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Baltogiannis GG, Lysitsas DN, di Giovanni G, Ciconte G, Sieira J, Conte G, Kolettis TM, Chierchia GB, de Asmundis C, Brugada P. CPVT: Arrhythmogenesis, Therapeutic Management, and Future Perspectives. A Brief Review of the Literature. Front Cardiovasc Med 2019; 6:92. [PMID: 31380394 PMCID: PMC6644488 DOI: 10.3389/fcvm.2019.00092] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 06/21/2019] [Indexed: 11/25/2022] Open
Abstract
Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT) is a primary electrical disease characterized by a normal resting electrocardiogram and induction of malignant arrhythmias during adrenergic stress leading to syncope or sudden cardiac death (SCD). CPVT is caused by mutations in the cardiac ryanodine receptor (RyR2) or in the sarcoplasmic reticulum protein calsequestrin 2 genes (CASQ2). The RyR2 mutations are responsible for the autosomal dominant form of CPVT, while CASQ2 mutations are rare and account for the recessive form. These mutations cause a substantial inballance in the homeostasis of intracellular calcium resulting in polymorphic ventricular tachycardia through triggered activity. Beta blockers were for years the cornerstone of therapy in these patients. Sodium channel blockers, especially flecainide, have an additive role in those not responding in beta blockade. Implantation of defibrillators needs a meticulous evaluation since inappropriate shocks may lead to electrical storm. Finally, cardiac sympathetic denervation might also be an alternative therapeutic option. Early identification and risk stratification is of major importance in patients with CPVT. The aim of the present review is to present the arrhythmogenic mechanisms of the disease, the current therapies applied and potential future perspectives.
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Affiliation(s)
- Giannis G Baltogiannis
- Heart Rhythm Management Centre, Vrije University, Brussels, Belgium.,St. Luke's Hospital Thessaloniki, Thessaloniki, Greece
| | | | | | - Giuseppe Ciconte
- Heart Rhythm Management Centre, Vrije University, Brussels, Belgium
| | - Juan Sieira
- Heart Rhythm Management Centre, Vrije University, Brussels, Belgium
| | - Giulio Conte
- Heart Rhythm Management Centre, Vrije University, Brussels, Belgium
| | | | | | | | - Pedro Brugada
- Heart Rhythm Management Centre, Vrije University, Brussels, Belgium
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152
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Finlay M, Bhar-Amato J, Ng KE, Santos D, Orini M, Vyas V, Taggart P, Grace AA, Huang CLH, Lambiase PD, Tinker A. Autonomic modulation of the electrical substrate in mice haploinsufficient for cardiac sodium channels: a model of the Brugada syndrome. Am J Physiol Cell Physiol 2019; 317:C576-C583. [PMID: 31291141 DOI: 10.1152/ajpcell.00028.2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
A murine line haploinsufficient in the cardiac sodium channel has been used to model human Brugada syndrome: a disease causing sudden cardiac death due to lethal ventricular arrhythmias. We explored the effects of cholinergic tone on electrophysiological parameters in wild-type and genetically modified, heterozygous, Scn5a+/- knockout mice. Scn5a+/- ventricular slices showed longer refractory periods than wild-type both at baseline and during isoprenaline challenge. Scn5a+/- hearts also showed lower conduction velocities and increased mean increase in delay than did littermate controls at baseline and blunted responses to isoprenaline challenge. Carbachol exerted limited effects but reversed the effects of isoprenaline with coapplication. Scn5a+/- mice showed a reduction in conduction reserve in that isoprenaline no longer increased conduction velocity, and this was not antagonized by muscarinic agonists.
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Affiliation(s)
- Malcolm Finlay
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Justine Bhar-Amato
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Keat-Eng Ng
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Diogo Santos
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Michele Orini
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Vishal Vyas
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Peter Taggart
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Andrew A Grace
- Department of Biochemistry, University of Cambridge, Cambridge, United Kingdom
| | - Christopher L-H Huang
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, United Kingdom
| | - Pier D Lambiase
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Andrew Tinker
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
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153
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Ribeiro S, Coelho L, Puentes K, Miltenberger-Miltenyi G, Faria B, Calvo L, Primo J, Sanfins V, Lourenço A. Postmortem genetic testing: Clinical diagnosis is not ended by the patient’s death. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.repce.2019.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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154
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European recommendations integrating genetic testing into multidisciplinary management of sudden cardiac death. Eur J Hum Genet 2019; 27:1763-1773. [PMID: 31235869 PMCID: PMC6870982 DOI: 10.1038/s41431-019-0445-y] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/24/2019] [Accepted: 05/21/2019] [Indexed: 02/04/2023] Open
Abstract
Sudden cardiac death (SCD) accounts for 10-20% of total mortality, i.e., one in five individuals will eventually die suddenly. Given the substantial genetic component of SCD in younger cases, postmortem genetic testing may be particularly useful in elucidating etiological factors in the cause of death in this subset. The identification of genes responsible for inherited cardiac diseases have led to the organization of cardiogenetic consultations in many countries worldwide. Expert recommendations are available, emphasizing the importance of genetic testing and appropriate information provision of affected individuals, as well as their relatives. However, the context of postmortem genetic testing raises some particular ethical, legal, and practical (including economic or financial) challenges. The Public and Professional Policy Committee of the European Society of Human Genetics (ESHG), together with international experts, developed recommendations on management of SCD after a workshop sponsored by the Brocher Foundation and ESHG in November 2016. These recommendations have been endorsed by the ESHG Board, the European Council of Legal Medicine, the European Society of Cardiology working group on myocardial and pericardial diseases, the ERN GUARD-HEART, and the Association for European Cardiovascular Pathology. They emphasize the importance of increasing the proportion of both medical and medicolegal autopsies and educating the professionals. Multidisciplinary collaboration is of utmost importance. Public funding should be allocated to reach these goals and allow public health evaluation.
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155
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Tse G, Reddy S, Chopra J, Lee S, Liu T, Bazoukis G, Haseeb S, Lee APW, Letsas KP, Li KHC. Electrocardiographic evidence of abnormal atrial phenotype in Brugada syndrome. J Electrocardiol 2019; 55:102-106. [PMID: 31152990 DOI: 10.1016/j.jelectrocard.2019.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/28/2019] [Accepted: 05/11/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Brugada syndrome (BrS) is an inherited ion channelopathy that may predispose affected individuals to atrial cardiomyopathy. We tested the hypothesis that BrS patients have higher degrees of atrial electrophysiological abnormalities compared to controls, and these can be reflected by changes in P-wave parameters determined on the electrocardiogram (ECG). METHODS This was a single-center retrospective study comparing BrS patients to age- and gender-matched control subjects. Mean P-wave duration (PWDmean), maximum PWD (PWDmax) and minimum PWD (PWDmin), P-wave dispersion (PWDmax - PWDmin), and P-wave terminal force in V1 (PTFV1) were measured. PWDmax ≥ 120 ms, in the presence and absence of biphasic P-waves in the inferior leads, were termed advanced and partial inter-atrial block (IAB), respectively. RESULTS The proportion of IAB was significantly higher in BrS patients (28/51; 55%) than in control subjects (14/51; 27%; Fisher's Exact test; P < 0.01). Advanced IAB was observed in two BrS patients but none of the control subjects (P = 0.50). Compared to controls, BrS patients showed higher PWDmean (107 [98-113] vs. 97 [90-108] ms; KWANOVA, P < 0.01), PWDmax (123 [110-132] vs. 113 [107-121] ms; P < 0.001) but statistically indistinguishable PWDmin (82 [72-92] vs. 77 [69-85]; P = 0.09), and P-wave dispersion (38 [26-52] vs. 37 [23-45] ms; P = 0.14). PTFV1 was significantly higher in BrS patients than in control subjects (24 [0-40] vs. 0 [0-27] mm.ms; P < 0.05). CONCLUSION Atrial conduction abnormalities are frequently observed in BrS. These patients may require monitoring for future development of atrial fibrillation and stroke.
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Affiliation(s)
- Gary Tse
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, PR China; Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, PR China; Faculty of Medicine, Newcastle University, United Kingdom
| | - Sunaina Reddy
- Faculty of Medicine, Palacký University of Olomouc, Czech Republic
| | | | - Sharen Lee
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, PR China; Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, PR China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, PR China
| | - George Bazoukis
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Athens, Greece
| | - Sohaib Haseeb
- Division of Cardiology, Kingston Health Science Center, Queen's University, Kingston, Ontario, Canada
| | - Alex Pui Wai Lee
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, PR China
| | - Konstantinos P Letsas
- Second Department of Cardiology, Laboratory of Cardiac Electrophysiology, Evangelismos General Hospital of Athens, Athens, Greece.
| | - Ka Hou Christien Li
- Department of Medicine and Therapeutics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, PR China; Li Ka Shing Institute of Health Sciences, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong, SAR, PR China; Division of Cardiology, Kingston Health Science Center, Queen's University, Kingston, Ontario, Canada.
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156
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Suna G, Saguner AM, Brunckhorst CB. [CME ECG 63/Answers: Stress-Induced Ventricular Arrhythmias]. PRAXIS 2019; 108:567-572. [PMID: 31185841 DOI: 10.1024/1661-8157/a003244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Gonca Suna
- 1 Klinik für Kardiologie, Universitäres Herzzentrum, Universitätsspital Zürich
| | - Ardan M Saguner
- 1 Klinik für Kardiologie, Universitäres Herzzentrum, Universitätsspital Zürich
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157
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Blom LJ, Visser M, Christiaans I, Scholten MF, Bootsma M, van den Berg MP, Yap SC, van der Heijden JF, Doevendans PA, Loh P, Postema PG, Barge-Schaapsveld DQ, Hofman N, Volders PGA, Wilde AA, Hassink RJ. Incidence and predictors of implantable cardioverter-defibrillator therapy and its complications in idiopathic ventricular fibrillation patients. Europace 2019; 21:1519-1526. [DOI: 10.1093/europace/euz151] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 04/26/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
Idiopathic ventricular fibrillation (IVF) is a rare cause of sudden cardiac arrest. Implantable cardioverter-defibrillator (ICD) implantation is currently the only treatment option. Limited data are available on the prevalence and complications of ICD therapy in these patients. We sought to investigate ICD therapy and its complications in patients with IVF.
Methods and results
Patients were selected from a national registry of IVF patients. Patients in whom no underlying diagnosis was found during follow-up were eligible for inclusion. Recurrence of ventricular arrhythmia (VA) was derived from medical and ICD records, electrogram records of ICD therapies were used to differentiate between appropriate or inappropriate interventions. Independent predictors for appropriate ICD shock were calculated using cox regression. In 217 IVF patients, recurrence of sustained VAs occurred in 66 patients (30%) during a median follow-up period of 6.1 years. Ten patients died (4.6%). Thirty-eight patients (17.5%) experienced inappropriate ICD therapy, and 32 patients (14.7%) had device-related complications. Symptoms before cardiac arrest [hazard ratio (HR): 2.51, 95% confidence interval (CI): 1.48–4.24], signs of conduction disease (HR: 2.27, 95% CI: 1.15–4.47), and carrier of the DPP6 risk haplotype (HR: 3.24, 1.70–6.17) were identified as independent predictors of appropriate shock occurrence.
