2 (diagnostic of vasovagal syncope). The patients received a mean dose of atomoxetine of 66 ± 16 mg (1.06 ± 0.21 mg/kg). The mean follow-up period was 1.21 ± 1.01 years. While taking atomoxetine, 11/12 patients appeared to improve and 7/12 had no syncope in follow-up (p = 0.0046). The annualized syncope frequency decreased from a median 5.5 (IQR 4, 6.75) syncope per year to 0 (IQR 0, 0.88) syncope per year (p = 0.002, Wilcoxon rank-sum test). According to the Poisson distribution, 7/12 subjects significantly improved with p values of < 0.0001 to 0.0235, 3/12 did not faint but had too brief follow-up times to detect significance, and 2/12 did not improve significantly. CONCLUSIONS In this case series, atomoxetine was a promising oral agent for the prevention of vasovagal syncope. The Poisson distribution permits individual patient-level assessment of improvement and detects insufficient follow-up despite apparent improvement.
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Affiliation(s)
- Robert S Sheldon
- Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, GAA02 HRIC Building, 3280 Hospital Drive NW AB, Calgary, T2N 4Z6, Canada.
| | - Colette Seifer
- Cardiac Sciences Programme, University of Manitoba, Winnipeg, Canada
| | - Ratika Parkash
- Department of Medicine, Dalhousie University, Halifax, Canada
| | - Roopinder K Sandhu
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, California, USA
| | - Rasha Hamzeh
- Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, GAA02 HRIC Building, 3280 Hospital Drive NW AB, Calgary, T2N 4Z6, Canada
| | - Satish R Raj
- Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, GAA02 HRIC Building, 3280 Hospital Drive NW AB, Calgary, T2N 4Z6, Canada
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8
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Pearman CM, Lee D, Davies B, Khan H, Tadros R, Cadrin-Tourigny J, Roberts JD, Sanatani S, Simpson C, Angaran P, Hansom S, Ilhan E, Seifer C, Green M, Gardner M, Talajic M, Laksman Z, Healey JS, Krahn AD. Incremental value of the signal-averaged ECG for diagnosing arrhythmogenic cardiomyopathy. Heart Rhythm 2023; 20:224-230. [PMID: 36244568 DOI: 10.1016/j.hrthm.2022.10.005] [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: 08/31/2022] [Revised: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Arrhythmogenic right ventricular cardiomyopathy (ARVC) is currently diagnosed using a combination of clinical features, imaging, electrocardiography, and genetic investigations. An abnormal signal-averaged electrocardiogram (SAECG) is defined as a minor diagnostic criterion by the 2010 Task Force Criteria, but doubts remain about the value of this investigation. OBJECTIVE We evaluated the utility of the SAECG in diagnosing ARVC using the Canadian Arrhythmogenic Right Ventricular Cardiomyopathy Registry, a population representative registry of probands with ARVC and relatives, less influenced by referral bias. METHODS Probands with ARVC and family members from the Canadian Arrhythmogenic Right Ventricular Cardiomyopathy Registry underwent phenotype review. SAECG parameters were compared individually and in combination between those with varying degrees of ARVC severity and healthy controls (family members of probands with ARVC and unexplained sudden death, free of evidence of cardiac disease). RESULTS A total of 196 patients with ARVC and 205 controls were included (mean age 44 ± 15 years; 186 of 401 men [46%]). SAECG abnormalities were seen in 83 of 205 controls (40%), 33 of 68 patients with ARVC and mild disease (51%), and 31 of 42 with severe disease (74%). The SAECG associated strongly with imaging abnormalities (major: odds ratio 3.0, 95% confidence interval 1.3-6.9; minor: odds ratio 3.5, 95% confidence interval 0.7-16.5) but not with other aspects of phenotype. Patients carrying pathogenic variants but with minimal phenotype had similar SAECGs to healthy controls (filtered QRS duration 111.2 ± 11.2 ms vs 111 ± 7.6 ms, P = .93; duration of low amplitude signals < 40 μV 32.3 ± 8.9 ms vs 34.2 ± 7.2 ms, P = .32; root mean square of the terminal 40 ms of the filtered QRS complex 43.1 ± 25.2 ms vs 38.2 ± 20.2 ms, P = .38). CONCLUSION The SAECG appears to be a surrogate marker for structural abnormalities seen on imaging in those with ARVC. Great caution is required in interpreting SAECG findings in those without other corroborating evidence of an ARVC phenotype.
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Affiliation(s)
- Charles Michael Pearman
- Center for Cardiovascular Innovation, Heart Rhythm Services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia; Unit of Cardiac Physiology, Division of Cardiovascular Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, United Kingdom
| | - David Lee
- Division of Cardiology, QEII Health Sciences Center, Halifax, Nova Scotia, Canada
| | - Brianna Davies
- Center for Cardiovascular Innovation, Heart Rhythm Services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia
| | - Habib Khan
- Division of Cardiology, Department of Medicine, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
| | - Rafik Tadros
- Cardiovascular Genetics Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Julia Cadrin-Tourigny
- Cardiovascular Genetics Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Jason D Roberts
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Shubhayan Sanatani
- Division of Cardiology, BC Children's Hospital, Vancouver, British Columbia, Canada
| | | | - Paul Angaran
- Division of Cardiology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Simon Hansom
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Erkan Ilhan
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Colette Seifer
- Section of Cardiology, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Martin Green
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Martin Gardner
- Division of Cardiology, QEII Health Sciences Center, Halifax, Nova Scotia, Canada
| | - Mario Talajic
- Cardiovascular Genetics Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Zachary Laksman
- Center for Cardiovascular Innovation, Heart Rhythm Services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia
| | - Jeff S Healey
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Andrew D Krahn
- Center for Cardiovascular Innovation, Heart Rhythm Services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia.
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9
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Yee LA, Han H, Davies B, Pearman CM, Laksman ZWM, Roberts JD, Steinberg C, Tadros R, Cadrin‐Tourigny J, Simpson CS, Gardner M, MacIntyre C, Arbour L, Leather R, Fournier A, Green MS, Kimber S, Angaran P, Sanatani S, Joza J, Khan H, Healey JS, Atallah J, Seifer C, Krahn AD. Sex Differences and Utility of Treadmill Testing in Long‐QT Syndrome. J Am Heart Assoc 2022; 11:e025108. [DOI: 10.1161/jaha.121.025108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
Diagnosis of congenital long‐QT syndrome (LQTS) is complicated by phenotypic ambiguity, with a frequent normal‐to‐borderline resting QT interval. A 3‐step algorithm based on exercise response of the corrected QT interval (QTc) was previously developed to diagnose patients with LQTS and predict subtype. This study evaluated the 3‐step algorithm in a population that is more representative of the general population with LQTS with milder phenotypes and establishes sex‐specific cutoffs beyond the resting QTc.
Methods and Results
We identified 208 LQTS likely pathogenic or pathogenic
KCNQ1
or
KCNH2
variant carriers in the Canadian NLQTS (National Long‐QT Syndrome) Registry and 215 unaffected controls from the HiRO (Hearts in Rhythm Organization) Registry. Exercise treadmill tests were analyzed across the 5 stages of the Bruce protocol. The predictive value of exercise ECG characteristics was analyzed using receiver operating characteristic curve analysis to identify optimal cutoff values. A total of 78% of male carriers and 74% of female carriers had a resting QTc value in the normal‐to‐borderline range. The 4‐minute recovery QTc demonstrated the best predictive value for carrier status in both sexes, with better LQTS ascertainment in female patients (area under the curve, 0.90 versus 0.82), with greater sensitivity and specificity. The optimal cutoff value for the 4‐minute recovery period was 440 milliseconds for male patients and 450 milliseconds for female patients. The 1‐minute recovery QTc had the best predictive value in female patients for differentiating LQTS1 versus LQTS2 (area under the curve, 0.82), and the peak exercise QTc had a marginally better predictive value in male patients for subtype with (area under the curve, 0.71). The optimal cutoff value for the 1‐minute recovery period was 435 milliseconds for male patients and 455 milliseconds for femal patients.
Conclusions
The 3‐step QT exercise algorithm is a valid tool for the diagnosis of LQTS in a general population with more frequent ambiguity in phenotype. The algorithm is a simple and reliable method for the identification and prediction of the 2 major genotypes of LQTS.
