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Sudden Infant Death Syndrome: the search for genetic predisposition. Heart Rhythm 2021; 19:674-675. [PMID: 34922005 DOI: 10.1016/j.hrthm.2021.12.014] [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] [Received: 12/10/2021] [Accepted: 12/10/2021] [Indexed: 11/24/2022]
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2
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Developmental changes in cardiac expression of KCNQ1 and SCN5A spliceoforms: Implications for sudden unexpected infant death. Heart Rhythm 2021; 19:667-673. [PMID: 34843966 DOI: 10.1016/j.hrthm.2021.11.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 10/27/2021] [Accepted: 11/19/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Sudden unexpected infant death (SUID) occurs unpredictably and remains unexplained after scene investigation and autopsy. Approximately 1 in 7 cases of SUID can be related to a cardiac cause, and developmental regulation of cardiac ion channel genes may contribute to SUID. OBJECTIVE The goal of this study was to investigate the developmental changes in the spliceoforms of SCN5A and KCNQ1, 2 genes implicated in SUID. METHODS Using reverse transcription quantitative real-time polymerase chain reaction, we quantified expression of SCN5A (adult and fetal) and KCNQ1 (KCNQ1a and b) spliceoforms in 153 human cardiac tissue samples from decedents that succumbed to SUID ("unexplained") and other known causes of death ("explained noncardiac"). RESULTS There is a stepwise increase in the adult/fetal SCN5A spliceoform ratio from <2 months (4.55 ± 0.36; n = 51) through infancy and into adulthood (17.41 ± 3.33; n = 5). For KCNQ1, there is a decrease in the ratio of KCNQ1b to KCNQ1a between the <2-month (0.37 ± 0.02; n = 46) and the 2- to 4-month (0.28 ± 0.02; n = 52) age groups. When broken down by sex, race, or cause of death, there were no differences in SCN5A or KCNQ1 spliceoform expression, except for a higher ratio of KCNQ1b to KCNQ1a at 5-12 months of age for SUID females (0.40 ± 0.04; n = 9) than for males (0.25 ± 0.03; n = 6) and at <2 months of age for SUID white (0.42 ± 0.03; n = 19) than for black (0.33 ± 0.05; n = 9) infants. CONCLUSION This study documents the developmental changes in SCN5A and KCNQ1 spliceoforms in humans. Our data suggest that spliceoform expression ratios change significantly throughout the first year of life.
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Matsuda S, Ohnuki Y, Okami M, Ochiai E, Yamada S, Takahashi K, Osawa M, Okami K, Iida M, Mochizuki H. Jervell and Lange-Nielsen syndrome with novel KCNQ1 and additional gene mutations. Hum Genome Var 2020; 7:34. [PMID: 33082985 PMCID: PMC7562699 DOI: 10.1038/s41439-020-00121-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 08/19/2020] [Accepted: 09/14/2020] [Indexed: 11/19/2022] Open
Abstract
We encountered a boy with Jervell and Lange-Nielsen syndrome (JLNS) with compound heterozygous KCNQ1 mutations, maternal Trp248Phe and a novel paternal mutation, Leu347Arg. His father showed long QT (LQT) and arrhythmia. His mother was asymptomatic with no ECG abnormalities. The proband and his father had an additional mutation (SNTA1 Thr372Met), which is reportedly related to SIDS. These results suggest that multiple gene mutations influence the phenotype of KCNQ1 mutation-related arrhythmia.
