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Siu A, Tandanu E, Ma B, Osas EE, Liu H, Liu T, Chou OHI, Huang H, Tse G. Precision medicine in catecholaminergic polymorphic ventricular tachycardia: Recent advances toward personalized care. Ann Pediatr Cardiol 2023; 16:431-446. [PMID: 38817258 PMCID: PMC11135882 DOI: 10.4103/apc.apc_96_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 12/12/2023] [Accepted: 01/14/2024] [Indexed: 06/01/2024] Open
Abstract
Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare inherited cardiac ion channelopathy where the initial disease presentation is during childhood or adolescent stages, leading to increased risks of sudden cardiac death. Despite advances in medical science and technology, several gaps remain in the understanding of the molecular mechanisms, risk prediction, and therapeutic management of patients with CPVT. Recent studies have identified and validated seven sets of genes responsible for various CPVT phenotypes, including RyR2, CASQ-2, TRDN, CALM1, 2, and 3, and TECRL, providing novel insights into the molecular mechanisms. However, more data on atypical CPVT genotypes are required to investigate the underlying mechanisms further. The complexities of the underlying genetics contribute to challenges in risk stratification as well as the uncertainty surrounding nongenetic modifiers. Therapeutically, although medical management involving beta-blockers and flecainide, or insertion of an implantable cardioverter defibrillator remains the mainstay of treatment, animal and stem cell studies on gene therapy for CPVT have shown promising results. However, its clinical applicability remains unclear. Current gene therapy studies have primarily focused on the RyR2 and CASQ-2 variants, which constitute 75% of all CPVT cases. Alternative approaches that target a broader population, such as CaMKII inhibition, could be more feasible for clinical implementation. Together, this review provides an update on recent research on CPVT, highlighting the need for further investigation of the molecular mechanisms, risk stratification, and therapeutic management of this potentially lethal condition.
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Affiliation(s)
- Anthony Siu
- Cardiac Electrophysiology Unit, Cardiovascular Analytics Group, Powerhealth Research Institute, Hong Kong, China
- GKT School of Medical Education, King’s College London, London, United Kingdom
| | - Edelyne Tandanu
- GKT School of Medical Education, King’s College London, London, United Kingdom
| | - Brian Ma
- Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | | | - Haipeng Liu
- Research Centre for Intelligent Healthcare, Coventry University, Coventry, United Kingdom
| | - Tong Liu
- Department of Cardiology, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Oscar Hou In Chou
- Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Helen Huang
- University of Medicine and Health Science, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Gary Tse
- Department of Cardiology, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
- Kent and Medway Medical School, University of Kent, Canterbury, United Kingdom
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China
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2
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Collins NJ, Finn D, O'Mahony O, Walsh M. Survival in a young child with out-of-hospital cardiac arrest: diagnostic dilemma and when to deviate from standard resuscitation guidelines. BMJ Case Rep 2023; 16:e255729. [PMID: 37852665 PMCID: PMC10603545 DOI: 10.1136/bcr-2023-255729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023] Open
Abstract
A boy in early childhood presented in cardiac arrest. Care was provided out of hospital and in the emergency department as per standard paediatric resuscitation guidelines. Despite initial return of spontaneous circulation following cardiopulmonary resuscitation, two defibrillation shocks and epinephrine via intraosseous access, he had recurrent episodes of pulseless ventricular tachycardia and ventricular fibrillation. In total, 40 defibrillation shocks were administered, and he subsequently stabilised on combined treatment with intravenous esmolol, amiodarone and milrinone. He was transferred to the paediatric intensive care unit and had an automated implantable cardioverter-defibrillator inserted prior to discharge. Genetic testing has confirmed a diagnosis of catecholaminergic polymorphic ventricular tachycardia and it is hypothesised that the childhood excitement at a popular time of year, combined with caffeinated drinks, instigated his initial cardiac arrest which was propagated with iatrogenic epinephrine. He has remained stable since, with no neurological sequelae thus far from a significantly prolonged downtime.