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Affiliation(s)
- Lauren A. Yee
- Center for Cardiovascular Innovation, Heart Rhythm Services, Division of Cardiology, Department of Medicine University of British Columbia Vancouver British Columbia Canada
| | - Hui‐Chen Han
- Center for Cardiovascular Innovation, Heart Rhythm Services, Division of Cardiology, Department of Medicine University of British Columbia Vancouver British Columbia Canada
| | - Brianna Davies
- Center for Cardiovascular Innovation, Heart Rhythm Services, Division of Cardiology, Department of Medicine University of British Columbia Vancouver British Columbia Canada
| | - Charles M. Pearman
- Center for Cardiovascular Innovation, Heart Rhythm Services, Division of Cardiology, Department of Medicine University of British Columbia Vancouver British Columbia Canada
| | - Zachary W. M. Laksman
- Center for Cardiovascular Innovation, Heart Rhythm Services, Division of Cardiology, Department of Medicine University of British Columbia Vancouver British Columbia Canada
| | - Jason D. Roberts
- Population Health Research Institute, McMaster University, and Hamilton Health Sciences Hamilton Ontario Canada
| | - Christian Steinberg
- Institut Universitaire de Cardiologie et Pneumologie de Québec, Laval University Quebec City Quebec Canada
| | - Rafik Tadros
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal Montreal Quebec Canada
| | - Julia Cadrin‐Tourigny
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal Montreal Quebec Canada
| | | | - Martin Gardner
- Queen Elizabeth II Health Sciences Center Halifax Nova Scotia Canada
| | - Ciorsti MacIntyre
- Queen Elizabeth II Health Sciences Center Halifax Nova Scotia Canada
| | - Laura Arbour
- Department of Medical Genetics University of British Columbia, and Island Health Victoria British Columbia Canada
| | | | - Anne Fournier
- Centre Hospitalier Universitaire Sainte‐Justine Montréal Quebec Canada
| | | | | | - Paul Angaran
- St. Michael’s Hospital, University of Toronto Toronto Ontario Canada
| | | | - Jacqueline Joza
- McGill University Health Sciences Center Montreal Quebec Canada
| | - Habib Khan
- London Health Sciences Center London Ontario Canada
| | | | | | | | - Andrew D. Krahn
- Center for Cardiovascular Innovation, Heart Rhythm Services, Division of Cardiology, Department of Medicine University of British Columbia Vancouver British Columbia Canada
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10
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Jordà P, Bosman LP, Gasperetti A, Mazzanti A, Gourraud JB, Davies B, Frederiksen TC, Moreno Weidmann Z, Di Marco A, Roberts JD, MacIntyre C, Seifer C, Delinière A, Alqarawi W, Kukavica D, Minois D, Trancuccio A, Arnaud M, Targetti M, Martino A, Oliviero G, Pipilas DC, Carbucicchio C, Compagnucci P, Dello Russo A, Olivotto I, Calò L, Lubitz SA, Cutler MJ, Chevalier P, Arbelo E, Priori SG, Healey JS, Calkins H, Casella M, Jensen HK, Tondo C, Tadros R, James CA, Krahn AD, Cadrin-Tourigny J. Arrhythmic risk prediction in arrhythmogenic right ventricular cardiomyopathy: external validation of the arrhythmogenic right ventricular cardiomyopathy risk calculator. Eur Heart J 2022; 43:3041-3052. [PMID: 35766180 PMCID: PMC9392650 DOI: 10.1093/eurheartj/ehac289] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 04/16/2022] [Accepted: 05/18/2022] [Indexed: 12/17/2022] Open
Abstract
AIMS Arrhythmogenic right ventricular cardiomyopathy (ARVC) causes ventricular arrhythmias (VAs) and sudden cardiac death (SCD). In 2019, a risk prediction model that estimates the 5-year risk of incident VAs in ARVC was developed (ARVCrisk.com). This study aimed to externally validate this prediction model in a large international multicentre cohort and to compare its performance with the risk factor approach recommended for implantable cardioverter-defibrillator (ICD) use by published guidelines and expert consensus. METHODS AND RESULTS In a retrospective cohort of 429 individuals from 29 centres in North America and Europe, 103 (24%) experienced sustained VA during a median follow-up of 5.02 (2.05-7.90) years following diagnosis of ARVC. External validation yielded good discrimination [C-index of 0.70 (95% confidence interval-CI 0.65-0.75)] and calibration slope of 1.01 (95% CI 0.99-1.03). Compared with the three published consensus-based decision algorithms for ICD use in ARVC (Heart Rhythm Society consensus on arrhythmogenic cardiomyopathy, International Task Force consensus statement on the treatment of ARVC, and American Heart Association guidelines for VA and SCD), the risk calculator performed better with a superior net clinical benefit below risk threshold of 35%. CONCLUSION Using a large independent cohort of patients, this study shows that the ARVC risk model provides good prognostic information and outperforms other published decision algorithms for ICD use. These findings support the use of the model to facilitate shared decision making regarding ICD implantation in the primary prevention of SCD in ARVC.
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Affiliation(s)
- Paloma Jordà
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, Montréal, QC, Canada.,Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Laurens P Bosman
- Division of Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Alessio Gasperetti
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Andrea Mazzanti
- Department of Molecular Medicine, University of Pavia, Pavia, Italy.,Department of Molecular Cardiology, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy.,Department of Molecular Cardiology, Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | | | - Brianna Davies
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, BC, Canada
| | - Tanja Charlotte Frederiksen
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Health, Aarhus University, Aarhus N, Denmark
| | - Zoraida Moreno Weidmann
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, Universitat Autònoma de Barcelona, CIBERCV, Barcelona, Spain
| | - Andrea Di Marco
- Arrhythmia Unit, Department of Cardiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Jason D Roberts
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada.,Division of Cardiology, Hamilton Health Sciences, Hamilton, ON, Canada.,Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, ON, Canada
| | - Ciorsti MacIntyre
- Cardiac Electrophysiology Service, Quenn Elisabeth II Health Sciences Center, Dalhousie University, Halifax, NS, Canada
| | - Colette Seifer
- St-Boniface Hospital, University of Manitoba, Winnipeg, MB, Canada
| | - Antoine Delinière
- National Reference Center for Inherited Arrhythmias of Lyon, Louis Pradel Cardiovascular Hospital, Hospices Civils de Lyon, Lyon, France
| | - Wael Alqarawi
- Cardiac Electrophysiology Service, Ottawa Heart Institute, University of Ottawa, Ottawa, ON, Canada
| | - Deni Kukavica
- Department of Molecular Medicine, University of Pavia, Pavia, Italy.,Department of Molecular Cardiology, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy.,Department of Molecular Cardiology, Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Damien Minois
- Department of Cardiology, Centre Hospitalier Universitaire Nantes, Nantes, France
| | - Alessandro Trancuccio
- Department of Molecular Medicine, University of Pavia, Pavia, Italy.,Department of Molecular Cardiology, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy.,Department of Molecular Cardiology, Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Marine Arnaud
- Department of Cardiology, Centre Hospitalier Universitaire Nantes, Nantes, France
| | - Mattia Targetti
- Cardiomyopathy Unit, Department of Cardiology, Careggi University Hospital, Florence, Italy
| | | | - Giada Oliviero
- Department of Cardiology, Policlinico Casilino, Rome, Italy
| | - Daniel C Pipilas
- Cardiovascular Research Center and Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA, USA
| | - Corrado Carbucicchio
- Department of Clinical Electrophysiology and Cardiac Pacing Centro Cardiologico Monzino, IRCCSC, Milan, Italy
| | - Paolo Compagnucci
- Department of Biomedical Sciences and Public Health, Cardiology and Arrhythmology Clinic, University Hospital Umberto I-Salesi-Lancisi, Marche Polytechnic University, Ancona, Italy
| | - Antonio Dello Russo
- Department of Biomedical Sciences and Public Health, Cardiology and Arrhythmology Clinic, University Hospital Umberto I-Salesi-Lancisi, Marche Polytechnic University, Ancona, Italy
| | - Iacopo Olivotto
- Cardiomyopathy Unit, Department of Cardiology, Careggi University Hospital, Florence, Italy
| | - Leonardo Calò
- Department of Cardiology, Policlinico Casilino, Rome, Italy
| | - Steven A Lubitz
- Cardiovascular Research Center and Cardiac Arrhythmia Service, Massachusetts General Hospital, Boston, MA, USA
| | - Michael J Cutler
- Intermountain Medical Center Heart Institute, Intermountain Medical Center, Murray, UT, USA
| | - Philippe Chevalier
- National Reference Center for Inherited Arrhythmias of Lyon, Louis Pradel Cardiovascular Hospital, Hospices Civils de Lyon, Lyon, France
| | - Elena Arbelo