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Affiliation(s)
- Shinichi Matsuda
- Department of Pediatrics, Tokai University School of Medicine, Isehara, Japan
| | - Yuko Ohnuki
- Department of Medical Ethics, Tokai University School of Medicine, Isehara, Japan
- Department of Clinical Genetics, Tokai University Hospital, Isehara, Japan
| | - Mayuri Okami
- Department of Clinical Genetics, Tokai University Hospital, Isehara, Japan
- Department of Otolaryngology, Tokai University School of Medicine, Isehara, Japan
- Department of Otolaryngology, Samukawa Hospital, Samukawa, Japan
| | - Eriko Ochiai
- Department of Forensic Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Shiro Yamada
- Department of Pediatrics, Tokai University Oiso Hospital, Oiso, Japan
| | - Kazumi Takahashi
- Department of Medical Ethics, Tokai University School of Medicine, Isehara, Japan
- Department of Clinical Genetics, Tokai University Hospital, Isehara, Japan
| | - Motoki Osawa
- Department of Forensic Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Kenji Okami
- Department of Otolaryngology, Tokai University School of Medicine, Isehara, Japan
| | - Masahiro Iida
- Department of Otolaryngology, Tokai University School of Medicine, Isehara, Japan
| | - Hiroyuki Mochizuki
- Department of Pediatrics, Tokai University School of Medicine, Isehara, Japan
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Shimoda-Sakano TM, Schvartsman C, Reis AG. Epidemiology of pediatric cardiopulmonary resuscitation. J Pediatr (Rio J) 2020; 96:409-421. [PMID: 31580845 PMCID: PMC9432320 DOI: 10.1016/j.jped.2019.08.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 07/31/2019] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To analyze the main epidemiological aspects of prehospital and hospital pediatric cardiopulmonary resuscitation and the impact of scientific evidence on survival. SOURCE OF DATA This was a narrative review of the literature published at PubMed/MEDLINE until January 2019 including original and review articles, systematic reviews, meta-analyses, annals of congresses, and manual search of selected articles. SYNTHESIS OF DATA The prehospital and hospital settings have different characteristics and prognoses. Pediatric prehospital cardiopulmonary arrest has a three-fold lower survival rate than cardiopulmonary arrest in the hospital setting, occurring mostly at home and in children under 1year. Higher survival appears to be associated with age progression, shockable rhythm, emergency medical care, use of automatic external defibrillator, high-quality early life support, telephone dispatcher-assisted cardiopulmonary resuscitation, and is strongly associated with witnessed cardiopulmonary arrest. In the hospital setting, a higher incidence was observed in children under 1year of age, and mortality increased with age. Higher survival was observed with shorter cardiopulmonary resuscitation duration, occurrence on weekdays and during daytime, initial shockable rhythm, and previous monitoring. Despite the poor prognosis of pediatric cardiopulmonary resuscitation, an increase in survival has been observed in recent years, with good neurological prognosis in the hospital setting. CONCLUSIONS A great progress in the science of pediatric cardiopulmonary resuscitation has been observed, especially in developed countries. The recognition of the epidemiological aspects that influence cardiopulmonary resuscitation survival may direct efforts towards more effective actions; thus, studies in emerging and less favored countries remains a priority regarding the knowledge of local factors.
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Affiliation(s)
- Tania Miyuki Shimoda-Sakano
- Universidade de São Paulo (USP), Pediatria, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina, Hospital das Clínicas, Pronto Socorro do Instituto da Criança, São Paulo, SP, Brazil; Sociedade de Pediatria de São Paulo (SPSP), Departamento de Emergência, Coordenação Ressuscitação Pediátrica, São Paulo, SP, Brazil; Sociedade de Cardiologia de São Paulo, Curso de PALS (Pediatric Advanced Life Support), São Paulo, SP, Brazil.
