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Lee S, Zhou J, Jeevaratnam K, Wong WT, Wong ICK, Mak C, Mok NS, Liu T, Zhang Q, Tse G. Paediatric/young versus adult patients with long QT syndrome. Open Heart 2021; 8:openhrt-2021-001671. [PMID: 34518285 PMCID: PMC8438947 DOI: 10.1136/openhrt-2021-001671] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/02/2021] [Indexed: 12/20/2022] Open
Abstract
Introduction Long QT syndrome (LQTS) is a less prevalent cardiac ion channelopathy than Brugada syndrome in Asia. The present study compared the outcomes between paediatric/young and adult LQTS patients. Methods This was a population-based retrospective cohort study of consecutive patients diagnosed with LQTS attending public hospitals in Hong Kong. The primary outcome was spontaneous ventricular tachycardia/ventricular fibrillation (VT/VF). Results A total of 142 LQTS (mean onset age=27±23 years old) were included. Arrhythmias other than VT/VF (HR 4.67, 95% CI (1.53 to 14.3), p=0.007), initial VT/VF (HR=3.25 (95% CI 1.29 to 8.16), p=0.012) and Schwartz score (HR=1.90 (95% CI 1.11 to 3.26), p=0.020) were predictive of the primary outcome for the overall cohort, while arrhythmias other than VT/VF (HR=5.41 (95% CI 1.36 to 21.4), p=0.016) and Schwartz score (HR=4.67 (95% CI 1.48 to 14.7), p=0.009) were predictive for the adult subgroup (>25 years old; n=58). A random survival forest model identified initial VT/VF, Schwartz score, initial QTc interval, family history of LQTS, initially asymptomatic and arrhythmias other than VT/VF as the most important variables for risk prediction. Conclusion Clinical and ECG presentation varies between the paediatric/young and adult LQTS population. Machine learning models achieved more accurate VT/VF prediction.
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Affiliation(s)
- Sharen Lee
- Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration
| | - Jiandong Zhou
- School of Data Science, City University of Hong Kong, Hong Kong, People's Republic of China
| | - Kamalan Jeevaratnam
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK
| | - Wing Tak Wong
- School of Life Sciences, Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | - Ian Chi Kei Wong
- Research Department of Practice and Policy, University College London School of Pharmacy, London, UK
| | - Chloe Mak
- Department of Pathology, Hong Kong Children's Hospital, Hong Kong, People's Republic of China
| | - Ngai Shing Mok
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, People's Republic of 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, People's Republic of China
| | - Qingpeng Zhang
- School of Data Science, City University of Hong Kong, Hong Kong, People's Republic of China
| | - Gary Tse
- Cardiovascular Analytics Group, Hong Kong, China-UK Collaboration .,Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, UK.,Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, People's Republic of China
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Czosek RJ, Kaltman JR, Cassedy AE, Shah MJ, Vetter VL, Tanel RE, Wernovksy G, Wray J, Marino BS. Quality of Life of Pediatric Patients With Long QT Syndrome. Am J Cardiol 2016; 117:605-610. [PMID: 26721659 DOI: 10.1016/j.amjcard.2015.11.051] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 11/18/2015] [Accepted: 11/18/2015] [Indexed: 11/24/2022]
Abstract
Children with long QT syndrome (LQTS) live with the risk of sudden death, activity restrictions, and the need for daily medications. We sought to evaluate the quality of life (QOL), self-perception, and behavior of patients with LQTS as perceived by both patients and their parents and identify predictors of lower QOL. QOL (Pediatric QOL Inventory [PedsQL] and Pediatric Cardiac Quality of Life Inventory [PCQLI]), self-perception, and behavioral inventories were completed by patients with LQTS and their parents. Comparison of PedsQL scores was made to published data for healthy children using t tests, and PCQLI scores were compared with those of patients with differing complexity of congenital heart disease. Mixed modeling was used for multivariable analysis. Sixty-one patients with LQTS were evaluated (age 13.6 ± 3.0 years; male 49%). Compared with healthy children, the PedsQL Total, Psychosocial, and Physical Health Summary scores were significantly lower for patients with LQTS and parent proxy reports (p ≤0.001). In general, PCQLI scores of patients with LQTS and parents were similar to those of patients with tetralogy of Fallot (p ≥0.2), lower than those of patients with bicuspid aortic valve (p ≤0.02), and higher than those of patients with single ventricle (p ≤0.03). Lower patient and parent PCQLI scores were associated with internalizing problems. For parents, the presence of a cardiac device and medication side effects were additionally associated with lower PCQLI scores. In conclusion, patients with LQTS and their parents report lower QOL than normal children secondary to physical and psychosocial factors. Increasing focus on the psychological well-being of these patients is needed in an effort to improve their QOL.