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.,Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,European Reference Network for rare, low prevalence and complex diseases of the heart - ERN GUARD-Heart
| | - Silvia Giuliana Priori
- Department of Molecular Medicine, University of Pavia, Pavia, Italy.,Department of Molecular Cardiology, IRCCS Istituti Clinici Scientifici Maugeri, Pavia, Italy.,Department of Molecular Cardiology, Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
| | - Jeffrey S Healey
- Population Health Research Institute, McMaster University, Hamilton, ON, Canada.,Division of Cardiology, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Michela Casella
- Department of Clinical, Special and Dental Sciences, Cardiology and Arrhythmology Clinic, University Hospital Umberto I-Salesi-Lancisi, MarchePolytechnic University, Ancona, Italy
| | - Henrik Kjærulf Jensen
- Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Health, Aarhus University, Aarhus N, Denmark
| | - Claudio Tondo
- Department of Clinical Electrophysiology and Cardiac Pacing Centro Cardiologico Monzino, IRCCSC, Milan, Italy.,Department of Biomedical, Surgical and Dentistry Sciences, University of Milan, Milan, Italy
| | - Rafik Tadros
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, Montréal, QC, Canada
| | - Cynthia A James
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Andrew D Krahn
- Centre for Cardiovascular Innovation, Division of Cardiology, University of British Columbia, Vancouver, BC, Canada
| | - Julia Cadrin-Tourigny
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, Montréal, QC, Canada
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11
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Grondin S, Davies B, Cadrin-Tourigny J, Steinberg C, Cheung CC, Jorda P, Healey JS, Green MS, Sanatani S, Alqarawi W, Angaran P, Arbour L, Antiperovitch P, Khan H, Leather R, Guerra PG, Rivard L, Simpson CS, Gardner M, MacIntyre C, Seifer C, Fournier A, Joza J, Gollob MH, Lettre G, Talajic M, Laksman ZW, Roberts JD, Krahn AD, Tadros R. OUP accepted manuscript. Eur Heart J 2022; 43:3071-3081. [PMID: 35352813 PMCID: PMC9392649 DOI: 10.1093/eurheartj/ehac145] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 01/25/2022] [Accepted: 03/07/2022] [Indexed: 12/04/2022] Open
Abstract
Aims Genetic testing is recommended in specific inherited heart diseases but its role remains unclear and it is not currently recommended in unexplained cardiac arrest (UCA). We sought to assess the yield and clinical utility of genetic testing in UCA using whole-exome sequencing (WES). Methods and results Survivors of UCA requiring external defibrillation were included from the Cardiac Arrest Survivor with Preserved Ejection fraction Registry. Whole-exome sequencing was performed, followed by assessment of rare variants in previously reported cardiovascular disease genes. A total of 228 UCA survivors (mean age at arrest 39 ± 13 years) were included. The majority were males (66%) and of European ancestry (81%). Following advanced clinical testing at baseline, the likely aetiology of cardiac arrest was determined in 21/228 (9%) cases. Whole-exome sequencing identified a pathogenic or likely pathogenic (P/LP) variant in 23/228 (10%) of UCA survivors overall, increasing the proportion of ‘explained’ cases from 9% only following phenotyping to 18% when combining phenotyping with WES. Notably, 13 (57%) of the 23 P/LP variants identified were located in genes associated with cardiomyopathy, in the absence of a diagnosis of cardiomyopathy at the time of arrest. Conclusions Genetic testing identifies a disease-causing variant in 10% of apparent UCA survivors. The majority of disease-causing variants was located in cardiomyopathy-associated genes, highlighting the arrhythmogenic potential of such variants in the absence of an overt cardiomyopathy diagnosis. The present study supports the use of genetic testing including assessment of arrhythmia and cardiomyopathy genes in survivors of UCA.
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Affiliation(s)
- Steffany Grondin
- Cardiovascular Genetics Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Belanger, Montreal, QC, Canada H1T 1C8
| | - Brianna Davies
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Julia Cadrin-Tourigny
- Cardiovascular Genetics Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Belanger, Montreal, QC, Canada H1T 1C8
| | - Christian Steinberg
- Institut universitaire de cardiologie et pneumologie de Québec, Université Laval, Québec City, QC, Canada
| | - Christopher C Cheung
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Paloma Jorda
- Cardiovascular Genetics Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Belanger, Montreal, QC, Canada H1T 1C8
| | - Jeffrey S Healey
- Population Health Research Institute, McMaster University, and Hamilton Health Sciences, Hamilton, ON, Canada
| | - Martin S Green
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Shubhayan Sanatani
- Division of Pediatric Cardiology, British Columbia Children’s Hospital, Vancouver, BC, Canada
| | - Wael Alqarawi
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON, Canada
- Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Paul Angaran
- Cardiac Arrhythmia Service, St Michael’s Hospital, Toronto, ON, Canada
| | - Laura Arbour
- Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada
| | - Pavel Antiperovitch
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, ON, Canada
| | - Habib Khan
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, ON, Canada
| | - Richard Leather
- Division of Cardiology, Royal Jubilee Hospital, Victoria, BC, Canada
| | - Peter G Guerra
- Cardiovascular Genetics Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Belanger, Montreal, QC, Canada H1T 1C8
| | - Lena Rivard
- Cardiovascular Genetics Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Belanger, Montreal, QC, Canada H1T 1C8
| | | | - Martin Gardner
- Queen Elizabeth II Health Sciences Center, Halifax, NS, Canada
| | | | - Colette Seifer
- St Boniface Hospital, University of Manitoba, Winnipeg, MB, Canada
| | - Anne Fournier
- Ste-Justine Hospital, Université de Montréal, Montreal, QC, Canada
| | - Jacqueline Joza
- Department of Medicine, McGill University Health Center, Montreal, QC, Canada
| | - Michael H Gollob
- Division of Cardiology, University Health Network, Toronto General Hospital, Toronto, ON, Canada
| | - Guillaume Lettre
- Cardiovascular Genetics Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Belanger, Montreal, QC, Canada H1T 1C8
| | - Mario Talajic
- Cardiovascular Genetics Center, Montreal Heart Institute, Department of Medicine, Université de Montréal, 5000 Belanger, Montreal, QC, Canada H1T 1C8
| | - Zachary W Laksman
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jason D Roberts
- Population Health Research Institute, McMaster University, and Hamilton Health Sciences, Hamilton, ON, Canada
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, ON, Canada
| | - Andrew D Krahn
- Center for Cardiovascular Innovation, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Rafik Tadros
- Corresponding author. Tel: +1 514 376 3330, Fax: +1 514 593 2158, , Twitter: @rafik_tadros
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Comber DA, Davies B, Roberts JD, Tadros R, Green MS, Healey JS, Simpson CS, Sanatani S, Steinberg C, MacIntyre C, Angaran P, Duff H, Hamilton R, Arbour L, Leather R, Seifer C, Fournier A, Atallah J, Kimber S, Makanjee B, Alqarawi W, Cadrin-Tourigny J, Joza J, Gibbs K, Robb L, Zahavich L, Gardner M, Talajic M, Virani A, Krahn AD, Lehman A, Laksman ZWM. Return of Results Policies for Genomic Research: Current Practices & The Hearts in Rhythm Organization Approach. Can J Cardiol 2021; 38:526-535. [PMID: 34715283 DOI: 10.1016/j.cjca.2021.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 11/02/2022] Open
Abstract
Research teams developing biobanks and/or genomic databases must develop policies for the disclosure and reporting of potentially actionable genomic results to research participants. Currently, a broad range of approaches to the return of results exist, with some studies opting for non-disclosure of research results while others follow clinical guidelines for the return of potentially actionable findings from sequencing. In this review, we describe current practices and highlight decisions a research team must make when designing a return of results policy, from informed consent to disclosure practices and clinical validation options. The unique challenges of returning incidental findings in cardiac genes, including reduced penetrance and the lack of clinical screening standards for phenotype-negative individuals are discussed. Lastly, the National Hearts in Rhythm Organization (HiRO) Registry approach is described to provide a rationale for the selective return of field-specific variants to those participating in disease-specific research. Our goal is to provide researchers with a resource when developing a return of results policy tailored for their research program, based on unique factors related to study design, research team composition and availability of clinical resources.