| | - Cláudio Schvartsman
- Universidade de São Paulo (USP), Pediatria, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina, Hospital das Clínicas, Pronto Socorro do Instituto da Criança, São Paulo, SP, Brazil
| | - Amélia Gorete Reis
- Universidade de São Paulo (USP), Pediatria, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina, Hospital das Clínicas, Pronto Socorro do Instituto da Criança, São Paulo, SP, Brazil; International Liaison Committee on Resuscitation (ILCOR), Brazil
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5
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Shimoda‐Sakano TM, Schvartsman C, Reis AG. Epidemiology of pediatric cardiopulmonary resuscitation. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2020. [DOI: 10.1016/j.jpedp.2019.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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6
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Santori M, Gil R, Blanco-Verea A, Riuró H, Díaz-Castro Ó, López-Abel B, Brugada R, Carracedo Á, Pérez GJ, Scornik FS, Brion M. Sudden infant death as the most severe phenotype caused by genetic modulation in a family with atrial fibrillation. Forensic Sci Int Genet 2019; 43:102159. [PMID: 31522018 DOI: 10.1016/j.fsigen.2019.102159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 08/26/2019] [Accepted: 08/29/2019] [Indexed: 12/29/2022]
Abstract
AIMS To assess the functional impact of two combined KCNH2 variants involved in atrial fibrillation, syncope and sudden infant death syndrome. METHODS AND RESULTS Genetic testing of a 4-month old SIDS victim identified a rare missense heterozygous in KCNH2 variant (V483I) and a missense homozygous polymorphism (K897T) which is often described as a genetic modifier. Electrophysiological characterisation of heterologous HERG channels representing two different KCNH2 genotypes within the family, showed significant differences in both voltage and time dependence of activation and inactivation with a global gain-of-function effect of mutant versus wild type channels and, also, differences between both types of recombinant channels. CONCLUSIONS The rare variant V483I in combination with K897T produces a gain-of-function effect that represents a pathological substrate for atrial fibrillation, syncope and sudden infant death syndrome events in this family. Ascertaining the genotype-phenotype correlation of genetic variants is imperative for the correct assessment of genetic testing and counselling. TRANSLATIONAL PERSPECTIVE According to the current guidelines for clinical interpretation of sequence variants, functional studies are an essential tool for the ascertainment of variant pathogenicity. They are especially relevant in the context of sudden infant death syndrome and sudden cardiac death, where individuals cannot be clinically evaluated. The patch-clamp technique is a gold-standard for analysis of the biophysical mechanisms of ion channels.
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Affiliation(s)
- Montserrat Santori
- Xenética Cardiovascular, Instituto de Investigación Sanitaria de Santiago de Compostela, Spain; Grupo de Medicina Xenómica, Universidade de Santiago de Compostela, Spain.
| | - Rocío Gil
- Xenética Cardiovascular, Instituto de Investigación Sanitaria de Santiago de Compostela, Spain; Grupo de Medicina Xenómica, Universidade de Santiago de Compostela, Spain
| | - Alejandro Blanco-Verea
- Xenética Cardiovascular, Instituto de Investigación Sanitaria de Santiago de Compostela, Spain; Grupo de Medicina Xenómica, Universidade de Santiago de Compostela, Spain
| | - Helena Riuró
- Cardiovascular Genetics Center, Institut d'Investigació Biomèdica de Girona, Spain; Department of Medical Sciences, Medical School, Universitat de Girona, Spain
| | - Óscar Díaz-Castro
- Servizo de Cardioloxía, Hospital de Pontevedra, Servizo Galego de Saúde, Pontevedra, Spain
| | - Bernardo López-Abel
- Xenética Cardiovascular, Instituto de Investigación Sanitaria de Santiago de Compostela, Spain; Servizo de Pediatría, Hospital Clínico Universitario de Santiago de Compostela, Spain
| | - Ramón Brugada
- Cardiovascular Genetics Center, Institut d'Investigació Biomèdica de Girona, Spain; Department of Medical Sciences, Medical School, Universitat de Girona, Spain; Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Ángel Carracedo
- Grupo de Medicina Xenómica, Universidade de Santiago de Compostela, Spain; Fundación Pública Galega de Medicina Xenómica, Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Santiago de Compostela, Spain
| | - Guillermo J Pérez
- Department of Medical Sciences, Medical School, Universitat de Girona, Spain; Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Fabiana S Scornik
- Department of Medical Sciences, Medical School, Universitat de Girona, Spain; Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - María Brion
- Xenética Cardiovascular, Instituto de Investigación Sanitaria de Santiago de Compostela, Spain; Grupo de Medicina Xenómica, Universidade de Santiago de Compostela, Spain; Red de Enfermedades Cardiovasculares (CIBERCV), Spain