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Affiliation(s)
- Neil John Collins
- Cardiac Services, The Royal Children's Hospital, Melbourne, Victoria, Australia
- Paediatrics, Cork University Hospital, Cork, Ireland
| | - Daragh Finn
- Paediatrics, Cork University Hospital, Cork, Ireland
| | | | - Mark Walsh
- Paediatric Cardiology, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
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Mascia G, Brugada J, Arbelo E, Porto I. Athletes and suspected catecholaminergic polymorphic ventricular tachycardia: Awareness and current knowledge. J Cardiovasc Electrophysiol 2023; 34:2095-2101. [PMID: 37655865 DOI: 10.1111/jce.16045] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 08/01/2023] [Accepted: 08/17/2023] [Indexed: 09/02/2023]
Abstract
INTRODUCTION Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a cardiac inherited arrhythmogenic disease potentially leading to sudden cardiac death that is determined by electrical instability exacerbated by acute adrenergic tone. METHODS AND RESULTS Despite its life-threatening nature, CPVT remains potentially unnoticed since diagnosis may be difficult especially in apparently healthy athletes. This review summarizes current knowledge and shortcomings of CPVT, focusing on genetics, arrhythmic mechanisms, sport preparticipation screening, and current recommendations. CONCLUSIONS The paper captures the importance of CPVT athletes regarding the necessity of risk stratification, as well as the importance of maintaining a healthy lifestyle.
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Affiliation(s)
- Giuseppe Mascia
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Josep Brugada
- Arrhythmia, Inherited Cardiac Diseases and Sudden Death Unit, Hospital Sant Joan de Deu, Universitat de Barcelona, Barcelona, Spain
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of The Heart-ERN GUARD-Heart
| | - Elena Arbelo
- Arrhythmia Section, Cardiology Department, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Member of the European Reference Network for Rare, Low Prevalence and Complex Diseases of The Heart-ERN GUARD-Heart
| | - Italo Porto
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine, University of Genoa, Genoa, Italy
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Ebrahim MA, Alkhabbaz AA, Albash B, AlSayegh AH, Webster G. Trans-2,3-enoyl-CoA reductase-like-related catecholaminergic polymorphic ventricular tachycardia with regular ventricular tachycardia and response to flecainide. J Cardiovasc Electrophysiol 2023; 34:1996-2001. [PMID: 37473425 DOI: 10.1111/jce.16011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 06/23/2023] [Accepted: 07/10/2023] [Indexed: 07/22/2023]
Abstract
INTRODUCTION We describe a unique case of TECRL-CPVT presented with cardiac arrest. METHODS Post resuscitation, the patient developed regular ventricular tachycardia featuring a left purkinje system morphology. RESULTS There was clear suppression of arrhythmia with the addition of flecainide and isolated ventricular ectopy causing secondary T-wave changes. CONCLUSION A high index of suspicion was required to eventually make the diagnosis through whole exome sequencing.
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Affiliation(s)
- Mohammad A Ebrahim
- Department of Pediatrics, Affiliated with Chest Diseases Hospital, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | | | - Buthaina Albash
- Department of Genetics, Ghanima Al Ghanem Center, Ministry of Health, Kuwait City, Kuwait
| | - Ali H AlSayegh
- Department of Cardiology, Chest Diseases Hospital, Ministry of Health, Kuwait City, Kuwait
| | - Gregory Webster
- Division of Cardiology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Bergeman AT, Wilde AAM, van der Werf C. Catecholaminergic Polymorphic Ventricular Tachycardia: A Review of Therapeutic Strategies. Card Electrophysiol Clin 2023; 15:293-305. [PMID: 37558300 DOI: 10.1016/j.ccep.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an inherited arrhythmia syndrome characterized by bidirectional or polymorphic ventricular arrhythmia provoked by exercise or emotion. Most cases are caused by pathogenic variants in the gene encoding the cardiac ryanodine receptor (RYR2). The options for treating patients with CPVT have increased during the years, and evidence suggests that these have led to lower arrhythmic event rates. In addition, numerous potential new therapies are being investigated. In this review, we summarize the state of knowledge on both established and potential future treatment strategies for patients with CPVT and describe our approach to their management.