Conclusion
Implantable cardioverter-defibrillator therapy is an effective treatment in IVF, treating recurrences of potentially lethal VAs in approximately one-third of patients during long-term follow-up. However, device-related complications and inappropriate shocks were also frequent. We found significant predictors for appropriate ICD therapy. This may imply that these patients require additional management to prevent recurrent events.
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Affiliation(s)
- Lennart J Blom
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marloes Visser
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Marcoen F Scholten
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Marianne Bootsma
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Maarten P van den Berg
- Department of Cardiology, University Medical Center Groningen, Groningen, the Netherlands
| | - Sing-Chien Yap
- Department of Cardiology, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Pieter A Doevendans
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
- Central Military Hospital, Utrecht, The Netherlands
- Netherlands Heart Institute (ICIN), Utrecht, The Netherlands
| | - Peter Loh
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pieter G Postema
- Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam UMC, Amsterdam, The Netherlands
| | | | - Nynke Hofman
- Department of Cardiogenetics, AMC, Amsterdam, The Netherlands
| | - Paul G A Volders
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Arthur A Wilde
- Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam UMC, Amsterdam, The Netherlands
| | - Rutger J Hassink
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
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158
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Chen C, Tan Z, Zhu W, Fu L, Kong Q, Xiong Q, Yu J, Hong K. Brugada syndrome with SCN5A mutations exhibits more pronounced electrophysiological defects and more severe prognosis: A meta-analysis. Clin Genet 2019; 97:198-208. [PMID: 30963536 DOI: 10.1111/cge.13552] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 03/25/2019] [Accepted: 03/26/2019] [Indexed: 12/19/2022]
Abstract
Whether the presence of SCN5A mutation is a predictor of BrS risk remains controversial, and patient selection bias may have weakened previous findings. Therefore, we performed this study to clarify the clinical characteristics and outcomes of BrS probands with SCN5A mutations. We systematically retrieved eligible studies published through October 2018. A total of 17 studies enrolling 1780 BrS patients were included. Overall, our results found that compared with BrS patients without SCN5A mutations, patients with SCN5A mutations exhibited a younger age at the onset of symptoms and higher rate of the spontaneous type-1 electrocardiogram pattern, more pronounced conduction or repolarization abnormalities, and increased atrial vulnerability. In addition, the presence of SCN5A mutations was associated with an elevated risk of major arrhythmic events in both Asian (odds ratio [OR] = 1.82, 95% confidence interval [CI] 1.07-3.11; P = .03) and Caucasian (OR = 2.24, 95% CI 1.02-4.90; P = .04) populations. In conclusions, patients with SCN5A mutations exhibit more pronounced electrophysiological defects and more severe prognosis. Clinicians should be cautious when utilizing genetic testing for risk stratification or treatment guidance before determining whether the causal relationship regarding SCN5A mutation status is an independent predictor of risk.
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Affiliation(s)
- Chen Chen
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Zhaochong Tan
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Wengen Zhu
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Linghua Fu
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Qiling Kong
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Qinmei Xiong
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Jianhua Yu
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Kui Hong
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang 330006, China.,Jiangxi Key Laboratory of Molecular Medicine, Nanchang 330006, China.,Department of Genetic Medicine, the Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
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159
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Chen CYJ, Juang JMJ, Lin LY, Liu YB, Ho LT, Yu CC, Huang HC, Lin TT, Liao MC, Chen JJ, Hwang JJ, Chen WJ, Yeh SFS, Yang DH, Chiang FT, Lin JL, Lai LP, Horie M. Gender difference in clinical and genetic characteristics of Brugada syndrome: SADS-TW BrS registry. QJM 2019; 112:343-350. [PMID: 30690642 DOI: 10.1093/qjmed/hcz028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Brugada syndrome (BrS) is a heritable sudden cardiac death (SCD) disease with male predominance. Information on gender difference of BrS remains scarce. AIM To investigate the gender difference of BrS in Han Chinese. DESIGN We consecutively enrolled 169 BrS patients (153 males and 16 females) from Han Chinese in Taiwan from 1998 to 2017. METHODS Clinical characteristics, electrocardiographic parameters and SCN5A mutation status were compared between genders. RESULTS The percentage of family history of SCD in females was slightly higher (31.3% vs. 15%, P = 0.15). Females exhibited longer QTc (457.8 ± 33.0 vs. 429.5 ± 42.1 ms, P < 0.01). Regarding cumulative event occurrence by age, Mantel-Cox test showed females had earlier age of onset of first cardiac events (SCD or syncope) than males (P = 0.049), which was mainly attributed to syncope (P < 0.01). Males with SCD exhibited longer QRS duration (114.2 ± 26.8 vs. 104.8 ± 15.3 ms, P = 0.02) and QTc (442.5 ± 57.4 vs. 422.9 ± 28.8 ms, P = 0.02). Males with syncope exhibited longer PR interval (181.2 ± 33.7 vs. 165.7 ± 27.1 ms, P = 0.01), whereas females with SCD or syncope had a trend towards slower heart rates (69.1 ± 9.6 vs. 82.2 ± 16.3 bpm, P = 0.10) than female with no or mild symptoms. There was no difference in the percentage of SCN5A mutation between genders. CONCLUSION Gender difference is present in BrS. Females have longer QTc and suffer from syncope earlier than males. Risk of SCD in males is associated with boarder QRS complex and longer QTc, whereas risk of syncope is associated with longer PR interval in males and slower heart rate in females.
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Affiliation(s)
- C-Y J Chen
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - J-M J Juang
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - L-Y Lin
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Y-B Liu
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - L-T Ho
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - C-C Yu
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - H-C Huang
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - T-T Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu City, Taiwan
| | - M-C Liao
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu City, Taiwan
| | - J-J Chen
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Yunlin Branch, Yunlin, Taiwan
| | - J-J Hwang
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - W-J Chen
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - S-F S Yeh
- Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - D-H Yang
- Department of Radiology, Tainan Municipal Hospital, Tainan, Taiwan
| | - F-T Chiang
- Division of Cardiology, Department of Internal Medicine, Fu Jen Catholic University Hospital, New Taipei City, Taiwan
| | - J-L Lin
- Division of Cardiology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - L-P Lai
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - M Horie
- Department of Cardiovascular Medicine, Shiga University of Medical Sciences, Shiga, Japan
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160
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El-Sherif N, Turitto G, Boutjdir M. Acquired Long QT Syndrome and Electrophysiology of Torsade de Pointes. Arrhythm Electrophysiol Rev 2019; 8:122-130. [PMID: 31114687 PMCID: PMC6528034 DOI: 10.15420/aer.2019.8.3] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 04/04/2019] [Indexed: 12/16/2022] Open
Abstract
Congenital long QT syndrome (LQTS) has been the most investigated cardiac ion channelopathy. Although congenital LQTS remains the domain of cardiologists, cardiac electrophysiologists and specialised centres, the much more frequently acquired LQTS is the domain of physicians and other members of healthcare teams required to make therapeutic decisions. This paper reviews the electrophysiological mechanisms of acquired LQTS, its ECG characteristics, clinical presentation, and management. The paper concludes with a comprehensive review of the electrophysiological mechanisms of torsade de pointes.
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Affiliation(s)
- Nabil El-Sherif
- SUNY Downstate Medical CenterNY, US
- VA NY Harbor Healthcare SystemNY, US
| | - Gioia Turitto
- Weill Cornell Medical College, NewYork-Presbyterian Brooklyn Methodist HospitalNY, US
| | - Mohamed Boutjdir
- SUNY Downstate Medical CenterNY, US
- VA NY Harbor Healthcare SystemNY, US
- NYU School of MedicineNew York NY, US
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161
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Asatryan B, Medeiros-Domingo A. Molecular and genetic insights into progressive cardiac conduction disease. Europace 2019; 21:1145-1158. [DOI: 10.1093/europace/euz109] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 03/27/2019] [Indexed: 12/14/2022] Open
Abstract
Abstract
Progressive cardiac conduction disease (PCCD) is often a primarily genetic disorder, with clinical and genetic overlaps with other inherited cardiac and metabolic diseases. A number of genes have been implicated in PCCD pathogenesis with or without structural heart disease or systemic manifestations. Precise genetic diagnosis contributes to risk stratification, better selection of specific therapy and allows familiar cascade screening. Cardiologists should be aware of the different phenotypes emerging from different gene-mutations and the potential risk of sudden cardiac death. Genetic forms of PCCD often overlap or coexist with other inherited heart diseases or manifest in the context of multisystem syndromes. Despite the significant advances in the knowledge of the genetic architecture of PCCD and overlapping diseases, in a measurable fraction of PCCD cases, including in familial clustering of disease, investigations of known cardiac disease-associated genes fail to reveal the underlying substrate, suggesting that new causal genes are yet to be discovered. Here, we provide insight into genetics and molecular mechanisms of PCCD and related diseases. We also highlight the phenotypic overlaps of PCCD with other inherited cardiac and metabolic diseases, present unmet challenges in clinical practice, and summarize the available therapeutic options for affected patients.
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Affiliation(s)
- Babken Asatryan
- Department of Cardiology, Inselspital, Bern University Hospital, Freiburgstrasse 8, Bern, Switzerland
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162
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Sun AY. Drug Provocation Testing in Brugada Syndrome: A Test of Uncertain Significance. JACC Clin Electrophysiol 2019; 5:513-515. [PMID: 31000107 DOI: 10.1016/j.jacep.2019.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 03/06/2019] [Indexed: 01/08/2023]
Affiliation(s)
- Albert Y Sun
- Section of Cardiac Electrophysiology, Division of Cardiovascular Diseases, Duke University Medical Center, Durham, North Carolina; Section of Cardiac Electrophysiology, Division of Cardiovascular Diseases, Durham Veterans Affairs Medical Center, Durham, North Carolina.