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Yoshinaga M, Kucho Y, Sarantuya J, Ninomiya Y, Horigome H, Ushinohama H, Shimizu W, Horie M. Genetic Characteristics of Children and Adolescents With Long-QT Syndrome Diagnosed by School-Based Electrocardiographic Screening Programs. Circ Arrhythm Electrophysiol 2014; 7:107-12. [DOI: 10.1161/circep.113.000426] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
A school-based electrocardiographic screening program has been developed in Japan. However, few data are available on the genetic characteristics of pediatric patients with long-QT syndrome who were diagnosed by this program.
Methods and Results—
A total of 117 unrelated probands aged ≤18 years were the subjects who were referred to our centers for genetic testing. Of these, 69 subjects diagnosed by the program formed the screened group. A total of 48 subjects were included in the clinical group and were diagnosed with long-QT syndrome–related symptoms, familial study, or by chance. Mutations were classified as radical, of high probability of pathogenicity, or of uncertain significance. Two subjects in the clinical group died. Genotypes were identified in 50 (72%) and 23 (48%) of subjects in the screened and clinical groups, respectively. Of the
KCNQ1
or
KCNH2
mutations, 31 of 33 (94%) in the screened group and 14 of 15 (93%) in the clinical group were radical and of high probability of pathogenicity. Prevalence of symptoms before (9/69 versus 31/48;
P
<0.0001) and after (12/69 versus 17/48;
P
=0.03) diagnosis was significantly lower in the screened group when compared with that in the clinical group although the QTc values, family history of long-QT syndrome, sudden death, and follow-up periods were not different between the groups.
Conclusions—
These data suggest that the screening program may be effective for early diagnosis of long-QT syndrome that may allow intervention before symptoms. In addition, screened patients should have follow-up equivalent to clinically identified patients.
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Affiliation(s)
- Masao Yoshinaga
- From the Department of Pediatrics, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan (M.Y., Y.K., Y.N.); Department of Molecular Biology and Genetics, School of Bio-medicine, Health Sciences University of Mongolia, Ulaanbaatar, Mongolia (J.S.); Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan (H.H.); Department of Cardiology, Fukuoka Children’s Hospital and Medical Center for Infectious Diseases, Fukuoka, Japan (H.U.); Department of
| | - Yu Kucho
- From the Department of Pediatrics, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan (M.Y., Y.K., Y.N.); Department of Molecular Biology and Genetics, School of Bio-medicine, Health Sciences University of Mongolia, Ulaanbaatar, Mongolia (J.S.); Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan (H.H.); Department of Cardiology, Fukuoka Children’s Hospital and Medical Center for Infectious Diseases, Fukuoka, Japan (H.U.); Department of
| | - Jav Sarantuya
- From the Department of Pediatrics, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan (M.Y., Y.K., Y.N.); Department of Molecular Biology and Genetics, School of Bio-medicine, Health Sciences University of Mongolia, Ulaanbaatar, Mongolia (J.S.); Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan (H.H.); Department of Cardiology, Fukuoka Children’s Hospital and Medical Center for Infectious Diseases, Fukuoka, Japan (H.U.); Department of
| | - Yumiko Ninomiya
- From the Department of Pediatrics, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan (M.Y., Y.K., Y.N.); Department of Molecular Biology and Genetics, School of Bio-medicine, Health Sciences University of Mongolia, Ulaanbaatar, Mongolia (J.S.); Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan (H.H.); Department of Cardiology, Fukuoka Children’s Hospital and Medical Center for Infectious Diseases, Fukuoka, Japan (H.U.); Department of
| | - Hitoshi Horigome
- From the Department of Pediatrics, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan (M.Y., Y.K., Y.N.); Department of Molecular Biology and Genetics, School of Bio-medicine, Health Sciences University of Mongolia, Ulaanbaatar, Mongolia (J.S.); Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan (H.H.); Department of Cardiology, Fukuoka Children’s Hospital and Medical Center for Infectious Diseases, Fukuoka, Japan (H.U.); Department of
| | - Hiroya Ushinohama