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Paludan-Müller C, Ghouse J, Vad OB, Herfelt CB, Lundegaard P, Ahlberg G, Schmitt N, Svendsen JH, Haunsø S, Bundgaard H, Hansen T, Kanters JK, Olesen MS. Reappraisal of variants previously linked with sudden infant death syndrome: results from three population-based cohorts. Eur J Hum Genet 2019; 27:1427-1435. [PMID: 31043699 PMCID: PMC6777469 DOI: 10.1038/s41431-019-0416-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 03/21/2019] [Accepted: 04/06/2019] [Indexed: 12/23/2022] Open
Abstract
We aimed to investigate the pathogenicity of cardiac ion channel variants previously associated with SIDS. We reviewed SIDS-associated variants previously reported in databases and the literature in three large population-based cohorts; The ExAC database, the Inter99 study, and the UK Biobank (UKBB). Variants were classified according to the American College of Medical Genetics and Genomics (ACMG) guidelines. Of the 92 SIDS-associated variants, 59 (64%) were present in ExAC, 18 (20%) in Inter99, and 24 (26%) in UKBB. Using the Inter99 cohort, we found no difference in J-point amplitude and QTc-interval between carriers and non-carriers for 14/18 variants. There was no difference in the risk of syncope (P = 0.32), malignant ventricular arrhythmia (P = 0.96), and all-cause mortality (P = 0.59) between carriers and non-carriers. The ACMG guidelines reclassified 75% of all variants as variant-of-uncertain significance, likely benign, and benign. We identified ~2/3 of variants previously associated with SIDS and found no significant associations with electrocardiographic traits, syncope, malignant ventricular arrhythmia, or all-cause mortality. These data indicate that many of these variants are not highly penetrant, monogenic causes of SIDS and underline the importance of frequent reappraisal of genetic variants to avoid future misdiagnosis.
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Affiliation(s)
- Christian Paludan-Müller
- Laboratory for Molecular Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jonas Ghouse
- Laboratory for Molecular Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Oliver B Vad
- Laboratory for Molecular Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Cecilie B Herfelt
- Laboratory for Molecular Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Pia Lundegaard
- Laboratory for Molecular Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Gustav Ahlberg
- Laboratory for Molecular Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Nicole Schmitt
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jesper H Svendsen
- Laboratory for Molecular 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
| | - Stig Haunsø
- Laboratory for Molecular 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
| | - Henning Bundgaard
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Unit for Inherited Cardiac Diseases, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Torben Hansen
- The Novo Nordisk Foundation Centre for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jørgen K Kanters
- Laboratory of Experimental Cardiology, Department of Biomedicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Herlev and Gentofte University Hospitals, Copenhagen, Denmark
| | - Morten S Olesen
- Laboratory for Molecular Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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Sarquella-Brugada G, Cesar S, Zambrano MD, Fernandez-Falgueras A, Fiol V, Iglesias A, Torres F, Garcia-Algar O, Arbelo E, Brugada J, Brugada R, Campuzano O. Electrocardiographic Assessment and Genetic Analysis in Neonates: a Current Topic of Discussion. Curr Cardiol Rev 2019; 15:30-37. [PMID: 30210005 PMCID: PMC6367699 DOI: 10.2174/1573403x14666180913114806] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/10/2018] [Accepted: 09/11/2018] [Indexed: 12/30/2022] Open
Abstract
Background: Sudden death of a newborn is a rare entity, which may be caused by genetic cardiac arrhythmias. Among these diseases, Long QT syndrome is the most prevalent arrhythmia in neonates, but other diseases such as Brugada syndrome, Short QT syndrome and Catecholaminergic Polymorphic Ventricular Tachycardia also cause sudden death in infants. All these entities are charac-terized by well-known alterations in the electrocardiogram and the first symptom of the disease may be an unexpected death. Despite the low prevalence of these diseases, the performance of an electro-cardiogram in the first hours or days after birth could help identify these electrical disruptions and adopt preventive measures. In recent years, there has been an important impulse by some experts in the scientific community towards the initiation of a newborn electrocardiogram-screening program, for the detection of these electrocardiographic abnormalities. In addition, the use of genetic analysis in neonates could identify the cause of these heart alterations. Identification of relatives carrying the ge-netic alteration associated with the disease allows adoption of measures to prevent lethal episodes. Conclusion: Recent technological advances enable a comprehensive genetic screening of a large number of genes in a cost-effective way. However, the interpretation of genetic data and its translation into clinical practice are the main challenges for cardiologists and geneticists. However, there is im-portant controversy as to the clinical value, and cost-effectiveness of the use of electrocardiogram as well as of genetic testing to detect these cases. Our review focuses on these current matters of argue.