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163
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Cheung CC, Mellor G, Deyell MW, Ensam B, Batchvarov V, Papadakis M, Roberts JD, Leather R, Sanatani S, Healey JS, Chauhan VS, Birnie DH, Champagne J, Angaran P, Klein GJ, Yee R, Simpson CS, Talajic M, Gardner M, Yeung-Lai-Wah JA, Chakrabarti S, Laksman ZW, Sharma S, Behr ER, Krahn AD. Comparison of Ajmaline and Procainamide Provocation Tests in the Diagnosis of Brugada Syndrome. JACC Clin Electrophysiol 2019; 5:504-512. [DOI: 10.1016/j.jacep.2019.01.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 01/02/2019] [Accepted: 01/31/2019] [Indexed: 01/20/2023]
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164
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Brugada Syndrome Caused by Autonomic Dysfunction in Multiple Sclerosis. Case Rep Cardiol 2019; 2019:3937248. [PMID: 30881703 PMCID: PMC6383422 DOI: 10.1155/2019/3937248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 04/18/2018] [Accepted: 12/10/2018] [Indexed: 11/21/2022] Open
Abstract
Only one case report has previously described a patient with multiple sclerosis and a type 1 Brugada pattern on the electrocardiogram. Patients with multiple sclerosis have several neurological deficits including sensory symptoms, acute or subacute motor weakness, gait disturbance, and balance problems that may lead to an increased risk of falls. Concurrent autonomic dysfunction and neurologic consequences of multiple sclerosis may precipitate both mechanical falls and falls with loss of consciousness. While mechanistically different, the type 1 Brugada pattern presents similarly with syncope due to an insufficient cardiac output during dysrhythmia. In such patients, intracardiac defibrillators have shown to prevent sudden cardiac death in patients with the Brugada syndrome. In light of these similarly presenting but unique clinical entities, MS patients who develop a syncopal event in the setting of a spontaneous type I Brugada pattern pose a diagnostic and therapeutic dilemma. This case illustrates an approach to the risks and benefits of an ICD placement in an MS patient with the type 1 Brugada pattern.
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165
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Arnar DO, Mairesse GH, Boriani G, Calkins H, Chin A, Coats A, Deharo JC, Svendsen JH, Heidbüchel H, Isa R, Kalman JM, Lane DA, Louw R, Lip GYH, Maury P, Potpara T, Sacher F, Sanders P, Varma N, Fauchier L, Haugaa K, Schwartz P, Sarkozy A, Sharma S, Kongsgård E, Svensson A, Lenarczyk R, Volterrani M, Turakhia M, Obel IWP, Abello M, Swampillai J, Kalarus Z, Kudaiberdieva G, Traykov VB, Dagres N, Boveda S, Vernooy K, Kalarus Z, Kudaiberdieva G, Mairesse GH, Kutyifa V, Deneke T, Hastrup Svendsen J, Traykov VB, Wilde A, Heinzel FR. Management of asymptomatic arrhythmias: a European Heart Rhythm Association (EHRA) consensus document, endorsed by the Heart Failure Association (HFA), Heart Rhythm Society (HRS), Asia Pacific Heart Rhythm Society (APHRS), Cardiac Arrhythmia Society of Southern Africa (CASSA), and Latin America Heart Rhythm Society (LAHRS). Europace 2019; 21:844–845. [DOI: 10.1093/europace/euz046] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 02/24/2019] [Indexed: 12/22/2022] Open
Abstract
AbstractAsymptomatic arrhythmias are frequently encountered in clinical practice. Although studies specifically dedicated to these asymptomatic arrhythmias are lacking, many arrhythmias still require proper diagnostic and prognostic evaluation and treatment to avoid severe consequences, such as stroke or systemic emboli, heart failure, or sudden cardiac death. The present document reviews the evidence, where available, and attempts to reach a consensus, where evidence is insufficient or conflicting.
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Affiliation(s)
- David O Arnar
- Department of Medicine, Landspitali - The National University Hospital of Iceland and University of Iceland, Reykjavik, Iceland
| | | | - Giuseppe Boriani
- Division of Cardiology, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Hugh Calkins
- Department of Arrhythmia Services, Johns Hopkins Medical Institutions Baltimore, MD, USA
| | - Ashley Chin
- Division of Cardiology, Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Andrew Coats
- Department of Cardiology, University of Warwick, Warwickshire, UK
| | - Jean-Claude Deharo
- Department of Rhythmology, Hôpital Universitaire La Timone, Marseille, France
| | - Jesper Hastrup Svendsen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Hein Heidbüchel
- Antwerp University Hospital, University of Antwerp, Edegem, Belgium
| | - Rodrigo Isa
- Clínica RedSalud Vitacura and Hospital el Carmen de Maipú, Santiago, Chile
| | - Jonathan M Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Deirdre A Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
| | - Ruan Louw
- Department Cardiology (Electrophysiology), Mediclinic Midstream Hospital, Centurion, South Africa
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
- Aalborg Thrombosis Research Unit, Aalborg University, Aalborg, Denmark
| | - Philippe Maury
- Cardiology, University Hospital Rangueil, Toulouse, France
| | - Tatjana Potpara
- Cardiology Clinic, Clinical Center of Serbia, School of Medicine, University of Belgrade, Serbia
| | - Frederic Sacher
- Service de Cardiologie, Institut Lyric, CHU de Bordeaux, Bordeaux, France
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Niraj Varma
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Laurent Fauchier
- Service de Cardiologie et Laboratoire d'Electrophysiologie Cardiaque, Centre Hospitalier Universitaire Trousseau et Université François Rabelais, Tours, France
| | - Kristina Haugaa
- Department of Cardiology, Center for Cardiological Innovation and Institute for Surgical Research, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Peter Schwartz
- Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin, Milan, Italy
| | - Andrea Sarkozy
- Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium
| | | | - Erik Kongsgård
- Department of Cardiology, OUS-Rikshospitalet, Oslo, Norway
| | - Anneli Svensson
- Department of Cardiology, University Hospital of Linkoping, Sweden
| | | | | | - Mintu Turakhia
- Stanford University, Cardiac Arrhythmia & Electrophysiology Service, Stanford, USA
| | | | | | - Janice Swampillai
- Electrophysiologist & Cardiologist, Waikato Hospital, University of Auckland, New Zealand
| | - Zbigniew Kalarus
- SMDZ in Zabrze, Medical University of Silesia, Katowice, Poland
- Department of Cardiology, Silesian Center for Heart Diseases, Zabrze
| | | | - Vassil B Traykov
- Department of Invasive Electrophysiology and Cardiac Pacing, Clinic of Cardiology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
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166
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Lester RM, Paglialunga S, Johnson IA. QT Assessment in Early Drug Development: The Long and the Short of It. Int J Mol Sci 2019; 20:ijms20061324. [PMID: 30884748 PMCID: PMC6471571 DOI: 10.3390/ijms20061324] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/01/2019] [Accepted: 03/05/2019] [Indexed: 11/16/2022] Open
Abstract
The QT interval occupies a pivotal role in drug development as a surface biomarker of ventricular repolarization. The electrophysiologic substrate for QT prolongation coupled with reports of non-cardiac drugs producing lethal arrhythmias captured worldwide attention from government regulators eventuating in a series of guidance documents that require virtually all new chemical compounds to undergo rigorous preclinical and clinical testing to profile their QT liability. While prolongation or shortening of the QT interval may herald the appearance of serious cardiac arrhythmias, the positive predictive value of an abnormal QT measurement for these arrhythmias is modest, especially in the absence of confounding clinical features or a congenital predisposition that increases the risk of syncope and sudden death. Consequently, there has been a paradigm shift to assess a compound's cardiac risk of arrhythmias centered on a mechanistic approach to arrhythmogenesis rather than focusing solely on the QT interval. This entails both robust preclinical and clinical assays along with the emergence of concentration QT modeling as a primary analysis tool to determine whether delayed ventricular repolarization is present. The purpose of this review is to provide a comprehensive understanding of the QT interval and highlight its central role in early drug development.
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Affiliation(s)
- Robert M Lester
- Cardiac Safety Services, Celerion, 2420 W Baseline Rd, Tempe, AZ 85283, USA.
| | | | - Ian A Johnson
- Cardiac Safety Services, Celerion, 2420 W Baseline Rd, Tempe, AZ 85283, USA.
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167
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Duchateau J, Sacher F, Pambrun T, Derval N, Chamorro-Servent J, Denis A, Ploux S, Hocini M, Jaïs P, Bernus O, Haïssaguerre M, Dubois R. Performance and limitations of noninvasive cardiac activation mapping. Heart Rhythm 2019; 16:435-442. [DOI: 10.1016/j.hrthm.2018.10.010] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Indexed: 11/24/2022]
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168
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Pflaumer A, Davis AM. An Update on the Diagnosis and Management of Catecholaminergic Polymorphic Ventricular Tachycardia. Heart Lung Circ 2019; 28:366-369. [DOI: 10.1016/j.hlc.2018.10.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 10/04/2018] [Indexed: 11/24/2022]
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169
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Boxhammer E, Goette A, Hammwöhner M, Lüker J, Patscheke M, Pavaci H, Pizzulli L, Razhniova A, Reek D, Schimpf R, Steven D, Wörmann J, Wolpert C, Zrenner B. [Rhythmogenic syncopes and survived sudden cardiac death]. Herzschrittmacherther Elektrophysiol 2019; 30:72-88. [PMID: 30847550 DOI: 10.1007/s00399-019-0614-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 01/29/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Elke Boxhammer
- Medizinische Klinik I, Krankenhaus Landshut-Achdorf, Achdorfer Weg 3, 84036, Landshut, Deutschland
| | - Andreas Goette
- Arbeitsgruppe Molekulare Elektrophysiologie, Institut für Klinische Chemie und Pathobiochemie, Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland.
- Medizinische Klinik II Kardiologie und Internistische Intensivtherapie, St. Vincenz-Krankenhaus, Am Busdorf 2, 33098, Paderborn, Deutschland.
| | - Matthias Hammwöhner
- Arbeitsgruppe Molekulare Elektrophysiologie, Institut für Klinische Chemie und Pathobiochemie, Medizinische Fakultät, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland
- Medizinische Klinik II Kardiologie und Internistische Intensivtherapie, St. Vincenz-Krankenhaus, Am Busdorf 2, 33098, Paderborn, Deutschland
| | - Jakob Lüker
- Herzzentrum, Abteilung für Elektrophysiologie, Universitätsklinik Köln, Kerpenerstraße 62, 50937, Köln, Deutschland
| | - Markus Patscheke
- Medizinische Klinik II Kardiologie und Internistische Intensivtherapie, St. Vincenz-Krankenhaus, Am Busdorf 2, 33098, Paderborn, Deutschland
| | - Herribert Pavaci
- Medizinische Klinik I, Krankenhaus Landshut-Achdorf, Achdorfer Weg 3, 84036, Landshut, Deutschland
| | - L Pizzulli
- Abteilung Kardiologie, Gemeinschaftskrankenhaus Bonn, Bonner Talweg 4-6, 53113, Bonn, Deutschland
| | - Alina Razhniova
- Abteilung Kardiologie, Gemeinschaftskrankenhaus Bonn, Bonner Talweg 4-6, 53113, Bonn, Deutschland
| | - David Reek
- Abteilung Kardiologie, Gemeinschaftskrankenhaus Bonn, Bonner Talweg 4-6, 53113, Bonn, Deutschland.
| | - Rainer Schimpf
- Kardiologische Praxisklinik Ludwigshafen, Standort Neustadt, Schütt 2, 64733, Neustadt a.d. Weinstraße, Deutschland.
| | - Daniel Steven
- Herzzentrum, Abteilung für Elektrophysiologie, Universitätsklinik Köln, Kerpenerstraße 62, 50937, Köln, Deutschland.
| | - Jonas Wörmann
- Herzzentrum, Abteilung für Elektrophysiologie, Universitätsklinik Köln, Kerpenerstraße 62, 50937, Köln, Deutschland
| | - Christian Wolpert
- 2. Medizinische Klinik, Klinikum Ludwigsburg, Posilipostraße 4, 71640, Ludwigsburg, Deutschland.
| | - Bernhard Zrenner
- Medizinische Klinik I, Krankenhaus Landshut-Achdorf, Achdorfer Weg 3, 84036, Landshut, Deutschland.