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Affiliation(s)
- Auke T Bergeman
- Department of Cardiology, Heart Centre, Amsterdam UMC Location Academic Medical Centre, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, the Netherlands
| | - Arthur A M Wilde
- Department of Cardiology, Heart Centre, Amsterdam UMC Location Academic Medical Centre, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, the Netherlands
| | - Christian van der Werf
- Department of Cardiology, Heart Centre, Amsterdam UMC Location Academic Medical Centre, University of Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands; Amsterdam Cardiovascular Sciences, Heart Failure and Arrhythmias, Amsterdam, the Netherlands.
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Pérez PR, Hylind RJ, Roston TM, Bezzerides VJ, Abrams DJ. Gene Therapy for Catecholaminergic Polymorphic Ventricular Tachycardia. Heart Lung Circ 2023; 32:790-797. [PMID: 37032191 DOI: 10.1016/j.hlc.2023.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/13/2022] [Accepted: 01/04/2023] [Indexed: 04/11/2023]
Abstract
Over the last three decades, the genetic basis of various inherited arrhythmia syndromes has been elucidated, providing key insights into cardiomyocyte biology and various regulatory pathways associated with cellular excitation, contraction, and repolarisation. As varying techniques to manipulate genetic sequence, gene expression, and different cellular pathways have become increasingly defined and understood, the potential to apply various gene-based therapies to inherited arrhythmia has been explored. The promise of gene therapy has generated significant interest in the medical and lay press, providing hope for sufferers of seemingly incurable disorders to imagine a future without repeated medical intervention, and, in the case of various cardiac disorders, without the risk of sudden death. In this review, we focus on catecholaminergic polymorphic ventricular tachycardia (CPVT), discussing the clinical manifestations, genetic basis, and molecular biology, together with current avenues of research related to gene therapy.
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Affiliation(s)
- Paloma Remior Pérez
- Center for Cardiovascular Genetics, Boston Children's Hospital, Harvard Medical School, Boston MA, USA; Department of Cardiology, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Robyn J Hylind
- Center for Cardiovascular Genetics, Boston Children's Hospital, Harvard Medical School, Boston MA, USA
| | - Thomas M Roston
- Center for Cardiovascular Genetics, Boston Children's Hospital, Harvard Medical School, Boston MA, USA; Clinician Investigator Program, The University of British Columbia, Vancouver, Canada
| | - Vassilios J Bezzerides
- Center for Cardiovascular Genetics, Boston Children's Hospital, Harvard Medical School, Boston MA, USA.
| | - Dominic J Abrams
- Center for Cardiovascular Genetics, Boston Children's Hospital, Harvard Medical School, Boston MA, USA.