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Affiliation(s)
- Georgia Sarquella-Brugada
- Arrhythmias Unit, Hospital Sant Joan de Deu, University of Barcelona, Barcelona, Spain.,Medical Science Department, School of Medicine, University of Girona, Girona, Spain
| | - Sergi Cesar
- Arrhythmias Unit, Hospital Sant Joan de Deu, University of Barcelona, Barcelona, Spain
| | | | | | - Victoria Fiol
- Arrhythmias Unit, Hospital Sant Joan de Deu, University of Barcelona, Barcelona, Spain
| | - Anna Iglesias
- Cardiovascular Genetics Center, University of Girona- IDIBGI, Girona, Spain.,Centro Investigación Biomédica Red Enfermedades Cardiovasculares (CIBERCV), Girona, Spain
| | - Francesc Torres
- GRIE, Neonatology Unit, Hospital Clinic-Maternitat, IDIBAPS, BCNatal, Barcelona, Spain
| | - Oscar Garcia-Algar
- GRIE, Neonatology Unit, Hospital Clinic-Maternitat, IDIBAPS, BCNatal, Barcelona, Spain
| | - Elena Arbelo
- Centro Investigación Biomédica Red Enfermedades Cardiovasculares (CIBERCV), Girona, Spain.,Arrhythmias Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Josep Brugada
- Arrhythmias Unit, Hospital Sant Joan de Deu, University of Barcelona, Barcelona, Spain.,Centro Investigación Biomédica Red Enfermedades Cardiovasculares (CIBERCV), Girona, Spain.,Arrhythmias Unit, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Ramon Brugada
- Medical Science Department, School of Medicine, University of Girona, Girona, Spain.,Cardiovascular Genetics Center, University of Girona- IDIBGI, Girona, Spain.,Centro Investigación Biomédica Red Enfermedades Cardiovasculares (CIBERCV), Girona, Spain.,Cardiology Service, Hospital Josep Trueta, University of Girona, Girona. Spain
| | - Oscar Campuzano
- Medical Science Department, School of Medicine, University of Girona, Girona, Spain.,Cardiovascular Genetics Center, University of Girona- IDIBGI, Girona, Spain.,Centro Investigación Biomédica Red Enfermedades Cardiovasculares (CIBERCV), Girona, Spain
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9
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Crotti L, Ghidoni A, Dagradi F. Genetics of Adult and Fetal Forms of Long QT Syndrome. GENETIC CAUSES OF CARDIAC DISEASE 2019. [DOI: 10.1007/978-3-030-27371-2_1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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10
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Molecular autopsy in a cohort of infants died suddenly at rest. Forensic Sci Int Genet 2018; 37:54-63. [PMID: 30086531 DOI: 10.1016/j.fsigen.2018.07.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 07/08/2018] [Accepted: 07/30/2018] [Indexed: 02/06/2023]
Abstract
Sudden infant death syndrome is the leading cause of death during the first year of life. A large part of cases remains without a conclusive cause of death after complete autopsy. In these situations, cardiac arrhythmia of genetic origin is suspected as the most plausible cause of death. Our aim was to ascertain whether genetic variants associated with sudden cardiac death might be the cause of death in a cohort of infants died suddenly. We analyzed 108 genes associated with sudden cardiac death in 44 post-mortem samples of infants less than 1 year old of age who died at rest. Definite cause of death was not conclusive in any case after a complete autopsy. Genetic analysis identified at least one rare variant in 90.90% of samples. A total of 121 rare genetic variants were identified. Of them, 33.05% were novel and 39.66% were located in genes encoding ion channels or associated proteins. A comprehensive genetic analysis in infants who died suddenly enables the unraveling of potentially causative cardiac variants in 2045% of cases. Molecular autopsy should be included in forensic protocols when no conclusive cause of death is identified. Large part genetic variants remain of uncertain significance, reinforcing the crucial role of genetic interpretation before clinical translation but also in early identification of relatives at risk.