- From the Department of Pediatrics, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan (M.Y., Y.K., Y.N.); Department of Molecular Biology and Genetics, School of Bio-medicine, Health Sciences University of Mongolia, Ulaanbaatar, Mongolia (J.S.); Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan (H.H.); Department of Cardiology, Fukuoka Children’s Hospital and Medical Center for Infectious Diseases, Fukuoka, Japan (H.U.); Department of
| | - Wataru Shimizu
- From the Department of Pediatrics, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan (M.Y., Y.K., Y.N.); Department of Molecular Biology and Genetics, School of Bio-medicine, Health Sciences University of Mongolia, Ulaanbaatar, Mongolia (J.S.); Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan (H.H.); Department of Cardiology, Fukuoka Children’s Hospital and Medical Center for Infectious Diseases, Fukuoka, Japan (H.U.); Department of
| | - Minoru Horie
- From the Department of Pediatrics, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan (M.Y., Y.K., Y.N.); Department of Molecular Biology and Genetics, School of Bio-medicine, Health Sciences University of Mongolia, Ulaanbaatar, Mongolia (J.S.); Department of Child Health, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan (H.H.); Department of Cardiology, Fukuoka Children’s Hospital and Medical Center for Infectious Diseases, Fukuoka, Japan (H.U.); Department of
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Ninomiya Y, Yoshinaga M, Kucho Y, Tanaka Y. Risk factors for symptoms in long QT syndrome patients in a single pediatric center. Pediatr Int 2013; 55:277-82. [PMID: 23566084 DOI: 10.1111/ped.12107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 03/19/2013] [Accepted: 03/21/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Long QT syndrome (LQTS) is a leading cause of sudden cardiac death due to arrhythmia in the pediatric population. This study aimed to determine risk factors for the presence of LQTS-related symptoms in a single pediatric center. METHODS Subjects were 146 consecutive LQTS patients (M:F = 72:74) who visited our hospital between April 2005 and August 2012 and during the preceding 24 months. A total of 103 subjects were discovered by the school-based screening, 15 subjects visited because of their symptoms, and the others were 28 subjects. One subject died. RESULTS Risk factors for the presence of symptoms after diagnosis were longer QTc values (P = 0.01), the presence of history of LQTS-related symptoms (P = 0.04), and longer follow-up periods (P = 0.03). Non-compliance with medicine was the sole risk factor for frequent symptoms after diagnosis (P = 0.02). In subjects discovered by the school-based screening, nine subjects (9%) had LQTS-related symptoms after diagnosis. Longer follow-up periods were the sole risk for the presence of symptoms (P = 0.04). The mean period until the presence of symptoms after diagnosis was 3.1 ± 2.7 years (0.1-7.1 years). CONCLUSION Good compliance with medicine is essential to prevent recurrent episodes. A new strategy is required to prevent subjects, including school-based screened subjects, from dropping out of hospital visits.
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Affiliation(s)
- Yumiko Ninomiya
- Department of Pediatrics, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan
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Lazar JM, Khanna N, Chesler R, Salciccioli L. Swimming and the heart. Int J Cardiol 2013; 168:19-26. [PMID: 23602872 DOI: 10.1016/j.ijcard.2013.03.063] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2012] [Revised: 02/04/2013] [Accepted: 03/17/2013] [Indexed: 11/15/2022]
Abstract
Exercise training is accepted to be beneficial in lowering morbidity and mortality in patients with cardiac disease. Swimming is a popular recreational activity, gaining recognition as an effective option in maintaining and improving cardiovascular fitness. Swimming is a unique form of exercise, differing from land-based exercises such as running in many aspects including medium, position, breathing pattern, and the muscle groups used. Water immersion places compressive forces on the body with resulting physiologic effects. We reviewed the physiologic effects and cardiovascular responses to swimming, the cardiac adaptations to swim training, swimming as a cardiac disease risk factor modifier, and the effects of swimming in those with cardiac disease conditions such as coronary artery disease, congestive heart failure and the long-QT syndrome.
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Affiliation(s)
- Jason M Lazar
- Division of Cardiovascular Medicine, State University of New York Downstate Medical Center, Brooklyn, New York, United States.