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Affiliation(s)
- Drake A Comber
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Brianna Davies
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jason D Roberts
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, ON, Canada
| | - Rafik Tadros
- Cardiovascular Genetics Center, Montreal Heart Institute, and Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Martin S Green
- University of Ottawa Heart Institute, Ottawa, ON, Canada
| | | | | | | | - Christian Steinberg
- Institut Universitaire de Cardiologie et Pneumologie de Québec, Laval University, Quebec City, QC, Canada
| | | | - Paul Angaran
- St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Henry Duff
- Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada
| | - Robert Hamilton
- The Hospital for Sick Children (SickKids), Toronto, ON, Canada
| | - Laura Arbour
- Department of Medical Genetics, University of British Columbia and Island Health, Victoria, BC, Canada
| | | | - Colette Seifer
- Section of Cardiology, Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Anne Fournier
- Division of Pediatric Cardiology, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Joseph Atallah
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Shane Kimber
- Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Bhavanesh Makanjee
- Heart Health Institute, Scarborough Health Network, Scarborough, ON, Canada
| | - Wael Alqarawi
- University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Julia Cadrin-Tourigny
- Cardiovascular Genetics Center, Montreal Heart Institute, and Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Jacqueline Joza
- Division of Cardiology, McGill University Health Centre, Montreal, QC, Canada
| | - Karen Gibbs
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Laura Robb
- Cardiovascular Genetics Center, Montreal Heart Institute, and Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Laura Zahavich
- The Hospital for Sick Children (SickKids), Toronto, ON, Canada
| | | | - Mario Talajic
- Cardiovascular Genetics Center, Montreal Heart Institute, and Department of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Alice Virani
- Department of Medical Genetics, The University of British, Columbia, Vancouver, British Columbia, Canada
| | - Andrew D Krahn
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Anna Lehman
- Department of Medical Genetics, The University of British, Columbia, Vancouver, British Columbia, Canada
| | - Zachary W M Laksman
- Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
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Steinberg C, Davies B, Mellor G, Tadros R, Laksman ZW, Roberts JD, Green M, Alqarawi W, Angaran P, Healey J, Sanatani S, Leather R, Seifer C, Fournier A, Duff H, Gardner M, McIntyre C, Hamilton R, Simpson CS, Krahn AD. Short-coupled ventricular fibrillation represents a distinct phenotype among latent causes of unexplained cardiac arrest: a report from the CASPER registry. Eur Heart J 2021; 42:2827-2838. [PMID: 34010395 DOI: 10.1093/eurheartj/ehab275] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [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: 11/08/2020] [Revised: 02/14/2021] [Accepted: 04/27/2021] [Indexed: 12/25/2022] Open
Abstract
AIMS The term idiopathic ventricular fibrillation (IVF) describes survivors of unexplained cardiac arrest (UCA) without a specific diagnosis after clinical and genetic testing. Previous reports have described a subset of IVF individuals with ventricular arrhythmia initiated by short-coupled trigger premature ventricular contractions (PVCs) for which the term short-coupled ventricular fibrillation (SCVF) has been proposed. The aim of this article is to establish the phenotype and frequency of SCVF in a large cohort of UCA survivors. METHODS AND RESULTS We performed a multicentre study including consecutive UCA survivors from the CASPER registry. Short-coupled ventricular fibrillation was defined as otherwise unexplained ventricular fibrillation initiated by a trigger PVC with a coupling interval of <350 ms. Among 364 UCA survivors, 24/364 (6.6%) met diagnostic criteria for SCVF. The diagnosis of SCVF was obtained in 19/24 (79%) individuals by documented ventricular fibrillation during follow-up. Ventricular arrhythmia was initiated by a mean PVC coupling interval of 274 ± 32 ms. Electrical storm occurred in 21% of SCVF probands but not in any UCA proband (P < 0.001). The median time to recurrent ventricular arrhythmia in SCVF was 31 months. Recurrent ventricular fibrillation resulted in quinidine administration in 12/24 SCVF (50%) with excellent arrhythmia control. CONCLUSION Short-coupled ventricular fibrillation is a distinct primary arrhythmia syndrome accounting for at least 6.6% of UCA. As documentation of ventricular fibrillation onset is necessary for the diagnosis, most cases are diagnosed at the time of recurrent arrhythmia, thus the true prevalence of SCVF remains still unknown. Quinidine is effective in SCVF and should be considered as first-line treatment for patients with recurrent episodes.
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Affiliation(s)
- Christian Steinberg
- Cardiac Electrophysiology Service, Department of Cardiology and Cardiac Surgery, Institut universitaire de cardiologie et pneumologie de Québec, Laval University, 2725, Chemin Ste-Foy, Quebec, QC G1V 4G5, Canada
| | - Brianna Davies
- Heart Rhythm Services, Department of Medicine, St-Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Greg Mellor
- Cardiac Electrophysiology Service, Royal Papworth Hospital, Cambridge, UK
| | - Rafik Tadros
- Section of Cardiac Electrophysiology, Montreal Heart Institute, University of Montreal, Montreal, QC, Canada
| | - Zachary W Laksman
- Heart Rhythm Services, Department of Medicine, St-Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Jason D Roberts
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, ON, Canada
| | - Martin Green
- Cardiac Electrophysiology Service, Ottawa Heart Institute, University of Ottawa, Ottawa, ON, Canada
| | - Wael Alqarawi
- Cardiac Electrophysiology Service, Ottawa Heart Institute, University of Ottawa, Ottawa, ON, Canada
| | - Paul Angaran
- Cardiac Arrhythmia Service, St-Michael's Hospital, Toronto, ON, Canada
| | - Jeffrey Healey
- Arrhythmia Services Hamilton Health Sciences, Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | | | - Richard Leather
- Cardiac Electrophysiology Service, Royal Jubilee Hospital, Victoria, BC, Canada
| | - Colette Seifer
- St-Boniface Hospital, University of Manitoba, Winnipeg, MB, Canada
| | - Anne Fournier
- Division of Pediatric Cardiology, Department of Pediatrics, Centre Hospitalier Universitaire de Sainte-Justine, Montreal, QC, Canada
| | - Henry Duff
- Division of Cardiology, Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada
| | - Martin Gardner
- Cardiac Electrophysiology Service, QEII Health Sciences Center, Dalhousie University, Halifax, NS, Canada
| | - Ciorsti McIntyre
- Cardiac Electrophysiology Service, QEII Health Sciences Center, Dalhousie University, Halifax, NS, Canada
| | - Robert Hamilton
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | | | - Andrew D Krahn
- Heart Rhythm Services, Department of Medicine, St-Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
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Davies B, Bartels K, Hathaway J, Xu F, Roberts JD, Tadros R, Green MS, Healey JS, Simpson CS, Sanatani S, Steinberg C, Gardner M, Angaran P, Talajic M, Hamilton R, Arbour L, Seifer C, Fournier A, Joza J, Krahn AD, Lehman A, Laksman ZWM. Variant Reinterpretation in Survivors of Cardiac Arrest With Preserved Ejection Fraction (the Cardiac Arrest Survivors With Preserved Ejection Fraction Registry) by Clinicians and Clinical Commercial Laboratories. Circ Genom Precis Med 2021; 14:e003235. [PMID: 33960826 DOI: 10.1161/circgen.120.003235] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Following an unexplained cardiac arrest, clinical genetic testing is increasingly becoming standard of care. Periodic review of variant classification is required, as reinterpretation can change the diagnosis, prognosis, and management of patients and their relatives. METHODS This study aimed to develop and validate a standardized algorithm to facilitate clinical application of the 2015 American College of Medical Genetics and Association for Molecular Pathology guidelines for the interpretation of genetic variants. The algorithm was applied to genetic results in the Cardiac Arrest Survivors With Preserved Ejection Fraction Registry, to assess the rate of variant reclassification over time. Variant classifications were then compared with the classifications of 2 commercial laboratories to determine the rate and identify sources of variant interpretation discordance. RESULTS Thirty-one percent of participants (40 of 131) had at least 1 genetic variant with a clinically significant reclassification over time. Variants of uncertain significance were more likely to be downgraded (73%) to benign than upgraded to pathogenic (27%; P=0.03). For the second part of the study, 50% (70 of 139) of variants had discrepant interpretations (excluding benign variants), provided by at least 1 team. CONCLUSIONS Periodic review of genetic variant classification is a key component of follow-up care given rapidly changing information in the field. There is potential for clinical care gaps with discrepant variant interpretations, based on the interpretation and application of current guidelines. The development of gene- and disease-specific guidelines and algorithms may provide an opportunity to further standardize variant interpretation reporting in the future. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00292032.