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Charafeddine F, Assaf N, Ismail A, Bulbul Z. Novel Trans-2,3-enoyl-CoA reductase-like Variant Associated with Catecholaminergic Polymorphic Ventricular Tachycardia Type 3. HeartRhythm Case Rep 2022; 9:171-177. [PMID: 36970382 PMCID: PMC10030308 DOI: 10.1016/j.hrcr.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Lawley CM, Tester M, Sanatani S, Prendiville T, Beach CM, Vinocur JM, Horie M, Uhm JS, Khongphatthanayothin A, Ayers MD, Starling L, Yoshida Y, Shah MJ, Skinner JR, Turner C. Life-threatening cardiac arrhythmia and sudden death during electronic gaming: An international case series and systematic review. Heart Rhythm 2022; 19:1826-1833. [PMID: 37850595 DOI: 10.1016/j.hrthm.2022.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 07/21/2022] [Accepted: 08/02/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Electronic gaming has recently been reported as a precipitant of life-threatening cardiac arrhythmia in susceptible individuals. OBJECTIVE The purpose of this study was to describe the population at risk, the nature of cardiac events, and the type of game linked to cardiac arrhythmia associated with electronic gaming. METHODS A multisite international case series of suspected or proven cardiac arrhythmia during electronic gaming in children and a systematic review of the literature were performed. RESULTS Twenty-two patients (18 in the case series and 4 via systematic review; aged 7-16 years; 19 males [86%]) were identified as having experienced suspected or proven ventricular arrhythmia during electronic gaming; 6 (27%) had experienced cardiac arrest, and 4 (18%) died suddenly. A proarrhythmic cardiac diagnosis was known in 7 (31%) patients before their gaming event and was established afterward in 12 (54%). Ten patients (45%) had catecholaminergic polymorphic ventricular tachycardia, 4 (18%) had long QT syndrome, 2 (9%) were post-congenital cardiac surgery, 2 (9%) had "idiopathic" ventricular fibrillation, and 1 (after Kawasaki disease) had coronary ischemia. In 3 patients (14%), including 2 who died, the diagnosis remains unknown. In 13 (59%) patients for whom the electronic game details were known, 8 (62%) were war games. CONCLUSION Electronic gaming can precipitate lethal cardiac arrhythmias in susceptible children. The incidence appears to be low, but syncope in this setting should be investigated thoroughly. In children with proarrhythmic cardiac conditions, electronic war games in particular are a potent arrhythmic trigger.
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Affiliation(s)
- Claire M Lawley
- The Heart Centre for Children, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia; The University of Sydney Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Department of Paediatric Cardiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom.
| | - Matthew Tester
- Children's Heart Centre, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Shubhayan Sanatani
- Children's Heart Centre, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Terence Prendiville
- Department of Cardiology and Cardiac Surgery, Children's Health Ireland at Crumlin, Dublin, Republic of Ireland
| | - Cheyenne M Beach
- Department of Pediatrics, Division of Pediatric Cardiology, Yale University School of Medicine, New Haven, Connecticut
| | - Jeffrey M Vinocur
- Department of Pediatrics, Division of Pediatric Cardiology, Yale University School of Medicine, New Haven, Connecticut; Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Minoru Horie
- Department of Cardiovascular Medicine, Shiga University of Medical Science, Shiga, Japan
| | - Jae-Sun Uhm
- Department of Cardiology, Yongin Severance Hospital, College of Medicine, Yonsei University, Yongin, Gyeonggi-do, Republic of Korea
| | - Apichai Khongphatthanayothin
- Department of Cardiology, Yongin Severance Hospital, College of Medicine, Yonsei University, Yongin, Gyeonggi-do, Republic of Korea; Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Mark D Ayers
- Department of Pediatrics, Division of Pediatric Cardiology, Pediatric Electrophysiology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Luke Starling
- Department of Paediatric Cardiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, United Kingdom
| | - Yoko Yoshida
- Department of Pediatric Electrophysiology, Osaka City General Hospital, Miyakojima-hondori, Miyakojima-ku, Osaka, Japan
| | - Maully J Shah
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jonathan R Skinner
- The Heart Centre for Children, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
| | - Christian Turner
- The Heart Centre for Children, Sydney Children's Hospitals Network, Sydney, New South Wales, Australia
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Abbas M, Miles C, Behr E. Catecholaminergic Polymorphic Ventricular Tachycardia. Arrhythm Electrophysiol Rev 2022; 11:e20. [PMID: 36644199 PMCID: PMC9820193 DOI: 10.15420/aer.2022.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 07/02/2022] [Indexed: 01/17/2023] Open
Abstract
Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an inherited arrhythmia syndrome characterised by adenergically mediated bidirectional and/or polymorphic ventricular tachycardia. CPVT is a significant cause of autopsy-negative sudden death in children and adolescents, although it can also affect adults. It is often caused by pathogenic variants in the cardiac ryanodine receptor gene as well as other rarer genes. Early identification and risk stratification is of major importance. β-blockers are the cornerstone of therapy. Sodium channel blockers, specifically flecainide, have an additive role. Left cardiac sympathetic denervation is playing an increasing role in suppression of arrhythmia and symptoms. Concerns have been raised, however, about the efficacy of implantable cardioverter defibrillator therapy and the risk of catecholamine driven proarrhythmic storms. In this review, we summarise the clinical characteristics, genetics, and diagnostic and therapeutic strategies for CPVT and describe recent advances and challenges.