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170
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Di Toro A, Giuliani L, Favalli V, Di Giovannantonio M, Smirnova A, Grasso M, Arbustini E. Genetics and clinics: current applications, limitations, and future developments. Eur Heart J Suppl 2019; 21:B7-B14. [PMID: 30948934 PMCID: PMC6439893 DOI: 10.1093/eurheartj/suz048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Alessandro Di Toro
- Centre for Inherited Cardiovascular Diseases, IRCCS Foundation University Hospital Policlinico San Matteo, Pavia, Italy
| | - Lorenzo Giuliani
- Centre for Inherited Cardiovascular Diseases, IRCCS Foundation University Hospital Policlinico San Matteo, Pavia, Italy
| | | | - Matteo Di Giovannantonio
- Centre for Inherited Cardiovascular Diseases, IRCCS Foundation University Hospital Policlinico San Matteo, Pavia, Italy
| | - Alexandra Smirnova
- Centre for Inherited Cardiovascular Diseases, IRCCS Foundation University Hospital Policlinico San Matteo, Pavia, Italy
| | - Maurizia Grasso
- Centre for Inherited Cardiovascular Diseases, IRCCS Foundation University Hospital Policlinico San Matteo, Pavia, Italy
| | - Eloisa Arbustini
- Centre for Inherited Cardiovascular Diseases, IRCCS Foundation University Hospital Policlinico San Matteo, Pavia, Italy
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171
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Brüggemann B, Djajadisastra I, Duncker D, Eitel C, Fink T, Grimm W, Heeger C, Israel CW, Müller-Leisse J, Sheta MK, Sinha AM, Tilz RR, Veltmann C, Vogler J, Zormpas C. [Canalopathies, arrhythmogenic right ventricular cardiomyopathy and artefacts]. Herzschrittmacherther Elektrophysiol 2019; 30:51-71. [PMID: 30825043 DOI: 10.1007/s00399-019-0611-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 01/29/2019] [Indexed: 06/09/2023]
Affiliation(s)
- B Brüggemann
- Medizinische Klinik II/Kardiologie, Angiologie und Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, Haus 40, 23538, Lübeck, Deutschland
| | - I Djajadisastra
- Abteilung Rhythmologie, Klinik für Innere Medizin I, St.-Johannes-Hospital Dortmund, Johannesstr. 9-17, 44137, Dortmund, Deutschland.
| | - D Duncker
- Rhythmologie und Elektrophysiologie, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| | - C Eitel
- Medizinische Klinik II/Kardiologie, Angiologie und Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, Haus 40, 23538, Lübeck, Deutschland
| | - T Fink
- Medizinische Klinik II/Kardiologie, Angiologie und Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, Haus 40, 23538, Lübeck, Deutschland
| | - W Grimm
- Universititätsklinik Marburg, Klinik für Innere Medizin - Kardiologie, Angiologie und Intensivmedizin, UKGM Gießen und Marburg, Standort Marburg, Baldingerstraße, 35033, Marburg, Deutschland.
| | - C Heeger
- Medizinische Klinik II/Kardiologie, Angiologie und Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, Haus 40, 23538, Lübeck, Deutschland
| | - C W Israel
- Klinik für Innere Medizin - Kardiologie, Diabetologie & Nephrologie, Ev. Klinikum Bethel, Burgsteig 13, 33617, Bielefeld, Deutschland.
| | - J Müller-Leisse
- Rhythmologie und Elektrophysiologie, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - M K Sheta
- Klinik für Kardiologie, Nephrologie, Pneumologie und Internistische Intensivmedizin, Sana Klinikum Hof GmbH, 95032, Eppenreuther Str. 9, Hof, Deutschland
| | - A M Sinha
- Klinik für Kardiologie, Nephrologie, Pneumologie und Internistische Intensivmedizin, Sana Klinikum Hof GmbH, 95032, Eppenreuther Str. 9, Hof, Deutschland.
| | - R R Tilz
- Medizinische Klinik II/Kardiologie, Angiologie und Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, Haus 40, 23538, Lübeck, Deutschland.
| | - C Veltmann
- Rhythmologie und Elektrophysiologie, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - J Vogler
- Medizinische Klinik II/Kardiologie, Angiologie und Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, Haus 40, 23538, Lübeck, Deutschland
| | - C Zormpas
- Rhythmologie und Elektrophysiologie, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
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172
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Nagayama T, Nagase S, Kamakura T, Wada M, Ishibashi K, Inoue YY, Miyamoto K, Noda T, Aiba T, Takaki H, Sugimachi M, Shimizu W, Noguchi T, Yasuda S, Kamakura S, Kusano K. Clinical and Electrocardiographic Differences in Brugada Syndrome With Spontaneous or Drug-Induced Type 1 Electrocardiogram. Circ J 2019; 83:532-539. [DOI: 10.1253/circj.cj-18-0643] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Tomomi Nagayama
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
- Department of Cardiovascular Medicine, Fukuoka City Hospital
| | - Satoshi Nagase
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Tsukasa Kamakura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Mitsuru Wada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kohei Ishibashi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yuko Y. Inoue
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Koji Miyamoto
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Takeshi Aiba
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hiroshi Takaki
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Masaru Sugimachi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
- Department of Cardiovascular Medicine, Nippon Medical School
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Shiro Kamakura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
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173
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Javanainen T, Ishihara S, Gayat E, Charbit B, Jurkko R, Cinotti R, Mebazaa A. Prolonged corrected QT interval is associated with short-term and long-term mortality in critically ill patients: results from the FROG-ICU study. Intensive Care Med 2019; 45:746-748. [PMID: 30741330 DOI: 10.1007/s00134-019-05555-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Tuija Javanainen
- Department of Anesthesiology, Critical Care and Burn Unit, Hôpitaux Universitaires Saint Louis, Lariboisière, Assistance Publique, Hôpitaux de Paris, Université Paris Diderot-Paris 7, Sorbonne Paris Cité, UMR-S 942, INSERM, Paris, France. .,Cardiology, Heart and Lung Center, Helsinki University Hospital, University of Helsinki, P.O. Box 340, 00029 HUS, Helsinki, Finland.
| | - Shiro Ishihara
- Department of Anesthesiology, Critical Care and Burn Unit, Hôpitaux Universitaires Saint Louis, Lariboisière, Assistance Publique, Hôpitaux de Paris, Université Paris Diderot-Paris 7, Sorbonne Paris Cité, UMR-S 942, INSERM, Paris, France.,Department of Cardiology, Nippon Medical School Musashi-Kosugi Hospital, Kawasaki, Japan
| | - Etienne Gayat
- Department of Anesthesiology, Critical Care and Burn Unit, Hôpitaux Universitaires Saint Louis, Lariboisière, Assistance Publique, Hôpitaux de Paris, Université Paris Diderot-Paris 7, Sorbonne Paris Cité, UMR-S 942, INSERM, Paris, France
| | - Beny Charbit
- Department of Anesthesiology and Intensive Care, CHU Reims, Hôpital Robert Debré, Reims, France
| | - Raija Jurkko
- Cardiology, Heart and Lung Center, Helsinki University Hospital, University of Helsinki, P.O. Box 340, 00029 HUS, Helsinki, Finland
| | - Raphaël Cinotti
- Department of Anesthesiology, Critical Care and Burn Unit, Hôpitaux Universitaires Saint Louis, Lariboisière, Assistance Publique, Hôpitaux de Paris, Université Paris Diderot-Paris 7, Sorbonne Paris Cité, UMR-S 942, INSERM, Paris, France.,Anesthesia and Critical Care Department, Hôtel Dieu, 1 Place Alexis Ricordeau 44093, Nantes, Cedex 44093, France
| | - Alexandre Mebazaa
- Department of Anesthesiology, Critical Care and Burn Unit, Hôpitaux Universitaires Saint Louis, Lariboisière, Assistance Publique, Hôpitaux de Paris, Université Paris Diderot-Paris 7, Sorbonne Paris Cité, UMR-S 942, INSERM, Paris, France
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174
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Faridi R, Tona R, Brofferio A, Hoa M, Olszewski R, Schrauwen I, Assir MZ, Bandesha AA, Khan AA, Rehman AU, Brewer C, Ahmed W, Leal SM, Riazuddin S, Boyden SE, Friedman TB. Mutational and phenotypic spectra of KCNE1 deficiency in Jervell and Lange-Nielsen Syndrome and Romano-Ward Syndrome. Hum Mutat 2019; 40:162-176. [PMID: 30461122 PMCID: PMC6328321 DOI: 10.1002/humu.23689] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 11/01/2018] [Accepted: 11/15/2018] [Indexed: 11/11/2022]
Abstract
KCNE1 encodes a regulatory subunit of the KCNQ1 potassium channel-complex. Both KCNE1 and KCNQ1 are necessary for normal hearing and cardiac ventricular repolarization. Recessive variants in these genes are associated with Jervell and Lange-Nielson syndrome (JLNS1 and JLNS2), a cardio-auditory syndrome characterized by congenital profound sensorineural deafness and a prolonged QT interval that can cause ventricular arrhythmias and sudden cardiac death. Some normal-hearing carriers of heterozygous missense variants of KCNE1 and KCNQ1 have prolonged QT intervals, a dominantly inherited phenotype designated Romano-Ward syndrome (RWS), which is also associated with arrhythmias and elevated risk of sudden death. Coassembly of certain mutant KCNE1 monomers with wild-type KCNQ1 subunits results in RWS by a dominant negative mechanism. This paper reviews variants of KCNE1 and their associated phenotypes, including biallelic truncating null variants of KCNE1 that have not been previously reported. We describe three homozygous nonsense mutations of KCNE1 segregating in families ascertained ostensibly for nonsyndromic deafness: c.50G>A (p.Trp17*), c.51G>A (p.Trp17*), and c.138C>A (p.Tyr46*). Some individuals carrying missense variants of KCNE1 have RWS. However, heterozygotes for loss-of-function variants of KCNE1 may have normal QT intervals while biallelic null alleles are associated with JLNS2, indicating a complex genotype-phenotype spectrum for KCNE1 variants.