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Affiliation(s)
- Brianna Davies
- Division of Cardiology, Department of Medicine (B.D., K.B., A.D.K., Z.W.M.L.), The University of British Columbia, Vancouver, Canada
| | - Kirsten Bartels
- Division of Cardiology, Department of Medicine (B.D., K.B., A.D.K., Z.W.M.L.), The University of British Columbia, Vancouver, Canada
| | | | - Fang Xu
- Prevention Genetics, Marshfield, WI (F.X.)
| | - Jason D Roberts
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario (J.D.R.)
| | - Rafik Tadros
- Department of Medicine, Cardiovascular Genetics Center, Montreal Heart Institute, Canada (R.T., M.T.)
| | | | | | | | | | - Christian Steinberg
- Institut Universitaire de Cardiologie et Pneumologie de Québec, Laval University (C. Steinberg)
| | | | - Paul Angaran
- St. Michael's Hospital, University of Toronto, Canada (P.A.)
| | - Mario Talajic
- Department of Medicine, Cardiovascular Genetics Center, Montreal Heart Institute, Canada (R.T., M.T.)
| | - Robert Hamilton
- hTe Hospital for Sick Children (SickKids), Toronto, Canada (R.H.)
| | - Laura Arbour
- Division of Medical Genetics, Island Health, Victoria, Canada (L.A.)
| | - Colette Seifer
- Section of Cardiology, Department of Internal Medicine, University of Manitoba, Winnipeg, Canada (C. Seifer)
| | - Anne Fournier
- Division of Pediatric Cardiology, CHU Sainte-Justine, Université de Montréal, QC (A.F.)
| | - Jacqueline Joza
- Division of Cardiology, McGill University Health Center, Montreal, Canada (J.J.)
| | - Andrew D Krahn
- Division of Cardiology, Department of Medicine (B.D., K.B., A.D.K., Z.W.M.L.), The University of British Columbia, Vancouver, Canada
| | - Anna Lehman
- Department of Medical Genetics (A.L.), The University of British Columbia, Vancouver, Canada
| | - Zachary W M Laksman
- Division of Cardiology, Department of Medicine (B.D., K.B., A.D.K., Z.W.M.L.), The University of British Columbia, Vancouver, Canada
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15
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Laksman Z, Davies B, Bartels K, Roberts J, Tadros R, Green M, Healey J, Simpson C, Sanatani S, Steinberg C, Gardner M, Angaran P, Talajic M, Arbour L, Seifer C, Fournier A, Joza J, Krahn A. VARIANT RE-INTERPRETATION IN SURVIVORS OF CARDIAC ARREST WITH PRESERVED EJECTION FRACTION (CASPER REGISTRY) BY CLINICIANS AND CLINICAL COMMERCIAL LABORATORIES. Can J Cardiol 2020. [DOI: 10.1016/j.cjca.2020.07.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Sandhu RK, Raj SR, Thiruganasambandamoorthy V, Kaul P, Morillo CA, Krahn AD, Guzman JC, Sheldon RS, Banijamali HS, MacIntyre C, Manlucu J, Seifer C, Sivilotti M. Canadian Cardiovascular Society Clinical Practice Update on the Assessment and Management of Syncope. Can J Cardiol 2020; 36:1167-1177. [PMID: 32624296 DOI: 10.1016/j.cjca.2019.12.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 12/19/2019] [Accepted: 12/22/2019] [Indexed: 10/23/2022] Open
Abstract
Syncope is a symptom that occurs in multiple settings and has a variety of underlying causes, ranging from benign to life threatening. Determining the underlying diagnosis and prognosis can be challenging and often results in an unstructured approach to evaluation, which is ineffective and costly. In this first ever document, the Canadian Cardiovascular Society (CCS) provides a clinical practice update on the assessment and management of syncope. It highlights similarities and differences between the 2017 American College of Cardiology/American Heart Association/Heart Rhythm Society and the 2018 European Society of Cardiology guidelines, draws on new data following a thorough review of medical literature, and takes the best available evidence and clinical experience to provide clinical practice tips. Where appropriate, a focus on a Canadian perspective is emphasized in order to illuminate larger international issues. This document represents the consensus of a Canadian panel comprised of multidisciplinary experts on this topic with a mandate to formulate disease-specific advice. The primary writing panel wrote the document, followed by peer review from the secondary writing panel. The CCS Guidelines Committee reviewed and approved the statement. The practice tips represent the consensus opinion of the primary writing panel authors, endorsed by the CCS. The CCS clinical practice update on the assessment and management of syncope focuses on epidemiology, the initial evaluation including risk stratification and disposition from the emergency department, initial diagnostic work-up, management of vasovagal syncope and orthostatic hypotension, and syncope and driving.
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Affiliation(s)
| | - Roopinder K Sandhu
- Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada.
| | - Satish R Raj
- Libin Cardiovascular Institute of Alberta, Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | | | - Padma Kaul
- Division of Cardiology, University of Alberta, Edmonton, Alberta, Canada
| | - Carlos A Morillo
- Libin Cardiovascular Institute of Alberta, Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Andrew D Krahn
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Juan C Guzman
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Robert S Sheldon
- Libin Cardiovascular Institute of Alberta, Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | | | - Hamid S Banijamali
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Ciorsti MacIntyre
- Division of Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jaimie Manlucu
- Division of Cardiology, Western University, London, Ontario, Canada
| | - Colette Seifer
- Division of Cardiology, University of Winnipeg, Winnipeg, Manitoba, Canada
| | - Marco Sivilotti
- Department of Emergency Medicine, Queen's University, Kingston, Ontario, Canada
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Raj SR, Guzman JC, Harvey P, Richer L, Schondorf R, Seifer C, Thibodeau-Jarry N, Sheldon RS. Canadian Cardiovascular Society Position Statement on Postural Orthostatic Tachycardia Syndrome (POTS) and Related Disorders of Chronic Orthostatic Intolerance. Can J Cardiol 2020; 36:357-372. [DOI: 10.1016/j.cjca.2019.12.024] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/15/2019] [Accepted: 12/16/2019] [Indexed: 11/26/2022] Open
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Essebag V, AlTurki A, Proietti R, Healey JS, Wells GA, Verma A, Krahn AD, Simpson CS, Ayala-Paredes F, Coutu B, Leather R, Ahmad K, Toal S, Sapp J, Sturmer M, Kavanagh K, Crystal E, Leiria TL, Seifer C, Rinne C, Birnie D. Concomitant anti-platelet therapy in warfarin-treated patients undergoing cardiac rhythm device implantation: A secondary analysis of the BRUISE CONTROL trial. Int J Cardiol 2019; 288:87-93. [DOI: 10.1016/j.ijcard.2019.04.066] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/03/2019] [Accepted: 04/23/2019] [Indexed: 12/21/2022]
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Lauck S, Seifer C, Carroll S, Davies B, Allan K, Fournier A, Gibbs K, Krahn A. HIRO SURVEY PROJECT: DESIGN OF A NATIONAL, MULTIDISCIPLINARY COLLABORATION TO IDENTIFY THE PREDICTORS OF PERCEIVED INFORMATIONAL SUPPORT AND SELF-EFFICACY IN PATIENTS AT INCREASED RISK OF SUDDEN UNEXPECTED DEATH. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Christie S, Hiebert B, Seifer C, Khoo C. COMPARING CLINICAL OUTCOMES OF CRT-P VS CRT-D IN ELDERLY PATIENTS WITH HEART FAILURE. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Arcinas L, McIntyre W, Hiebert B, Pytlewski D, Faraj A, Seifer C. RIGHT VENTRICULAR PACING IS ASSOCIATED WITH INCREASED RATES OF APPROPRIATE IMPLANTABLE CARDIOVERTER DEFIBRILLATOR SHOCKS. Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Cheung C, Laksman Z, Roberts J, Green M, Healey J, Sanatani S, Arbour L, Leather R, Chauhan V, Steinberg C, Angaran P, Duff H, Chakrabarti S, Simpson C, Talajic M, Tadros R, Seifer C, Gardner M, Krahn A. ARRHYTHMIC OUTCOMES IN CARDIAC ARREST SURVIVORS WITH PRESERVED EJECTION FRACTION REGISTRY (CASPER). Can J Cardiol 2018. [DOI: 10.1016/j.cjca.2018.07.296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Mellor G, Laksman ZWM, Tadros R, Roberts JD, Gerull B, Simpson CS, Klein GJ, Champagne J, Talajic M, Gardner M, Steinberg C, Arbour L, Birnie DH, Angaran P, Leather R, Sanatani S, Chauhan VS, Seifer C, Healey JS, Krahn AD. Genetic Testing in the Evaluation of Unexplained Cardiac Arrest: From the CASPER (Cardiac Arrest Survivors With Preserved Ejection Fraction Registry). ACTA ACUST UNITED AC 2018; 10:CIRCGENETICS.116.001686. [PMID: 28600387 DOI: 10.1161/circgenetics.116.001686] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 03/27/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Unexplained cardiac arrest may be because of an inherited arrhythmia syndrome. The role of genetic testing in cardiac arrest survivors without a definite clinical phenotype is unclear. METHODS AND RESULTS The CASPER (Cardiac Arrest Survivors with Preserved Ejection Fraction Registry) is a large registry of cardiac arrest survivors where initial assessment reveals normal coronary arteries, left ventricular function, and resting ECG. Of 375 cardiac arrest survivors in CASPER from 2006 to 2015, 174 underwent genetic testing. Patients were classified as phenotype-positive (n=72) or phenotype-negative (n=102). Genetic testing was performed at treating physicians' discretion in line with contemporary guidelines and availability. All genetic variants identified from original laboratory reports were reassessed by the investigators in line with modern criteria. Pathogenic variants were identified in 29 (17%) patients (60% channelopathy-associated and 40% cardiomyopathy-associated genes) and 70 variants of unknown significance were identified in 32 (18%) patients. Prior syncope (odds ratio, 4.0; 95% confidence interval, 1.6-9.7) and a family history of sudden death (odds ratio, 3.2; 95% confidence interval, 1.1-9.4) were independently associated with the presence of a pathogenic variant. In phenotype-negative patients, broad multiphenotype genetic testing led to higher yields (21% versus 8%; P=0.04) but was associated with more variants of unknown significance (55% versus 5%; P<0.01). CONCLUSIONS Genetic testing identifies a pathogenic variant in a significant proportion of unexplained cardiac arrest survivors. Prior syncope and family history of sudden death are predictors of a positive genetic test. Both arrhythmia and cardiomyopathy genes are implicated. Broad, multiphenotype testing revealed the highest frequency of pathogenic variants in phenotype-negative patients. CLINICAL TRIAL REGISTRATION https://www.clinicaltrials.gov. Unique Identifier: NCT00292032.
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Lee C, McIntyre W, Maria H, Tam J, Seifer C. THE FRAIL-D STUDY: ASSESSING FRAILTY AS A RISK FACTOR FOR OUTCOMES IN PATIENTS WITH IMPLANTABLE CARDIOVERTER DEFIBRILLATORS FOR PRIMARY PREVENTION. Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Scott-Herridge J, Steigerwald R, Drobot G, Seifer C, McIntyre W. ACTIONABLE ATRIAL FIBRILLATION: WHEN DO I GET MY OAC? Can J Cardiol 2017. [DOI: 10.1016/j.cjca.2017.07.496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Alfraidi H, Torbiak L, Mcintyre W, Seifer C. QRS DURATION PREDICTS OUTCOME IN A HEART FAILURE POPULATION. Can J Cardiol 2016. [DOI: 10.1016/j.cjca.2016.07.340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Jhinger R, Seifer C, McLean L, McIntyre W. INCIDENCE AND OUTCOMES FOR ACTIONABLE ATRIAL FIBRILLATION IN A TERTIARY ELECTROCARDIOGRAM READING CENTRE. Can J Cardiol 2016. [DOI: 10.1016/j.cjca.2016.07.413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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28
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Steinberg C, Padfield GJ, Champagne J, Sanatani S, Angaran P, Andrade JG, Roberts JD, Healey JS, Chauhan VS, Birnie DH, Janzen M, Gerull B, Klein GJ, Leather R, Simpson CS, Seifer C, Talajic M, Gardner M, Krahn AD. Cardiac Abnormalities in First-Degree Relatives of Unexplained Cardiac Arrest Victims. Circ Arrhythm Electrophysiol 2016; 9:CIRCEP.115.004274. [DOI: 10.1161/circep.115.004274] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 08/02/2016] [Indexed: 01/06/2023]
Abstract
Background—
Unexplained cardiac arrest (UCA) may be explained by inherited arrhythmia syndromes. The Cardiac Arrest Survivors With Preserved Ejection Fraction Registry prospectively assessed first-degree relatives of UCA or sudden unexplained death victims to screen for cardiac abnormalities.
Methods and Results—
Around 398 first-degree family members (186 UCA, 212 sudden unexplained death victims’ relatives; mean age, 44±17 years) underwent extensive cardiac workup, including ECG, signal averaged ECG, exercise testing, cardiac imaging, Holter-monitoring, and selective provocative drug testing with epinephrine or procainamide. Genetic testing was performed when a mutation was identified in the UCA survivor or when the diagnostic workup revealed a phenotype suggestive of a specific inherited arrhythmia syndrome. The diagnostic strength was classified as definite, probable, or possible based on previously published definitions. Cardiac abnormalities were detected in 120 of 398 patients (30.2%) with 67 of 398 having a definite or probable diagnosis (17%), including Long-QT syndrome (13%), catecholaminergic polymorphic ventricular tachycardia (4%), arrhythmogenic right ventricular cardiomyopathy (4%), and Brugada syndrome (3%). The detection yield was similar for family members of UCA and sudden unexplained death victims (31% versus 27%;
P
=0.59). Genetic testing was performed more often in family members of UCA patients (29% versus 20%;
P
=0.03). Disease-causing mutations were identified in 20 of 398 relatives (5%). The most common pathogenic mutations were RyR2 (2%), SCN5A (1%), and KNCQ1 (0.8%).
Conclusions—
Cardiac screening revealed abnormalities in 30% of first-degree relatives of UCA or sudden unexplained death victims, with a clear working diagnosis in 17%. Long-QT, arrhythmogenic right ventricular cardiomyopathy, and catecholaminergic polymorphic ventricular tachycardia were the most common diagnoses. Systematic cascade screening and genetic testing in asymptomatic individuals will lead to preventive lifestyle and medical interventions with potential to prevent sudden cardiac death.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00292032.
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Affiliation(s)
| | | | | | | | - Paul Angaran
- For the author affiliations, please see the Appendix
| | | | | | | | | | | | - Mikyla Janzen
- For the author affiliations, please see the Appendix
| | - Brenda Gerull
- For the author affiliations, please see the Appendix
| | | | | | | | | | - Mario Talajic
- For the author affiliations, please see the Appendix
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29
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Krahn AD, Healey JS, Gerull B, Angaran P, Chakrabarti S, Sanatani S, Arbour L, Laksman ZWM, Carroll SL, Seifer C, Green M, Roberts JD, Talajic M, Hamilton R, Gardner M. The Canadian Arrhythmogenic Right Ventricular Cardiomyopathy Registry: Rationale, Design, and Preliminary Recruitment. Can J Cardiol 2016; 32:1396-1401. [PMID: 27474350 DOI: 10.1016/j.cjca.2016.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 03/31/2016] [Accepted: 04/11/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a complex and clinically heterogeneous arrhythmic condition. Incomplete penetrance and variable expressivity are particularly evident in ARVC, making clinical decision-making challenging. METHODS Pediatric and adult cardiologists, geneticists, genetic counsellors, ethicists, nurses, and qualitative researchers are collaborating to create the Canadian ARVC registry using a web-based clinical database. Biological samples will be banked and systematic analysis will be performed to examine potentially causative mutations, variants, and biomarkers. Outcomes will include syncope, ventricular arrhythmias, defibrillator therapies, heart failure, and mortality. RESULTS Preliminary recruitment has enrolled 365 participants (aged 42.7 ± 17.1 years; 50% women), including 129 probands and 236 family members. Previous cardiac arrest occurred in 28 (8%) participants, syncope occurred in 43 (12%) participants, and 46% of probands had a family history of sudden death. Overall yield of genetic testing was 36% for a disease-causing mutation and 20% for a variant of unknown significance. Target enrollment is 1000 affected patients and 500 unaffected family member controls over 7 years. The cross-sectional and longitudinal data collected in this manner will allow a robust assessment of the natural history and clinical course of genetic subtypes. CONCLUSIONS The Canadian ARVC Registry will create a population-based cohort of patients and their families to inform clinical decisions regarding patients with ARVC.