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Affiliation(s)
- Mohamed Abbas
- Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK
| | - Chris Miles
- Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Institute, St George's, University of London and St George's University Hospitals NHS Foundation Trust, London, UK
| | - Elijah Behr
- Cardiovascular Clinical Academic Group, Molecular and Clinical Sciences Institute, St George's, University of London and St George's University Hospitals NHS Foundation Trust, London, UK
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Singh AK. Recognition and Management Considerations of Cardiac Channelopathies in the Intensive Care Unit. Crit Care Clin 2022; 38:231-242. [DOI: 10.1016/j.ccc.2021.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Cicenia M, Silvetti MS, Drago F. When Should Premature Ventricular Contractions Be Considered as a Red Flag in Children with Cardiomyopathy? J Cardiovasc Dev Dis 2021; 8:jcdd8120176. [PMID: 34940531 PMCID: PMC8707971 DOI: 10.3390/jcdd8120176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/02/2021] [Accepted: 12/07/2021] [Indexed: 11/16/2022] Open
Abstract
Premature ventricular contractions (PVCs) are common and generally benign in childhood and tend to resolve spontaneously in most cases. When PVCs occur frequently, an arrhythmia-induced cardiomyopathy may be present requiring medical or catheter ablation. PVCs are only rarely the manifestation of a cardiomyopathy. The purpose of this review is to provide some tips and tricks to raise the suspicion of a cardiac disease based on the presence and characteristics of PVCs in children.
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Siskin M, Cerrone M, Shokr M, Aizer A, Barbhaiya C, Dai M, Bernstein S, Holmes D, Knotts R, Park DS, Spinelli M, Chinitz LA, Jankelson L. ICD shocks and complications in patients with inherited arrhythmia syndromes. IJC HEART & VASCULATURE 2021; 37:100908. [PMID: 34765721 PMCID: PMC8569698 DOI: 10.1016/j.ijcha.2021.100908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 10/25/2021] [Indexed: 11/26/2022]
Abstract
Background There is limited information on the long-term outcomes of ICDs in patients with inherited arrhythmia syndromes. Methods Prospective registry study of inherited arrhythmia patients with an ICD. Incidence of therapies and complications were measured as 5-year cumulative incidence proportions and analyzed with the Kaplan-Meier method. Incidence was compared by device indication, diagnosis type and device type. Cox-regression analysis was used to identify predictors of appropriate shock and device complication. Results 123 patients with a mean follow up of 6.4 ± 4.8 years were included. The incidence of first appropriate shock was 56.52% vs 24.44%, p < 0.05 for cardiomyopathy and channelopathy patients, despite similar ejection fraction (61% vs 60%, p = 0.6). The incidence of first inappropriate shock was 13.46% vs 56.25%, p < 0.01 for single vs. multi-lead devices. The incidence of first lead complication was higher for multi-lead vs. single lead devices, 43.75% vs. 17.31%, p = 0.04. Patients with an ICD for secondary prevention were more likely to receive an appropriate shock than those with primary prevention indication (HR 2.21, CI 1.07-4.56, p = 0.03). Multi-lead devices were associated with higher risk of inappropriate shock (HR 3.99, CI 1.27-12.52, p = 0.02), with similar appropriate shock risk compared to single lead devices. In 26.5% of patients with dual chamber devices, atrial sensing or pacing was not utilized. Conclusion The rate of appropriate therapies and ICD complications in patients with inherited arrhythmia is high, particularly in cardiomyopathies with multi-lead devices. Risk-benefit ratio should be carefully considered when assessing the indication and type of device in this population.