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Neubauer J, Rougier JS, Abriel H, Haas C. Functional implications of a rare variant in the sodium channel β1B subunit ( SCN1B) in a 5-month-old male sudden infant death syndrome case. HeartRhythm Case Rep 2018; 4:187-190. [PMID: 29915715 PMCID: PMC6003537 DOI: 10.1016/j.hrcr.2018.01.010] [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] [Indexed: 12/11/2022] Open
Affiliation(s)
- Jacqueline Neubauer
- Zurich Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
| | | | - Hugues Abriel
- Institute of Biochemistry and Molecular Medicine, University of Bern, Bern, Switzerland
| | - Cordula Haas
- Zurich Institute of Forensic Medicine, University of Zurich, Zurich, Switzerland
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12
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van Deventer BS, du Toit-Prinsloo L, van Niekerk C. Feasibility of analysis of the SCN5A gene in paraffin embedded samples in sudden infant death cases at the Pretoria Medico-Legal Laboratory, South Africa. Forensic Sci Med Pathol 2018; 14:276-284. [PMID: 29907895 DOI: 10.1007/s12024-018-9995-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2018] [Indexed: 12/19/2022]
Abstract
To determine variations in the SCN5A gene linked to inherited cardiac arrhythmogenic disorders in sudden, unexplained infant death (SUID) cases examined at the Pretoria Medico-Legal Laboratory, South Africa. A retrospective study was conducted on SUID cases and controls, analyzing DNA extracted from archived formalin-fixed, paraffin-embedded (FFPE) myocardial tissue samples as well as blood samples. A total of 48 FFPE tissue samples (cases), 10 control FFPE tissue samples and nine control blood samples were included. DNA extracted from all samples was used to test for variations in the SCN5A gene by using high resolution melt (HRM) real-time PCR and sequencing. Genetic analysis showed 31 different single nucleotide variants in the entire study population (n = 67). Five previously reported variants of known pathogenic significance, and 14 variants of benign clinical significance, were identified. The study found 12 different variants in the cases that were not published in any database or literature and were considered novel. Of these novel variants, two were predicted as "probably damaging" with a high level of certainty (found in four case samples), one (identified in another case sample) was predicted to be "possibly damaging" with a 50% chance of being disease-causing, and nine were predicted to be benign. This study shows the significant added value of using genetic testing in determining the cause of death in South African SUID cases. Considering the high heritability of these arrhythmic disorders, post mortem genetic testing could play an important role in the understanding of the pathogenesis thereof and could also aid in the diagnosis and treatment of family members at risk, ultimately preventing similar future cases.