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Affiliation(s)
- Andrew D Krahn
- Heart Rhythm Vancouver, Vancouver, British Columbia, Canada; Heart Rhythm Vancouver, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Jeffrey S Healey
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Brenda Gerull
- Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Paul Angaran
- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Santabhanu Chakrabarti
- Heart Rhythm Vancouver, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Laura Arbour
- Department of Medical Genetics, University of British Columbia, Victoria, British Columbia, Canada
| | - Zachary W M Laksman
- Heart Rhythm Vancouver, Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sandra L Carroll
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Colette Seifer
- St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Martin Green
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | | | | | - Martin Gardner
- QEII Health Sciences Center, Halifax, Nova Scotia, Canada
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30
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Sheldon R, Raj SR, Rose MS, Morillo CA, Krahn AD, Medina E, Talajic M, Kus T, Seifer CM, Lelonek M, Klingenheben T, Parkash R, Ritchie D, McRae M, Sheldon R, Rose S, Ritchie D, McCrae M, Morillo C, Malcolm V, Krahn A, Spindler B, Medina E, Talajic M, Kus T, Langlois A, Lelonek M, Raj S, Seifer C, Gardner M, Romeo M, Poirier P, Simpson C, Abdollah H, Reynolds J, Dorian P, Birnie D, Giuffre M, Gilligan D, Benditt D, Sheldon R, Raj S, Rose M, Krahn A, Morillo C, Medina E. Fludrocortisone for the Prevention of Vasovagal Syncope. J Am Coll Cardiol 2016; 68:1-9. [DOI: 10.1016/j.jacc.2016.04.030] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 03/31/2016] [Accepted: 04/05/2016] [Indexed: 10/21/2022]
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31
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Cloutier J, Khoo C, Hiebert B, Wassef A, Seifer C. PHYSICIAN DECISION MAKING IN ANTICOAGULATING ATRIAL FIBRILLATION: A PROSPECTIVE SURVEY EVALUATING A PHYSICIAN ALERT SYSTEM FOR ATRIAL FIBRILLATION DETECTED ON CARDIAC IMPLANTABLE ELECTRONIC DEVICES. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)30838-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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32
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Saeed M, Seifer C, Cordova F, Hiebert B. AMIODARONE MONITORING IN PATIENTS WITH IMPLANTABLE CARDIOVERTER DEFIBRILLATORS. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.07.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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33
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Golian M, Moussa M, White C, Aletta G, Koley L, Seifer C. Venous Thromboembolism Prophylaxis on a Cardiology In-Patient Unit: A Surprising Result? Can J Cardiol 2015; 32:256-8. [PMID: 26268047 DOI: 10.1016/j.cjca.2015.05.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 05/28/2015] [Accepted: 05/28/2015] [Indexed: 12/22/2022] Open
Abstract
To determine whether a guideline-based protocol improves compliance with venous thromboembolism (VTE) prophylaxis guidelines, 10 single-day audits of a cardiology inpatient unit were performed. All patients at high risk for VTE were included (n = 420; male/female = 282/138; median age, 66 ± 14 years). Before the protocol, 36% of patients were not receiving VTE prophylaxis; after the protocol, 26% did not receive prophylaxis (P = 0.024). In conclusion, there is a high rate of noncompliance with accepted guidelines for the prevention of VTE. The introduction of a guideline-based protocol significantly increased compliance, but a substantial proportion of patients still did not receive VTE prophylaxis despite meriting such therapy.
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Affiliation(s)
- Mehrdad Golian
- Section of Cardiology, Department of Internal Medicine, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Cardiac Sciences Program, St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Motaz Moussa
- Section of Cardiology, Department of Internal Medicine, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Cardiac Sciences Program, St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Charlene White
- Cardiac Sciences Program, St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Giuseppe Aletta
- Cardiac Sciences Program, St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Lillian Koley
- Cardiac Sciences Program, St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Colette Seifer
- Section of Cardiology, Department of Internal Medicine, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Cardiac Sciences Program, St Boniface Hospital, University of Manitoba, Winnipeg, Manitoba, Canada.
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34
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Wassef A, Hiebert B, Seifer C. Results OF A PHYSICIAN ALERT SYSTEM FOR ANTICOAGULATION OF ATRIAL FIBRILLATION DETECTED ON CARDIAC IMPLANTED ELECTRONIC DEVICES. Can J Cardiol 2014. [DOI: 10.1016/j.cjca.2014.07.516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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35
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Verma A, Ha AC, Dennie C, Essebag V, Exner DV, Khan N, Lane C, Leipsic J, Philippon F, Sampaio M, Schieda N, Seifer C, Berthiaume A, Campbell D, Chakraborty S. Canadian Heart Rhythm Society and Canadian Association of Radiologists Consensus Statement on Magnetic Resonance Imaging With Cardiac Implantable Electronic Devices. Can J Cardiol 2014; 30:1131-41. [DOI: 10.1016/j.cjca.2014.07.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 07/10/2014] [Indexed: 11/30/2022] Open
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36
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Golian M, Moussa M, White C, Aletta G, Koley L, Seifer C. QUALITY ASSURANCE OF VENOUS THROMBOEMBOLISM PROPHYLAXIS. HOW ARE WE COMPARED TO GUIDELINES? Can J Cardiol 2014. [DOI: 10.1016/j.cjca.2014.07.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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37
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Seifer C, Farag A. Right Ventricular Pacing and Implantable Cardioverter Defibrillator Therapy. Can J Cardiol 2013. [DOI: 10.1016/j.cjca.2013.07.314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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38
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Ducas RA, Seftel MD, Ducas J, Seifer C. Monomorphic ventricular tachycardia caused by arsenic trioxide therapy for acute promyelocytic leukaemia. J R Coll Physicians Edinb 2011; 41:117-8. [PMID: 21677914 DOI: 10.4997/jrcpe.2011.204] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Arsenic trioxide has become the treatment of choice for patients with acute promyelocytic leukaemia. Cardiovascular toxicity is known to occur with this therapy, in particular heart rhythm disorders due to QT interval prolongation. We present a case of ventricular arrhythmia with no QT prolongation in a patient receiving arsenic trioxide therapy.
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Affiliation(s)
- R A Ducas
- Section of Cardiology, Cardiac Sciences Department, St Boniface General Hospital, 401 Tache Avenue, Winnipeg, Manitoba, Canada
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39
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Chelvanthan A, Golian M, Zieroth S, Seifer C. 503 Incidence of device upgrades to cardiac resynchronization therapy in heart failure population. Can J Cardiol 2011. [DOI: 10.1016/j.cjca.2011.07.422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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40
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Sheldon RS, Morillo CA, Krahn AD, O'Neill B, Thiruganasambandamoorthy V, Parkash R, Talajic M, Tu JV, Seifer C, Johnstone D, Leather R. Standardized Approaches to the Investigation of Syncope: Canadian Cardiovascular Society Position Paper. Can J Cardiol 2011; 27:246-53. [DOI: 10.1016/j.cjca.2010.11.002] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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41
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Walker JR, Mousavi N, Horlick E, Seifer C, Jassal DS. Tricuspid valvular papillary muscle rupture with intractable hypoxia: a rare complication post MI. J Am Soc Echocardiogr 2009; 22:863.e1-3. [PMID: 19359140 DOI: 10.1016/j.echo.2009.02.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2008] [Indexed: 11/18/2022]
Abstract
Acute inferior ST-elevation myocardial infarction (STEMI) alone contributes to approximately 10% of in-hospital mortality due to ischemic heart disease. Right ventricular involvement occurs in 50% of patients who present with inferior STEMIs, increasing in-hospital mortality to 31%. In the setting of concomitant severe tricuspid regurgitation, acute rupture of the papillary muscles within the right ventricle should be considered in the differential diagnosis. The authors present the case of a patient with intractable hypoxia in the setting of an acute inferior STEMI complicated by rupture of the posterior tricuspid valve papillary muscle.