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Affiliation(s)
- Matthew Siskin
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York, NY, USA
| | - Marina Cerrone
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York, NY, USA
| | - Mohamed Shokr
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York, NY, USA
| | - Anthony Aizer
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York, NY, USA
| | - Chirag Barbhaiya
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York, NY, USA
| | - Matthew Dai
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York, NY, USA
| | - Scott Bernstein
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York, NY, USA
| | - Douglas Holmes
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York, NY, USA
| | - Robert Knotts
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York, NY, USA
| | - David S Park
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York, NY, USA
| | - Michael Spinelli
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York, NY, USA
| | - Larry A Chinitz
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York, NY, USA
| | - Lior Jankelson
- Leon H. Charney Division of Cardiology, NYU Langone Health, New York, NY, USA
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Affiliation(s)
- Jitae A Kim
- Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Mihail G Chelu
- Section of Cardiology, Baylor College of Medicine, Houston, Texas
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Duong T, Rose R, Blazeski A, Fine N, Woods CE, Thole JF, Sotoodehnia N, Soliman EZ, Tung L, McCallion AS, Arking DE. Development and optimization of an in vivo electrocardiogram recording method and analysis program for adult zebrafish. Dis Model Mech 2021; 14:dmm048827. [PMID: 34378773 PMCID: PMC8380046 DOI: 10.1242/dmm.048827] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 06/30/2021] [Indexed: 12/18/2022] Open
Abstract
Clinically pertinent electrocardiogram (ECG) data from model systems, such as zebrafish, are crucial for illuminating factors contributing to human cardiac electrophysiological abnormalities and disease. Current zebrafish ECG collection strategies have not adequately addressed the consistent acquisition of high-quality traces or sources of phenotypic variation that could obscure data interpretation. Thus, we developed a novel platform to ensure high-quality recording of in vivo subdermal adult zebrafish ECGs and zebrafish ECG reading GUI (zERG), a program to acquire measurements from traces that commercial software cannot examine owing to erroneous peak calling. We evaluate normal ECG trait variation, revealing highly reproducible intervals and wave amplitude variation largely driven by recording artifacts, and identify sex and body size as potential confounders to PR, QRS and QT intervals. With this framework, we characterize the effect of the class I anti-arrhythmic drug flecainide acetate on adults, provide support for the impact of a Long QT syndrome model, and establish power calculations for this and other studies. These results highlight our pipeline as a robust approach to evaluate zebrafish models of human cardiac electrophysiological phenotypes.
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Affiliation(s)
- ThuyVy Duong
- McKusick-Nathans Institute, Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Rebecca Rose
- McKusick-Nathans Institute, Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Adriana Blazeski
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Noah Fine
- McKusick-Nathans Institute, Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Courtney E. Woods
- McKusick-Nathans Institute, Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Joseph F. Thole
- McKusick-Nathans Institute, Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Nona Sotoodehnia
- Cardiovascular Health Research Unit, Departments of Medicine and Epidemiology, University of Washington, Seattle, WA 98101, USA
| | - Elsayed Z. Soliman
- Epidemiological Cardiology Research Center (EPICARE), Wake Forest School of Medicine, Winston Salem, NC 27101, USA
| | - Leslie Tung
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Andrew S. McCallion
- McKusick-Nathans Institute, Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Dan E. Arking
- McKusick-Nathans Institute, Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
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Sallmon H, Weber SC, Berger F, Will JC. Unexpected ventricular tachycardia following acoustic provocation during electroencephalography. Arch Dis Child 2021; 106:708. [PMID: 33087389 DOI: 10.1136/archdischild-2020-320420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Hannes Sallmon
- Department of Pediatric Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sven C Weber
- Department of Pediatric Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Felix Berger
- Department of Pediatric Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Joachim C Will
- Department of Pediatric Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Precision Medicine in Catecholaminergic Polymorphic Ventricular Tachycardia: JACC Focus Seminar 5/5. J Am Coll Cardiol 2021; 77:2592-2612. [PMID: 34016269 DOI: 10.1016/j.jacc.2020.12.073] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/14/2020] [Accepted: 12/21/2020] [Indexed: 11/20/2022]
Abstract
In this final of a 5-part Focus Seminar series on precision medicine, we focus on catecholaminergic polymorphic ventricular tachycardia (CPVT). This focus on CPVT allows us to take a "deep dive" and explore the full extent of the precision medicine opportunities for a single cardiovascular condition at a level that was not possible in the preceding articles. As a new paradigm presented in this article, it has become clear that CPVT can occur as either a typical or atypical form. Although there is a degree of overlap between the typical and atypical forms, it is notable that they arise due to different underlying genetic changes, likely exhibiting differing mechanisms of action, and presenting with different phenotypic features. The recognition of these differing forms of CPVT and their different etiologies and mechanisms is an important step toward implementing rapidly emerging precision medicine approaches that will tailor novel therapies to specific gene defects.