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Affiliation(s)
- Rabia Faridi
- Laboratory of Molecular Genetics, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD 20892, USA
- National Centre of Excellence in Molecular Biology, University of the Punjab, Lahore 54550, Pakistan
| | - Risa Tona
- Laboratory of Molecular Genetics, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD 20892, USA
| | - Alessandra Brofferio
- Cardiology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health Clinical Center, Bethesda, MD 20892, USA
| | - Michael Hoa
- Auditory Development and Restoration Program, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD 20892, USA
| | - Rafal Olszewski
- Auditory Development and Restoration Program, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD 20892, USA
| | - Isabelle Schrauwen
- Center for Statistical Genetics, Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Muhammad Z.K. Assir
- Allama Iqbal Medical Research Centre, Jinnah Hospital Complex, Lahore 54550, Pakistan
| | - Akhtar A. Bandesha
- Cardiology Department, The Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Asma A. Khan
- National Centre of Excellence in Molecular Biology, University of the Punjab, Lahore 54550, Pakistan
| | - Atteeq U. Rehman
- Laboratory of Molecular Genetics, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD 20892, USA
| | - Carmen Brewer
- Audiology Unit, National Institute on Deafness and Other Communication Disorders (NIDCD), National Institutes of Health, Bethesda, MD 20892, USA
| | - Wasim Ahmed
- Department of Biochemistry, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad 45320, Pakistan
| | - Suzanne M. Leal
- Center for Statistical Genetics, Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX 77030, USA
| | - Sheikh Riazuddin
- Allama Iqbal Medical Research Centre, Jinnah Hospital Complex, Lahore 54550, Pakistan
| | - Steven E. Boyden
- Section on Genetics of Communication Disorders, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD 20892, USA
| | - Thomas B. Friedman
- Laboratory of Molecular Genetics, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, MD 20892, USA
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175
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Switching Between β-Blockers: An Empiric Tool for the Cardiovascular Practitioner. Can J Cardiol 2019; 35:539-543. [PMID: 30935645 DOI: 10.1016/j.cjca.2019.01.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 01/24/2019] [Accepted: 01/24/2019] [Indexed: 12/17/2022] Open
Abstract
β-Blockers are a cornerstone of therapy for cardiovascular disease, but their clinical benefits are not consistent across the class and specific agents are preferred for certain indications. Further, when prescribed, a patient's clinical status might change, requiring the cardiologist to switch to an alternate agent. Examples of such scenarios include the development or a worsening of chronic noncardiac diseases (eg, hyperthyroidism, renal failure), new cardiac-related disease (eg, heart failure, atrial fibrillation), or practical/safety issues (eg, pregnancy, cost, side effects). However, guidelines on how to best switch to a different β-blocker are lacking. Additionally, most hospital-based formularies and guidelines do not provide recommendations around common challenges, like medication intolerance or adjustments for acute illness. We present a practical approach to switching between commonly prescribed β-blockers, which considers drug interchangeability for various indications, rationale for switching, necessary initial adjustments to dose/frequency, and differences in target/maximal doses.
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176
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Bjune T, Risgaard B, Kruckow L, Glinge C, Ingemann-Hansen O, Leth PM, Linnet K, Banner J, Winkel BG, Tfelt-Hansen J. Post-mortem toxicology in young sudden cardiac death victims: a nationwide cohort study. Europace 2019; 20:614-621. [PMID: 28339816 DOI: 10.1093/europace/euw435] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 12/14/2016] [Indexed: 01/09/2023] Open
Abstract
Aims Several drugs increase the risk of ventricular fibrillation and sudden cardiac death (SCD). We aimed to investigate in detail the toxicological findings of all young SCD throughout Denmark. Methods and results Deaths in persons aged 1-49 years were included over a 10-year period. Death certificates and autopsy reports were retrieved and read to identify cases of sudden death and establish cause of death. All medico-legal autopsied SCD were included and toxicological reports collected. Positive toxicology was defined as the presence of any substance (licit and/or illicit). All toxicological findings had previously been evaluated not to have caused the death (i.e. lethal concentrations were excluded). We identified 620 medico-legal autopsied cases of SCD, of which 77% (n = 477) were toxicologically investigated post-mortem, and 57% (n = 270) had a positive toxicology profile. Sudden cardiac death with positive toxicology had higher rates of sudden arrhythmic death syndrome (SADS), compared with SCD with negative toxicology (56% vs. 42%, P < 0.01). In total, 752 agents were detected, and polypharmacy (defined as the presence of more than one drug) was present in 61% (n = 164), all substances combined. Psychotropic drugs were the most frequent (62%, n = 467), and 82% (n = 385) were in pharmacological or subpharmacological levels. Conclusion We found that more than half of all toxicologically investigated SCD victims have positive post-mortem toxicological findings, and polypharmacy is displayed in a considerable proportion. SCD with positive toxicology had higher rate of SADS, suggesting that the compounds may play a proarrhythmic role in these cases.
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Affiliation(s)
- Thea Bjune
- Department of Cardiology, University Hospital of Copenhagen, Rigshospitalet, 2142, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Bjarke Risgaard
- Department of Cardiology, University Hospital of Copenhagen, Rigshospitalet, 2142, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Line Kruckow
- Faculty of Medical Sciences, Section of Forensic Pathology, Department of Forensic Medicine, University of Copenhagen, Frederik V's vej 11, 2100 Copenhagen Ø, Denmark
| | - Charlotte Glinge
- Department of Cardiology, University Hospital of Copenhagen, Rigshospitalet, 2142, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Ole Ingemann-Hansen
- Department of Forensic Medicine, Aarhus University, Palle Juul-Jensens Blvd. 82, 8200 Aarhus N, Denmark
| | - Peter Mygind Leth
- Department of Forensic Medicine, University of Southern Denmark, J.B. Winsløws vej 17, 5000 Odense C, Denmark
| | - Kristian Linnet
- Faculty of Medical Sciences, Section of Forensic Chemistry, Department of Forensic Medicine, , University of Copenhagen, Frederik V's vej 11, 2100 Copenhagen Ø, Denmark
| | - Jytte Banner
- Faculty of Medical Sciences, Section of Forensic Pathology, Department of Forensic Medicine, University of Copenhagen, Frederik V's vej 11, 2100 Copenhagen Ø, Denmark
| | - Bo Gregers Winkel
- Department of Cardiology, University Hospital of Copenhagen, Rigshospitalet, 2142, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Jacob Tfelt-Hansen
- Department of Cardiology, University Hospital of Copenhagen, Rigshospitalet, 2142, Blegdamsvej 9, 2100 Copenhagen, Denmark
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177
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Zakka P, Refaat MM. Sudden cardiac arrest and Brugada syndrome: The search is on for better risk stratification. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:265-266. [DOI: 10.1111/pace.13588] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 12/17/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Patrick Zakka
- Department of Internal Medicine; Emory University Hospital; Atlanta Georgia
| | - Marwan M. Refaat
- Division of Cardiology, Department of Internal Medicine; American University of Beirut Medical Center; Beirut Lebanon
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178
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Abstract
Genetic testing has an increasingly important role in the diagnosis and management of cardiac disorders, where it confirms the diagnosis, aids prognostication and risk stratification and guides treatment. A genetic diagnosis in the proband also enables clarification of the risk for family members by cascade testing. Genetics in cardiac disorders is complex where epigenetic and environmental factors might come into interplay. Incomplete penetrance and variable expressivity is also common. Genetic results in cardiac conditions are mostly probabilistic and should be interpreted with all available clinical information. With this complexity in cardiac genetics, testing is only indicated in patients with a strong suspicion of an inheritable cardiac disorder after a full clinical evaluation. In this review we discuss the genetics underlying the major cardiomyopathies and channelopathies, and the practical aspects of diagnosing these conditions in the laboratory.
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179
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Werner R, Niederseer D, Saguner AM, Brunckhorst CB. [CME ECG 62/Answer: An Atypical Right Bundle Branch Block?]. PRAXIS 2019; 108:157-160. [PMID: 30722744 DOI: 10.1024/1661-8157/a003152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Regine Werner
- 1 Klinik für Kardiologie, Universitäres Herzzentrum, Universitätsspital Zürich
| | - David Niederseer
- 1 Klinik für Kardiologie, Universitäres Herzzentrum, Universitätsspital Zürich
| | - Ardan M Saguner
- 1 Klinik für Kardiologie, Universitäres Herzzentrum, Universitätsspital Zürich
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180
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Anastasakis A, Papatheodorou E, Ritsatos K, Protonotarios N, Rentoumi V, Gatzoulis K, Antoniades L, Agapitos E, Koutsaftis P, Spiliopoulou C, Tousoulis D. Sudden unexplained death in the young: epidemiology, aetiology and value of the clinically guided genetic screening. Europace 2018; 20:472-480. [PMID: 28177452 DOI: 10.1093/europace/euw362] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 10/26/2016] [Indexed: 11/14/2022] Open
Abstract
Aims To determine the incidence and the causes of sudden death (SD) in persons aged 1-35 years old and the diagnostic yield of clinically guided genetic screening in the sudden arrhythmic death syndrome (SADS) victims' families. Methods and results Incidence and causes of SD in the Attica region of Greece in 2002-10 were determined using death certificates and autopsy reports. We evaluated clinically consecutive families of SADS victims and if a clinical diagnosis was established, we proceeded to targeted genetic analysis. Out of 6030 deaths, 56% were due to traumatic or violent causes, 40.5% were natural deaths, and 3.3% were of undetermined cause. There were 349 SD cases. Cardiovascular causes accounted for 65%, non-cardiovascular causes for 17%, and SADS for 18%. Clinical evaluation identified an inherited heart disease in 5/20 SADS families (25%). Targeted genetic analysis identified a causative mutation in all of the five screened families and reconfirmed the diagnosis in three of five proband victims. Clinical and genetic evaluation of 28 family members identified eight affected carriers and eight non-affected carriers. Molecular autopsy failed to identify any of these families. Conclusion Sudden death in the young is of cardiovascular origin in the majority of cases. A considerable rate of SD cases remains of unknown cause on post-mortem. Apart from channelopathies, subclinical forms of inherited structural heart diseases would appear to be implicated in SADS. Clinically guided genetic screening has a significant diagnostic yield and identifies affected families that would have been missed by the current suggested molecular autopsy panel.