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Affiliation(s)
| | - Lorraine du Toit-Prinsloo
- Department of Forensic Medicine, University of Pretoria, Pretoria, South Africa.,Department of Forensic Medicine, Sydney, Forensic & Analytical Science Services (FASS), NSW Health Pathology, Sydney, New South Wales, Australia
| | - Chantal van Niekerk
- Department of Chemical Pathology, University of Pretoria, R3-43 Pathology Building, Prinshof Campus, Pretoria, 0002, Republic of South Africa. .,Department of Chemical Pathology, National Health Laboratory Services (NHLS), Tshwane Academic Division, Pretoria, South Africa.
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13
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Cano-Hernández KS, Nava-Townsend S, Sánchez-Boiso A, Sánchez-Urbina R, Contreras-Ramos A, Erdmenger-Orellana JR, Tamayo-Espinosa T, Becerra-Becerra R, Segura-Stanford B, Solano-Fiesco L, Balderrábano-Saucedo NA. [Prevalence and spectrum of diseases that predispose to sudden cardiac death in Mexican children: a sample obtained from The Federico Gomez Children's Hospital of Mexico]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2017; 88:268-276. [PMID: 28943109 DOI: 10.1016/j.acmx.2017.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 08/21/2017] [Accepted: 08/22/2017] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To determine the prevalence and spectrum of diseases that predispose to sudden cardiac death in Mexican children, and to identify the main early signs and symptoms that can enable the health personnel to suspect these diseases and to refer the patients to a tertiary hospital in a timely manner. METHODS Incidence, prevalence, and period prevalence, as well as early symptoms, clinical data, and follow-up were recorded on all children found with diseases that predispose to sudden cardiac death in The Children's Hospital of Mexico. RESULTS The study included 59 patients, with a mean age of 8 ± 5 years old, with 40 cardiomyopathies, and 19 with inherited arrhythmogenic diseases. The period prevalence was 9.5/1,000 patients/year. The most common early symptoms were dyspnoea, palpitations, and syncope. A Mendelian inheritance pattern was found in 9 cases. Three patients died of sudden cardiac death during the period of the study. CONCLUSION Diseases that predispose to sudden cardiac death in children are not very well known by the general medical community. Every child with dyspnoea, palpitations and/or syncope, should be referred for the intensive search of these diseases. A complete cardiological evaluation in all members of the family is indicated.
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Affiliation(s)
- Karla Sarahí Cano-Hernández
- Laboratorio de Investigación en Cardiopatías Congénitas y Arritmias, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Santiago Nava-Townsend
- Departamento de Electrofisiología, Instituto Nacional de Cardiología Ignacio Chávez, Ciudad de México, México
| | - Adriana Sánchez-Boiso
- Laboratorio de Investigación en Cardiopatías Congénitas y Arritmias, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Rocío Sánchez-Urbina
- Laboratorio de Biología del Desarrollo y Teratogénesis Experimental, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Alejandra Contreras-Ramos
- Laboratorio de Biología del Desarrollo y Teratogénesis Experimental, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | | | - Tania Tamayo-Espinosa
- Departamento de Cardiología Pediátrica, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Rosario Becerra-Becerra
- Departamento de Cardiología Pediátrica, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Begoña Segura-Stanford
- Departamento de Cardiología Pediátrica, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Liborio Solano-Fiesco
- Departamento de Cardiología Pediátrica, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Norma Alicia Balderrábano-Saucedo
- Laboratorio de Investigación en Cardiopatías Congénitas y Arritmias, Hospital Infantil de México Federico Gómez, Ciudad de México, México; Departamento de Cardiología Pediátrica, Hospital Infantil de México Federico Gómez, Ciudad de México, México.