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Stępień-Wojno M, Ponińska J, Biernacka EK, Foss-Nieradko B, Chwyczko T, Syska P, Płoski R, Bilińska ZT. A Recurrent Exertional Syncope and Sudden Cardiac Arrest in a Young Athlete with Known Pathogenic p.Arg420Gln Variant in the RYR2 Gene. Diagnostics (Basel) 2020; 10:diagnostics10070435. [PMID: 32605058 PMCID: PMC7399804 DOI: 10.3390/diagnostics10070435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/17/2020] [Accepted: 06/25/2020] [Indexed: 11/16/2022] Open
Abstract
Catecholaminergic polymorphic ventricular tachycardia (CPVT) is one of causes of sudden cardiac death in the young, especially in athletes. Diagnosis of CPVT may be difficult since all cardiological examinations performed at rest are usually normal, and exercise stress test-induced ventricular tachycardia is not commonly present. The identification of a pathogenic mutation in RYR2 or CASQ2 is diagnostic in CPVT. We report on a 20-year-old athlete who survived two sudden cardiac arrests during swimming. Moreover, he suffered repeated syncopal spells on exercise. The diagnosis was made only following genetic testing using a multi-gene panel, and the p.Arg420Gln RYR2 variant was identified. We present diagnostic and therapeutic issues in this young athlete with CPVT.
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Affiliation(s)
- Małgorzata Stępień-Wojno
- Unit for Screening Studies in Inherited Cardiovascular Diseases, National Institute of Cardiology, 04-628 Warsaw, Poland; (M.S.-W.); (B.F.-N.)
| | - Joanna Ponińska
- Department of Medical Biology, National Institute of Cardiology, 04-628 Warsaw, Poland;
| | - Elżbieta K. Biernacka
- Department of Congenital Heart Diseases, National Institute of Cardiology, 04-628 Warsaw, Poland;
| | - Bogna Foss-Nieradko
- Unit for Screening Studies in Inherited Cardiovascular Diseases, National Institute of Cardiology, 04-628 Warsaw, Poland; (M.S.-W.); (B.F.-N.)
| | - Tomasz Chwyczko
- Department of Coronary Artery Disease and Cardiac Rehabilitation, National Institute of Cardiology, 04-628 Warsaw, Poland;
| | - Piotr Syska
- 2nd Department of Arrhythmia, National Institute of Cardiology, 04-628 Warsaw, Poland;
| | - Rafał Płoski
- Department of Medical Genetics, Medical University of Warsaw, 02-106 Warsaw, Poland;
| | - Zofia T. Bilińska
- Unit for Screening Studies in Inherited Cardiovascular Diseases, National Institute of Cardiology, 04-628 Warsaw, Poland; (M.S.-W.); (B.F.-N.)
- Correspondence:
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