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Affiliation(s)
- Aris Anastasakis
- Inherited Cardiovascular Diseases Unit, 1st Department of Cardiology, University of Athens Medical School, 99, Michalakopoulou Ave 11527 Athens, Greece
| | - Efstathios Papatheodorou
- Inherited Cardiovascular Diseases Unit, 1st Department of Cardiology, University of Athens Medical School, 99, Michalakopoulou Ave 11527 Athens, Greece.,Cardiovascular and Cell Sciences Research Institute, Jenner Wing, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK
| | - Konstantinos Ritsatos
- Inherited Cardiovascular Diseases Unit, 1st Department of Cardiology, University of Athens Medical School, 99, Michalakopoulou Ave 11527 Athens, Greece
| | - Nikos Protonotarios
- Inherited Cardiovascular Diseases Unit, 1st Department of Cardiology, University of Athens Medical School, 99, Michalakopoulou Ave 11527 Athens, Greece
| | - Vasiliki Rentoumi
- Inherited Cardiovascular Diseases Unit, 1st Department of Cardiology, University of Athens Medical School, 99, Michalakopoulou Ave 11527 Athens, Greece
| | - Konstantinos Gatzoulis
- Inherited Cardiovascular Diseases Unit, 1st Department of Cardiology, University of Athens Medical School, 99, Michalakopoulou Ave 11527 Athens, Greece
| | | | - Emmanuel Agapitos
- Department of Pathology, Medical School, University of Athens, Athens, Greece
| | | | - Chara Spiliopoulou
- Department of Forensic Medicine and Toxicology, School of Medicine, University of Athens, Athens, Greece
| | - Dimitrios Tousoulis
- Inherited Cardiovascular Diseases Unit, 1st Department of Cardiology, University of Athens Medical School, 99, Michalakopoulou Ave 11527 Athens, Greece
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181
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Roston TM, Yuchi Z, Kannankeril PJ, Hathaway J, Vinocur JM, Etheridge SP, Potts JE, Maginot KR, Salerno JC, Cohen MI, Hamilton RM, Pflaumer A, Mohammed S, Kimlicka L, Kanter RJ, LaPage MJ, Collins KK, Gebauer RA, Temple JD, Batra AS, Erickson C, Miszczak-Knecht M, Kubuš P, Bar-Cohen Y, Kantoch M, Thomas VC, Hessling G, Anderson C, Young ML, Choi SHJ, Cabrera Ortega M, Lau YR, Johnsrude CL, Fournier A, Van Petegem F, Sanatani S. The clinical and genetic spectrum of catecholaminergic polymorphic ventricular tachycardia: findings from an international multicentre registry. Europace 2018; 20:541-547. [PMID: 28158428 DOI: 10.1093/europace/euw389] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 11/03/2016] [Indexed: 11/12/2022] Open
Abstract
Aims Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an ion channelopathy characterized by ventricular arrhythmia during exertion or stress. Mutations in RYR2-coded Ryanodine Receptor-2 (RyR2) and CASQ2-coded Calsequestrin-2 (CASQ2) genes underlie CPVT1 and CPVT2, respectively. However, prognostic markers are scarce. We sought to better characterize the phenotypic and genotypic spectrum of CPVT, and utilize molecular modelling to help account for clinical phenotypes. Methods and results This is a Pediatric and Congenital Electrophysiology Society multicentre, retrospective cohort study of CPVT patients diagnosed at <19 years of age and their first-degree relatives. Genetic testing was undertaken in 194 of 236 subjects (82%) during 3.5 (1.4-5.3) years of follow-up. The majority (60%) had RyR2-associated CPVT1. Variant locations were predicted based on a 3D structural model of RyR2. Specific residues appear to have key structural importance, supported by an association between cardiac arrest and mutations in the intersubunit interface of the N-terminus, and the S4-S5 linker and helices S5 and S6 of the RyR2 C-terminus. In approximately one quarter of symptomatic patients, cardiac events were precipitated by only normal wakeful activities. Conclusion This large, multicentre study identifies contemporary challenges related to the diagnosis and prognostication of CPVT patients. Structural modelling of RyR2 can improve our understanding severe CPVT phenotypes. Wakeful rest, rather than exertion, often precipitated life-threatening cardiac events.
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Affiliation(s)
- Thomas M Roston
- Departments of Pediatrics/Medicine/Biochemistry & Molecular Biology, University of British Columbia, 4480 Oak Street, Room 1F3, Vancouver, BC, V6H 3V4, Canada
| | - Zhiguang Yuchi
- Departments of Pediatrics/Medicine/Biochemistry & Molecular Biology, University of British Columbia, 4480 Oak Street, Room 1F3, Vancouver, BC, V6H 3V4, Canada
| | - Prince J Kannankeril
- Department of Pediatrics and the Vanderbilt Center for Arrhythmia Research and Therapeutics (VanCART) Vanderbilt University Medical Center and the Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way, Suite 5230, Nashville, TN 37232-9119, USA
| | - Julie Hathaway
- BC Inherited Arrhythmia Program, 211-1033 Davie St, Vancouver, BC V6E 1M7, Canada
| | - Jeffrey M Vinocur
- Department of Pediatrics, University of Rochester, 601 Elmwood Ave, Box 631, Rochester, NY 14642, USA
| | - Susan P Etheridge
- Department of Pediatrics, University of Utah, 81 N Mario Capecchi Drive Salt Lake City, UT 84113, USA
| | - James E Potts
- Departments of Pediatrics/Medicine/Biochemistry & Molecular Biology, University of British Columbia, 4480 Oak Street, Room 1F3, Vancouver, BC, V6H 3V4, Canada
| | - Kathleen R Maginot
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, 1675 Highland Ave, Madison, WI 53792, USA
| | - Jack C Salerno
- Department of Pediatrics, University of Washington, 4800 Sand Point Way NE, Seattle, WA 98105, USA
| | - Mitchell I Cohen
- Division of Cardiology Phoenix Children's Hospital, 1919 E. Thomas Road, 2nd Floor, Heart Center, Phoenix, AZ 85016, USA
| | - Robert M Hamilton
- Department of Pediatrics, University of Toronto, Hospital for Sick Children, 555 University Avenue Toronto, Ontario M5G 1X8, Canada
| | - Andreas Pflaumer
- Royal Children's Hospital MCRI and University of Melbourne, 50 Flemington Road Parkville, Melbourne 3052, Australia
| | - Saira Mohammed
- Departments of Pediatrics/Medicine/Biochemistry & Molecular Biology, University of British Columbia, 4480 Oak Street, Room 1F3, Vancouver, BC, V6H 3V4, Canada
| | - Lynn Kimlicka
- Departments of Pediatrics/Medicine/Biochemistry & Molecular Biology, University of British Columbia, 4480 Oak Street, Room 1F3, Vancouver, BC, V6H 3V4, Canada
| | - Ronald J Kanter
- Nicklaus Children's Hospital, 3100 SW 62 Ave, Cardiology ACB - 2nd Floor Miami, FL 33155, USA
| | - Martin J LaPage
- Department of Pediatrics, University of Michigan, 1500 E Medical Center Drive, #6303, Ann Arbor, MI 48109, USA
| | - Kathryn K Collins
- Department of Pediatrics, University of Colorado, 13123 East 16th Avenue, Aurora, CO 80045, USA
| | - Roman A Gebauer
- Department of Pediatric Cardiology, Heart Center, University of Leipzig, Strümpellstrasse 39, Leipzig, Germany
| | - Joel D Temple
- Department of Pediatrics, A. I. DuPont Hospital For Children, 1600 Rockland Rd, Wilmington, DE 19803, USA
| | - Anjan S Batra
- Department of Pediatrics, University of California at Irvine Medical Center, 1140 W. La Veta Ave., Suite 750, Orange, CA 92868, USA
| | - Christopher Erickson
- Division of Cardiology, UNMC/CUMC/Children's Hospital and Medical Center, 8200 Dodge Street, Omaha, NE 68114, USA
| | - Maria Miszczak-Knecht
- Department of Cardiology, Children's Memorial Health Institute, Dzieci Polskich 20, 04 -730 Warsaw, Poland
| | - Peter Kubuš
- Children's Heart Centre, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Vúvalu 84, 15006, Prague, Czech Republic
| | - Yaniv Bar-Cohen
- Department of Pediatrics, Children's Hospital Los Angeles, 4650 Sunset Blvd #34, Los Angeles, CA 90027, USA
| | - Michal Kantoch
- Stollery Children's Hospital, University of Alberta, Clinical Sciences Building, 8440 112 St NW, Edmonton, AB T6G 2B7, Canada
| | - Vincent C Thomas
- Division of Cardiology, UNMC/CUMC/Children's Hospital and Medical Center, 8200 Dodge Street, Omaha, NE 68114, USA
| | - Gabriele Hessling
- Department of Electrophysiology, German Heart Center Munich, Technical University, Lazarettstr. 3680636 Munich, Germany
| | - Chris Anderson
- Providence Sacred Heart Children's Hospital, 101 W. 8th Ave. Suite 4300E, Spokane, WA 99204, USA
| | - Ming-Lon Young
- Department of Pediatrics, Joe DiMaggio Children's Hospital, 1150 North 35th Avenue Suite 575, Hollywood, FL 33021, USA
| | - Sally H J Choi
- Departments of Pediatrics/Medicine/Biochemistry & Molecular Biology, University of British Columbia, 4480 Oak Street, Room 1F3, Vancouver, BC, V6H 3V4, Canada
| | - Michel Cabrera Ortega
- Department of Arrhythmia and Cardiac Pacing, Cardiocentro Pediatrico William Soler, 100 y perla, Boyeros. 10800, Havana, Cuba
| | - Yung R Lau
- Division of Pediatric Cardiology, University of Alabama at Birmingham, 1700 6th Ave S, Birmingham, AL 35233, USA
| | - Christopher L Johnsrude
- Department of Pediatrics, University of Louisville, 601 S Floyd St #602, Louisville, KY 40208, USA
| | - Anne Fournier
- Département de Pédiatrie, CHU Ste Justine, 3175, chemin Côte Sainte-Catherine, Montréal, QC H3T 1C5 Canada
| | - Filip Van Petegem
- Departments of Pediatrics/Medicine/Biochemistry & Molecular Biology, University of British Columbia, 4480 Oak Street, Room 1F3, Vancouver, BC, V6H 3V4, Canada
| | - Shubhayan Sanatani
- Departments of Pediatrics/Medicine/Biochemistry & Molecular Biology, University of British Columbia, 4480 Oak Street, Room 1F3, Vancouver, BC, V6H 3V4, Canada
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182
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Nocturnal enuresis as the initial symptom of life-threatening arrhythmia: a case report. BJGP Open 2018; 2:bjgpopen18X101624. [PMID: 30723807 PMCID: PMC6348320 DOI: 10.3399/bjgpopen18x101624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 08/17/2018] [Indexed: 11/25/2022] Open
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183
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Stutzman MJ, Ye D, Tester DJ, Giudicessi JR, Ackerman MJ. Is variant pathogenicity in the eye of the beholder? A case of unexplained sudden cardiac arrest highlights the potentially dangerous role of historical rare variant compendia in SCN5A rare variant adjudication. HeartRhythm Case Rep 2018; 5:163-168. [PMID: 30891416 PMCID: PMC6404365 DOI: 10.1016/j.hrcr.2018.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Marissa J Stutzman
- Windland Smith Rice Sudden Death Genomics Laboratory, Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota
| | - Dan Ye
- Windland Smith Rice Sudden Death Genomics Laboratory, Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota.,Division of Heart Rhythm Services, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.,Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - David J Tester
- Windland Smith Rice Sudden Death Genomics Laboratory, Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota.,Division of Heart Rhythm Services, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.,Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - John R Giudicessi
- Clinician-Investigator Training Program, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Michael J Ackerman
- Windland Smith Rice Sudden Death Genomics Laboratory, Department of Molecular Pharmacology & Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota.,Division of Heart Rhythm Services, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.,Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
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184
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Eyal S. The Fever Tree: from Malaria to Neurological Diseases. Toxins (Basel) 2018; 10:E491. [PMID: 30477182 PMCID: PMC6316520 DOI: 10.3390/toxins10120491] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 11/14/2018] [Accepted: 11/15/2018] [Indexed: 01/07/2023] Open
Abstract
This article describes the discovery and use of the South American cinchona bark and its main therapeutic (and toxic) alkaloids, quinine and quinidine. Since the introduction of cinchona to Europe in the 17th century, it played a role in treating emperors and peasants and was central to colonialism and wars. Over those 400 years, the medical use of cinchona alkaloids has evolved from bark extracts to chemical synthesis and controlled clinical trials. At the present time, the use of quinine and quinidine has declined, to a large extent due to their toxicity. However, quinine is still being prescribed in resource-limited settings, in severe malaria, and in pregnant women, and quinidine made a limited comeback in the treatment of several cardiac and neurological syndromes. In addition, the article presents more recent studies which improved our understanding of cinchona alkaloids' pharmacology. The knowledge gained through these studies will hopefully lead to a wider use of these drugs in precision medicine and to design of new generation, safer quinine and quinidine derivatives.