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Affiliation(s)
- Jonathan R Walker
- Institute of Cardiovascular Sciences, St Boniface General Hospital, Winnipeg, MN, Canada
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42
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Mousavi N, Bhagirath K, Ariyarajah V, Fang T, Ahmadie R, Lytwyn M, Jassal DS, Seifer C. Chiari Network Endocarditis: Not Just an Innocent Bystander. Echocardiography 2008; 25:642-5. [DOI: 10.1111/j.1540-8175.2008.00651.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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43
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Abstract
Summary This molecular epidemiology study integrated questionnaire and genotype information to examine a disease susceptibility hypothesis. The study was based on a previously reported association demonstrated between a single nucleotide polymorphism (SNP) identified as A-564G within the promoter of the proteinase-3 gene (PRTN3) and the autoimmune disease Wegener's granulomatosis (WG). To further examine the strength of this association, we employed a family-based design in which the inheritance of alternate alleles could be ascertained from the parents of affected and unaffected progeny. Genotype information for the study participants was derived from DNA samples from participants who collected buccal cells using a harvesting method that was non-invasive and self-administered. A brief questionnaire captured demographic data on the participants, the family relationships between participants, and the prevalence of autoimmune disease among family members. Samples were obtained on 132 individuals representing 43 WG cases and 89 unaffected controls. Thirty-four nuclear families containing at least one unaffected sibling or parent of a WG case were represented in this sample. We found no evidence for an association between A-564G and the likelihood of a WG diagnosis. We examined five additional SNPs and a sixth SNP haplotype within the PRTN3 promoter region in a family-based association analysis and found no evidence that mutations within PRTN3 are associated with WG diagnosis.
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Affiliation(s)
- P Cooley
- RTI International, Research Computing Division, 3040 Conrwallis Road, Research Triangle Park, NC 27709-2194, USA.
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44
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Abstract
Falls are a major health priority. Eight percent of persons over age 70 present to emergency departments each year due to a fall; fall-related injuries account for 6% of all medical expenditures for persons age 65 and older in the United States. Pacing reduces falls by 70% in patients with cardioinhibitory carotid sinus hypersensitivity. The prevalence of falls in other bradyarrhythmic disorders is not known. The purpose of the following study was to compare the prevalence of falls in older adults with atrioventricular block and sick sinus syndrome with case controls. Consecutive subjects who had pacemakers implanted for atrioventricular block and sick sinus syndrome were assessed. Age and gender-matched admissions to the coronary care unit were similarly studied. Eighty-one subjects were included in the study, 31 paced and 50 controls. There were 134 falls in the bradyarrhythmic group and 12 in the control group. The authors conclude that this is the first series that clearly shows a significant association between atrioventricular block, sick sinus syndrome, and falls. Further prospective studies are needed to substantiate these results.
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Affiliation(s)
- Colette Seifer
- Cardiovascular Investigation Unit and MRC Development Centre for Brain Ageing, Newcastle upon Tyne, United Kingdom
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45
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Affiliation(s)
- J Harbison
- Cardiovascular Investigations Unit, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
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46
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47
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Kenny RA, Seifer C. Brief Report - SAFE PACE 2 Syncope And Falls in the Elderly Pacing And Carotid Sinus Evaluation: A Randomized Control Trial of Cardiac Pacing in Older Patients With Falls and Carotid Sinus Hypersensitivity. Am J Geriatr Cardiol 1999; 8:87-87. [PMID: 11416495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Affiliation(s)
- Rose Anne Kenny
- Cardiovascular Investigation Unit, University of Newcastle, School of Clinical Medical Sciences, Newcastle upon the Tyne, UK
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48
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Seifer C, McNeill B, O’Donnell M, Daly K, Kellett J, McGee HM, Montogomery AJ, O’Callaghan D, Horgan JH, Mahon NG, Codd M, Brennan J, Egan B, McCann HA, Sugrue DD, Menown IBA, Patterson RSHW, McMechan SR, Hameed S, Adgey AAJ, Baird SH, McBride SJ, Trouton TG, Wilson C, McRedmond JP, Fitzgerald DJ, Crowley JJ, Tanguay JF, Santos RM, Stack RS, Mahon NG, Keelan P, McCann HA, Sugrue DD, McKenna CJ, AuBuchon R, Camrud AR, Holmes DR, Schwartz RS, McKenna CJ, Camrud AR, Wolff R, Edwards WD, Holmes DR, Schwartz RS, Hanratty C, McAuley D, Young I, Murtagh G, O’Keeffe B, Richardson G, Scott M, Chew EW, Bailie NA, Graham AMJ, O’Kane H, McKenna CJ, Kwon HM, Ellis L, Holmes DR, Virmani R, Schwartz RS, Noelke L, Wood AE, Javadpour H, Veerasingham D, Wood AE, O’Kane D, Allen JD, Adgey AAJ, Hennessy T, Johnson P, Hildick-Smith D, Winter E, Shapiro L, McKenna CJ, Edwards WD, Lerman A, Holmes DR, Schwartz RS, McGrath LT, Passmore P, Silke B, McAuley D, Nugent AG, McGurk C, Hanratty C, Maguire S, Johnston GD, McAuley D, Nugent AG, McGurk C, Hanratty C, Maguire S, Johnston GD, Lovell SL, McDowell G, McEneany D, Riley MS, Nicholls DP, Gilligan D, Sargent D, Dan D, Gilligan D, Elam G, Rhee B, Keane D, Zhou L, McGovern B, Garan H, Ruskin J, O’Shea JC, Tan HC, Zidar JP, Stack RS, Crowley JJ, O’Keeffe DB, Graffin S, Fitzsimmons D, Brown S, Duff D, Denham B, Woods F, Neligan M, Oslizlok P, Connolly CK, Danton MHD, O’Kane H, Danton M, Gladstone DJ, Craig B, Mulholland HC, Casey F, Chaudhuri S, Hinchion J, Wood AE, Hinchion J, Wood AE, Menown IBA, Patterson RHSW, MacKenzie G, Adgey AAJ, Harbinson MT, Burgess LM, Moohan V, McEneaney DJ, Adgey AAJ, Menown IBA, MacKenzie G, Patterson RSHW, Adgey AAJ, Finnegan OC, Doherty L, Silke B, Riddell JG, Meleady R, Daly L, Graham I, Quinn M, Foley B, Lee J, Mulvihill N, Crean P, Walsh M, O’Morain C, Quinn M, Crean P, Foley B, Walsh M, Hynes C, King SM, David S, Newton H, Maguire M, Rafferty F, Horgan JH, Sullivan PA, Murphy D, Gallagher S, Menown IBA, Allen J, Anderson JM, Adgey AAJ, Dan D, Hoag J, Eckberg D, Gilligan D, Galvin J, Garan H, McGovern B, Ruskin J, Mahon NG, Diamond P, Neilan T, Keelan E, H. A., McCarthy C, Sugrue DD, Harbinson MT, Moohan VP, McEneaney DJ, Burgess LM, Anderson JM, Ayers GM, Adgey AAJ, Roberts M, Burgess L, Anderson C, Wilson C, Khan M, Clements IP, Miller WL, Seifer C, O’Donnell M, McNeill B, Daly K, Turtle F, McDowell G, Long H, McNair W, Campbell NPS, Mathew TP, Turtle F, Smye M, Nesbitt GS, Young IS, Adgey AAJ, Meleady R, Mulcahy D, Graham IM, Moore D, Menown IBA, McMechan SR, MacKenzie G, Adgey AAJ, Diamond P, Sugrue D, Codd MB, Galvin J, Zimmerman P, Winget J, Capeless M, Galvin J, Garan H, McGovern B, Ruskin J, McKelvey TA, Danton MHD, Sarsam MIA, McEneaney D, Roberts M, Burgess L, Anderson C, Wilson C, Khan M. Irish cardiac society. Ir J Med Sci 1998. [DOI: 10.1007/bf02937898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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