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Itoh H, Horie M, Ito M, Imoto K. Arrhythmogenesis in the short-QT syndrome associated with combined HERG channel gating defects: a simulation study. Circ J 2006; 70:502-8. [PMID: 16565572 DOI: 10.1253/circj.70.502] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND This study aimed to show the mechanism how the HERG channel gating defects causes life-threatening arrhythmia in the short-QT syndrome, using a simulation model of ventricular action potentials (APs). METHODS AND RESULTS To evaluate the electrophysiological consequences of the short-QT syndrome at the level of the cardiac AP, the Markov model of wild-type (WT) KCNH2 channel was modified to obtain a model of the KCNH2 channel with the N588K mutation associated with the short-QT syndrome. Two parameters (betai and betabeta) were changed to reconstruct the N588K mutant Markov model, which successfully reproduced the experimental results of voltage-clamp recordings. The WT and mutant models were then integrated into the Luo-Rudy theoretical model of the cardiac ventricular AP. Unexpectedly, 1 parameter change alone, which caused gain of function, could shorten the AP duration (APD) but failed to induce early after-depolarizations (EADs). Only the condition with the combined gating defects could lead to EAD. CONCLUSIONS Although the gain of function for KCNH2 shortened APD in the short-QT syndrome, this simulation study suggested that arrhythmogenesis was associated not only with gain of function, but also with accelerated deactivation of KCNH2.
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Affiliation(s)
- Hideki Itoh
- Department of Information Physiology, National Institute for Physiological Sciences, Myodaiji, Okazaki, Japan
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Kinoshita T, Nagata S, Baba R, Kohmoto T, Iwagaki S. Cold-Water Face Immersion Per Se Elicits Cardiac Parasympathetic Activity. Circ J 2006; 70:773-6. [PMID: 16723802 DOI: 10.1253/circj.70.773] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Cold-water face immersion (FI) is known to produce physiological changes, including bradycardia, by stimulating the parasympathetic system. However, other factors such as sympathetic activity, intrapleural pressures, and changes in chemical mediators may also contribute to these changes. METHODS AND RESULTS Eight healthy volunteers underwent a series of experiments designed to observe the effects of FI on heart rate and its variability, as detected using wavelet transformation. Each subject was instructed to bend over and put the entire face into an empty basin with and without breathing (protocols 1 and 2, respectively), and then perform FI in warm-water (protocols 3 and 4, respectively) and cold-water (protocols 5 and 6, respectively) while breathing and breath holding. Change in the R-R interval with FI was only significantly greater for protocol 6 than for the control procedure (protocol 1). Also, changes in the natural logarithm of high-frequency power with FI were significantly greater for protocols 5 and 6 than the protocol 1. CONCLUSIONS Bradycardia associated with cold-water FI is mainly attributed to cardiac vagal activity, which is independent of both the change in body position caused by bending over a basin and breath holding.
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Affiliation(s)
- Tomoko Kinoshita
- Department of Paediatrics/Developmental Paediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Haraguchi Y, Yoshinaga M, Sarantuya J, Shimago A, Nishi J, Kono Y, Nomura Y, Kubo R, Eguchi T, Tanaka S, Yanagi S, Fukushige T, Maruyama I, Kawano Y. Interval Representative of Transmural Dispersion of Repolarization in Children and Young Adolescents With Congenital Long QT Syndrome. Circ J 2005; 69:78-82. [PMID: 15635208 DOI: 10.1253/circj.69.78] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND It has been shown experimentally that the interval from the nadir of the initial negative T wave to the end of the T wave is representative of transmural dispersion of repolarization (TDR) when complex T waves are present. In the clinical setting, however, the interval representative of TDR in patients with long QT syndrome (LQTS) is a controversial subject. METHODS AND RESULTS Five symptomatic patients (3 boys, 2 girls; 3 LQT1, 2 LQT2) were evaluated by a face immersion test before and after treatment to compare the configuration of the T wave. When the notch disappeared after treatment, the single peak of the T wave after treatment coincided with the nadir of the notch before treatment. When the notch remained the same after treatment as before treatment and when the QTc decreased, the corrected interval from the nadir of the notch to the end of the T wave was for the most part shortened. CONCLUSIONS The present study showed that the interval representative of the TDR in the clinical surface electrocardiogram can be obtained from the nadir of the notch to the end of the T wave in children and adolescents with LQTS, as was shown in the experimental study.
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Affiliation(s)
- Yasue Haraguchi
- Department of Pediatrics, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
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