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Affiliation(s)
- Sara Eyal
- Institute for Drug Research, School of Pharmacy, The Hebrew University of Jerusalem, Jerusalem 91120, Israel.
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185
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Hermans BJM, Stoks J, Bennis FC, Vink AS, Garde A, Wilde AAM, Pison L, Postema PG, Delhaas T. Support vector machine-based assessment of the T-wave morphology improves long QT syndrome diagnosis. Europace 2018; 20:iii113-iii119. [DOI: 10.1093/europace/euy243] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 11/06/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ben J M Hermans
- Department of Biomedical Engineering, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, MD Maastricht, The Netherlands
- Department of Cardiology, Maastricht University Medical Centre, AZ Maastricht, The Netherlands
| | - Job Stoks
- Department of Biomedical Engineering, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, MD Maastricht, The Netherlands
- MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, AE Enschede, The Netherlands
| | - Frank C Bennis
- Department of Biomedical Engineering, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
- MHeNS School for Mental Health and Neuroscience, Maastricht University, MD Maastricht, The Netherlands
| | - Arja S Vink
- Heart Centre, Department of Clinical and Experimental Cardiology, Academic Medical Center, DD Amsterdam, the Netherlands
| | - Ainara Garde
- Department of Biomedical Signals and Systems, Faculty EEMCS, University of Twente, AE Enschede, The Netherlands
| | - Arthur A M Wilde
- Heart Centre, Department of Clinical and Experimental Cardiology, Academic Medical Center, DD Amsterdam, the Netherlands
| | - Laurent Pison
- Department of Cardiology, Maastricht University Medical Centre, AZ Maastricht, The Netherlands
| | - Pieter G Postema
- Heart Centre, Department of Clinical and Experimental Cardiology, Academic Medical Center, DD Amsterdam, the Netherlands
| | - Tammo Delhaas
- Department of Biomedical Engineering, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, MD Maastricht, The Netherlands
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186
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Vaidyanathan R, Reilly L, Eckhardt LL. Caveolin-3 Microdomain: Arrhythmia Implications for Potassium Inward Rectifier and Cardiac Sodium Channel. Front Physiol 2018; 9:1548. [PMID: 30473666 PMCID: PMC6238080 DOI: 10.3389/fphys.2018.01548] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 10/16/2018] [Indexed: 11/13/2022] Open
Abstract
In human cardiac ventricular myocytes, caveolin-3 functions as a scaffolding and regulatory protein for signaling molecules and compartmentalizes ion channels. Our lab has recently explored this sub-cellular microdomain and found that potassium inward rectifier Kir2.x is found in association with caveolin-3. The three cardiac Kir2.x isoforms (Kir2.1, Kir2.2, and Kir2.3) are the molecular correlates of IK1 in the heart, of which Kir2.1 is the dominant isoform in the ventricle. Kir2.1 channels assemble with Kir2.2 and Kir2.3 forming hetero-tetramers that modulate IK1. IK1 sets the resting membrane potential and assists with terminal phase 3 ventricular repolarization. In our studies using native human ventricular tissue, Kir2.x co-localizes with caveolin-3 and significance of the association between Kir2.x and caveolin-3 is emphasized in relation to mutations in the gene which encodes caveolin-3, CAV3, associated with Long QT Syndrome 9 (LQT9). LQT9-associated CAV3 mutations cause decreased current density in Kir2.1 and Kir2.2 as homomeric and heteromeric channels, which affects repolarization and membrane potential stability. A portion of Kir2.1 cardiac localization parallels that of the cardiac sodium channel (Nav1.5). This may have implications for Long QT9 in which CAV3 mutations cause an increase in the late current of Nav1.5 (INa-L) via nNOS mediated nitrosylation of Nav1.5. In iPS-CMs, expression of LQT9 CAV3 mutations resulted in action potential duration (APD) prolongation and early-after depolarizations (EADs), supporting the arrhythmogenicity of LQT9. To evaluate the combined effect of the CAV3 mutants on INa-L and IK1, we studied both ventricular and Purkinje myocyte mathematical modeling. Interestingly, mathematical ventricular myocytes, similar to iPS-CMs, demonstrated EADs but no sustained arrhythmia. In contrast, Purkinje modeling demonstrated delayed-after depolarizations (DADs) driven mechanism for sustained arrhythmia, dependent on the combined loss of IK1 and gain of INa-L. This finding changes the overall assumed arrhythmia phenotype for LQT9. In future studies, we are exploring caveolar micro-domain disruption in heart failure and how this effects Kir2.x and Nav1.5. Here we review the caveolae cardiac microdomain of Kir2.x and Nav1.5 and explore some of the downstream effects of caveolin-3 and caveolae disruption in specific clinical scenarios.
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Affiliation(s)
- Ravi Vaidyanathan
- Cellular and Molecular Arrhythmia Research Program, University of Wisconsin-Madison, Madison, WI, United States
| | - Louise Reilly
- Cellular and Molecular Arrhythmia Research Program, University of Wisconsin-Madison, Madison, WI, United States
| | - Lee L Eckhardt
- Cellular and Molecular Arrhythmia Research Program, University of Wisconsin-Madison, Madison, WI, United States
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187
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Early Repolarization Pattern Inheritance in the Cardiac Arrest Survivors With Preserved Ejection Fraction Registry (CASPER). JACC Clin Electrophysiol 2018; 4:1473-1479. [DOI: 10.1016/j.jacep.2018.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 07/05/2018] [Accepted: 07/06/2018] [Indexed: 11/20/2022]
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188
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Raju H, Parsons S, Thompson TN, Morgan N, Zentner D, Trainer AH, James PA, Winship IM, Kalman JM, Vohra J. Insights into sudden cardiac death: exploring the potential relevance of non-diagnostic autopsy findings. Eur Heart J 2018; 40:831-838. [DOI: 10.1093/eurheartj/ehy654] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 06/09/2018] [Accepted: 10/15/2018] [Indexed: 01/05/2023] Open
Affiliation(s)
- Hariharan Raju
- Department of Cardiology, Royal Melbourne Hospital, 300 Grattan Street, Melbourne, VIC, Australia
- Faculty of Medicine & Health Sciences, Macquarie University, Sydney, NSW, Australia
| | - Sarah Parsons
- Forensic Pathology Services, Victorian Institute of Forensic Medicine, 65 Kavanagh St, Melbourne, VIC, Australia
- Department of Forensic Medicine, Monash University, 381 Royal Parade, Melbourne, VIC, Australia
| | - Tina N Thompson
- Department of Genomic Medicine, Royal Melbourne Hospital, 300 Grattan Street, Melbourne, VIC, Australia
| | - Natalie Morgan
- Forensic Pathology Services, Victorian Institute of Forensic Medicine, 65 Kavanagh St, Melbourne, VIC, Australia
| | - Dominica Zentner
- Department of Cardiology, Royal Melbourne Hospital, 300 Grattan Street, Melbourne, VIC, Australia
- Department of Genomic Medicine, Royal Melbourne Hospital, 300 Grattan Street, Melbourne, VIC, Australia
- Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Grattan Street, Melbourne, VIC, Australia
| | - Alison H Trainer
- Department of Genomic Medicine, Royal Melbourne Hospital, 300 Grattan Street, Melbourne, VIC, Australia
- Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Grattan Street, Melbourne, VIC, Australia
| | - Paul A James
- Department of Genomic Medicine, Royal Melbourne Hospital, 300 Grattan Street, Melbourne, VIC, Australia
- Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Grattan Street, Melbourne, VIC, Australia
| | - Ingrid M Winship
- Department of Genomic Medicine, Royal Melbourne Hospital, 300 Grattan Street, Melbourne, VIC, Australia
- Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Grattan Street, Melbourne, VIC, Australia
| | - Jonathan M Kalman
- Department of Cardiology, Royal Melbourne Hospital, 300 Grattan Street, Melbourne, VIC, Australia
- Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Grattan Street, Melbourne, VIC, Australia
| | - Jitendra Vohra
- Department of Cardiology, Royal Melbourne Hospital, 300 Grattan Street, Melbourne, VIC, Australia
- Department of Genomic Medicine, Royal Melbourne Hospital, 300 Grattan Street, Melbourne, VIC, Australia
- Faculty of Medicine, Dentistry & Health Sciences, University of Melbourne, Grattan Street, Melbourne, VIC, Australia
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189
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Linde C, Bongiorni MG, Birgersdotter-Green U, Curtis AB, Deisenhofer I, Furokawa T, Gillis AM, Haugaa KH, Lip GYH, Van Gelder I, Malik M, Poole J, Potpara T, Savelieva I, Sarkozy A. Sex differences in cardiac arrhythmia: a consensus document of the European Heart Rhythm Association, endorsed by the Heart Rhythm Society and Asia Pacific Heart Rhythm Society. Europace 2018; 20:1565-1565ao. [PMID: 29961863 DOI: 10.1093/europace/euy067] [Citation(s) in RCA: 143] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Cecilia Linde
- Heart and Vascular Theme, Karolinska University Hospital, S-17176 Stockholm, Sweden
| | | | | | | | - Isabel Deisenhofer
- Department of Electrophysiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | | | - Anne M Gillis
- Department of Cardiac Sciences, University of Calgary, Libin Cardiovascular Institute of Alberta, Alberta, Canada
| | - Kristina H Haugaa
- Department of Cardiology, Center for Cardiological Innovation and Institute for Surgical Research, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, UK
- Thrombosis Research Unit, Aalborg University, Denmark
| | - Isabelle Van Gelder
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marek Malik
- National Heart and Lung Institute, Imperial College, London
| | - Jeannie Poole
- University of Washington Medical center, Seattle, Washington, USA
| | - Tatjana Potpara
- School of Medicine, Belgrade University, Belgrade, Serbia
- Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | - Irina Savelieva
- St. George's, University of London, Cranmer Terrace, London, UK
| | - Andrea Sarkozy
- Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium
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190
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Milman A, Gourraud JB, Andorin A, Postema PG, Sacher F, Mabo P, Conte G, Giustetto C, Sarquella-Brugada G, Hochstadt A, Kim SH, Juang JJ, Maeda S, Takahashi Y, Kamakura T, Aiba T, Leshem E, Michowitz Y, Rahkovich M, Mizusawa Y, Arbelo E, Huang Z, Denjoy I, Wijeyeratne YD, Napolitano C, Brugada R, Casado-Arroyo R, Champagne J, Calo L, Tfelt-Hansen J, Priori SG, Takagi M, Veltmann C, Delise P, Corrado D, Behr ER, Gaita F, Yan GX, Brugada J, Leenhardt A, Wilde AA, Brugada P, Kusano KF, Hirao K, Nam GB, Probst V, Belhassen B. Gender differences in patients with Brugada syndrome and arrhythmic events: Data from a survey on arrhythmic events in 678 patients. Heart Rhythm 2018; 15:1457-1465. [DOI: 10.1016/j.hrthm.2018.06.019] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Indexed: 10/14/2022]
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191
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Complex aberrant splicing in the induced pluripotent stem cell–derived cardiomyocytes from a patient with long QT syndrome carrying KCNQ1-A344Aspl mutation. Heart Rhythm 2018; 15:1566-1574. [DOI: 10.1016/j.hrthm.2018.05.028] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Indexed: 02/06/2023]
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192
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Hendriks AA, Szili-Torok T. Editor's Choice-The treatment of electrical storm: an educational review. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2018; 7:478-483. [PMID: 30035628 PMCID: PMC6282269 DOI: 10.1177/2048872618781358] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Electrical storm is characterised by a state of severe electrical instability that occurs in a rare combination of circumstances, and may lead to multiple implantable cardioverter defibrillator shocks and haemodynamic instability, and possible death. The main goal of treating electrical storm is to eliminate the trigger and modify the substrate of the arrhythmia. The aim of this educational review is to provide information for a better understanding of the underlying mechanisms and therefore help to improve the treatment of electrical storm patients.
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Affiliation(s)
- Astrid A Hendriks
- Department of Clinical Electrophysiology, Erasmus Medical Center, The Netherlands
| | - Tamas Szili-Torok
- Department of Clinical Electrophysiology, Erasmus Medical Center, The Netherlands
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193
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Wisten A, Krantz P, Stattin EL. Unravelling the mystery behind sudden death in the young: a wake-up call for nationwide autopsy-based approach-Authors' reply. Europace 2018; 20:f273-f274. [PMID: 29300884 DOI: 10.1093/europace/eux349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Aase Wisten
- Department of Community Medicine and Rehabilitation, Sunderby Research Unit, Umeå University, Umeå Sweden
| | - Peter Krantz
- Department of Forensic Medicine, Lund University, Lund, Sweden
| | - Eva-Lena Stattin
- Department of Immunology, Genetics and Pathology, Uppsala University, Science for Life Laboratory, Uppsala, Sweden
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194
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Blanco-Verea A, Ramos-Luis E, García-Seara J, Carracedo Á, González-Juanatey JR, Brion M. A Novel Calsequestrin 2 Deletion Causing Catecholaminergic Polymorphic Ventricular Tachycardia and Sudden Cardiac Death. ACTA ACUST UNITED AC 2018; 72:681-683. [PMID: 30139651 DOI: 10.1016/j.rec.2018.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 07/06/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Alejandro Blanco-Verea
- Xenética Cardiovascular, Instituto de Investigación Sanitaria de Santiago de Compostela, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Servicio de Cardiología, Hospital Clínico Universitario de Santiago de Compostela-SERGAS, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Santiago de Compostela, A Coruña, Spain; Grupo de Medicina Xenómica, Instituto de Investigación Sanitaria de Santiago de Compostela -Universidade de Santiago de Compostela- Fundación Pública Galega de Medicina Xenómica, Santiago de Compostela, A Coruña, Spain
| | - Eva Ramos-Luis
- Xenética Cardiovascular, Instituto de Investigación Sanitaria de Santiago de Compostela, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Servicio de Cardiología, Hospital Clínico Universitario de Santiago de Compostela-SERGAS, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Santiago de Compostela, A Coruña, Spain; Grupo de Medicina Xenómica, Instituto de Investigación Sanitaria de Santiago de Compostela -Universidade de Santiago de Compostela- Fundación Pública Galega de Medicina Xenómica, Santiago de Compostela, A Coruña, Spain
| | - Javier García-Seara
- Servicio de Cardiología, Hospital Clínico Universitario de Santiago de Compostela-SERGAS, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Santiago de Compostela, A Coruña, Spain
| | - Ángel Carracedo
- Grupo de Medicina Xenómica, Instituto de Investigación Sanitaria de Santiago de Compostela -Universidade de Santiago de Compostela- Fundación Pública Galega de Medicina Xenómica, Santiago de Compostela, A Coruña, Spain
| | - José Ramón González-Juanatey
- Servicio de Cardiología, Hospital Clínico Universitario de Santiago de Compostela-SERGAS, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Santiago de Compostela, A Coruña, Spain
| | - María Brion
- Xenética Cardiovascular, Instituto de Investigación Sanitaria de Santiago de Compostela, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; Servicio de Cardiología, Hospital Clínico Universitario de Santiago de Compostela-SERGAS, Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Santiago de Compostela, A Coruña, Spain; Grupo de Medicina Xenómica, Instituto de Investigación Sanitaria de Santiago de Compostela -Universidade de Santiago de Compostela- Fundación Pública Galega de Medicina Xenómica, Santiago de Compostela, A Coruña, Spain.
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195
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Calcagnino M, Crocamo A, Ardissino D. Genetic testing in predicting the risk of sudden death. J Cardiovasc Med (Hagerstown) 2018; 18 Suppl 1:e64-e66. [PMID: 28009642 DOI: 10.2459/jcm.0000000000000477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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196
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Di Diego JM, Antzelevitch C. J wave syndromes as a cause of malignant cardiac arrhythmias. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:684-699. [PMID: 29870068 DOI: 10.1111/pace.13408] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 05/05/2018] [Indexed: 12/19/2022]
Abstract
The J wave syndromes, including the Brugada (BrS) and early repolarization (ERS) syndromes, are characterized by the manifestation of prominent J waves in the electrocardiogram appearing as an ST segment elevation and the development of life-threatening cardiac arrhythmias. BrS and ERS differ with respect to the magnitude and lead location of abnormal J waves and are thought to represent a continuous spectrum of phenotypic expression termed J wave syndromes. Despite over 25 years of intensive research, risk stratification and the approach to therapy of these two inherited cardiac arrhythmia syndromes are still rapidly evolving. Our objective in this review is to provide an integrated synopsis of the clinical characteristics, risk stratifiers, as well as the molecular, ionic, cellular, and genetic mechanisms underlying these two syndromes that have captured the interest and attention of the cardiology community over the past two decades.
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Affiliation(s)
| | - Charles Antzelevitch
- Lankenau Institute for Medical Research, Wynnewood, PA, USA.,Lankenau Heart Institute, Wynnewood, PA, USA.,Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
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197
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Sieira J, Brugada P. The definition of the Brugada syndrome. Eur Heart J 2018; 38:3029-3034. [PMID: 29020354 DOI: 10.1093/eurheartj/ehx490] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 08/07/2017] [Indexed: 12/30/2022] Open
Abstract
Brugada syndrome (BS) is an inherited disease characterized by a coved-type ST-segment elevation in the right precordial leads and increased risk of sudden cardiac death (SCD), in the absence of structural abnormalities. The cornerstone of BS diagnosis and definition, is its characteristic ECG pattern that can be present spontaneously or unmasked by drugs. Brugada syndrome was first described 25 years ago; paradoxically, in an era of great technological development, a new syndrome was described with a technology developed almost a century before. Great scientific knowledge has been gathered since the description of the syndrome. The better understanding of its pathophysiology and genetic basis has led to several modifications in its definition. Despite these facts, the essential, the description of the specific ECG pattern has remained almost unchanged since the initial report. In this article, we present the definition of the BS, the rationale behind it and our thoughts about its future.
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Affiliation(s)
- Juan Sieira
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Brussels, Belgium
| | - Pedro Brugada
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate program in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Brussels, Belgium
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198
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Stallmeyer B, Dittmann S, Schulze-Bahr E. Genetische Diagnostik zur Vermeidung des plötzlichen Herztods. Internist (Berl) 2018; 59:776-789. [DOI: 10.1007/s00108-018-0462-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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199
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Concomitant Brugada syndrome substrate ablation and epicardial abdominal cardioverter-defibrillator implantation in a child. HeartRhythm Case Rep 2018; 4:214-218. [PMID: 29928586 PMCID: PMC6007146 DOI: 10.1016/j.hrcr.2017.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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200
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Silvetti MS, Pazzano V, Verticelli L, Battipaglia I, Saputo FA, Albanese S, Lovecchio M, Valsecchi S, Drago F. Subcutaneous implantable cardioverter-defibrillator: is it ready for use in children and young adults? A single-centre study. Europace 2018; 20:1966-1973. [DOI: 10.1093/europace/euy139] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 05/28/2018] [Indexed: 01/30/2023] Open
Affiliation(s)
- Massimo Stefano Silvetti
- Pediatric Cardiology and Cardiac Arrhythmias Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital and Research Institute, Palidoro, Via Torre di Palidoro 1, Palidoro-Fiumicino, Rome, Italy
| | - Vincenzo Pazzano
- Pediatric Cardiology and Cardiac Arrhythmias Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital and Research Institute, Palidoro, Via Torre di Palidoro 1, Palidoro-Fiumicino, Rome, Italy
| | - Letizia Verticelli
- Pediatric Cardiology and Cardiac Arrhythmias Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital and Research Institute, Palidoro, Via Torre di Palidoro 1, Palidoro-Fiumicino, Rome, Italy
| | - Irma Battipaglia
- Pediatric Cardiology and Cardiac Arrhythmias Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital and Research Institute, Palidoro, Via Torre di Palidoro 1, Palidoro-Fiumicino, Rome, Italy
| | - Fabio Anselmo Saputo
- Pediatric Cardiology and Cardiac Arrhythmias Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital and Research Institute, Palidoro, Via Torre di Palidoro 1, Palidoro-Fiumicino, Rome, Italy
| | - Sonia Albanese
- Heart Surgery Team, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital and Research Institute, Palidoro, Rome, Italy
| | | | - Sergio Valsecchi
- Heart Surgery Team, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital and Research Institute, Palidoro, Rome, Italy
| | - Fabrizio Drago
- Pediatric Cardiology and Cardiac Arrhythmias Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital and Research Institute, Palidoro, Via Torre di Palidoro 1, Palidoro-Fiumicino, Rome, Italy
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