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14
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Abstract
Sudden unexpected infant death (SUID) is the leading cause for post-neonatal mortality in industrialized nations. Case-control studies have identified risk factors for SUID that have shaped research into studies of causation. Most current hypotheses for the mechanisms for SUID contribute to the "SUID sequence"-hypoxia and/or hypercarbia in sleep to which a vulnerable infant fails to respond adequately and that results in death. Reducing vulnerability in infants and promoting safe sleep for infants is important for prevention and requires knowledge of the prevalence of risk factors within the target population and a culturally sensitive approach. [Pediatr Ann. 2017;46(8):e278-e283.].
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15
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Van Niekerk C, Van Deventer BS, du Toit-Prinsloo L. Long QT syndrome and sudden unexpected infant death. J Clin Pathol 2017; 70:808-813. [PMID: 28663329 DOI: 10.1136/jclinpath-2016-204199] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 06/01/2017] [Accepted: 06/05/2017] [Indexed: 12/30/2022]
Abstract
Long QT syndrome (LQTS) is an inheritable primary electric disease of the heart characterised by abnormally long QT intervals and a propensity to develop atrial and ventricular tachyarrhythmias. It is caused by an inherited channelopathy responsible for sudden cardiac death in individuals with structurally normal hearts. Long QT syndrome can present early in life, and some studies suggest that it may be associated with up to 20% of sudden unexplained infant death (SUID), particularly when associated with external stressors such as asphyxia, which is commonly seen in many infant death scenes. With an understanding of the genetic defects, it has now been possible to retrospectively analyse samples from infants who have presented to forensic pathology services with a history of unexplained sudden death, which may, in turn, enable the implementation of preventative treatment for siblings previously not known to have pathogenic genetic variations. In this viewpoint article, we will discuss SUID, LQTS and postmortem genetic analysis.
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Affiliation(s)
- Chantal Van Niekerk
- Department of Chemical Pathology, National Health Laboratory Service, Johannesburg, Gauteng, South Africa.,Department of Chemical Pathology, University of Pretoria, Pretoria, South Africa
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16
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The role of the autonomic nervous system in arrhythmias and sudden cardiac death. Auton Neurosci 2017; 205:1-11. [PMID: 28392310 DOI: 10.1016/j.autneu.2017.03.005] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 03/11/2017] [Accepted: 03/28/2017] [Indexed: 12/16/2022]
Abstract
The autonomic nervous system (ANS) is complex and plays an important role in cardiac arrhythmia pathogenesis. A deeper understanding of the anatomy and development of the ANS has shed light on its involvement in cardiac arrhythmias. Alterations in levels of Sema-3a and NGF, both growth factors involved in innervation patterning during development of the ANS, leads to cardiac arrhythmias. Dysregulation of the ANS, including polymorphisms in genes involved in ANS development, have been implicated in sudden infant death syndrome. Disruptions in the sympathetic and/or parasympathetic systems of the ANS can lead to cardiac arrhythmias and can vary depending on the type of arrhythmia. Simultaneous stimulation of both the sympathetic and parasympathetic systems is thought to lead to atrial fibrillation whereas increased sympathetic stimulation is thought to lead to ventricular fibrillation or ventricular tachycardia. In inherited arrhythmia syndromes, such as Long QT and Catecholaminergic Polymorphic Ventricular Tachycardia, sympathetic system stimulation is thought to lead to ventricular tachycardia, subsequent arrhythmias, and in severe cases, cardiac death. On the other hand, arrhythmic events in Brugada Syndrome have been associated with periods of high parasympathetic tone. Increasing evidence suggests that modulation of the ANS as a therapeutic strategy in the treatment of cardiac arrhythmias is safe and effective. Further studies investigating the involvement of the ANS in arrhythmia pathogenesis and its modulation for the treatment of cardiac arrhythmias is warranted.
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17
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Burns KM, Bienemann L, Camperlengo L, Cottengim C, Covington TM, Dykstra H, Faulkner M, Kobau R, Erck Lambert AB, MacLeod H, Parks SE, Rosenberg E, Russell MW, Shapiro-Mendoza CK, Shaw E, Tian N, Whittemore V, Kaltman JR. The Sudden Death in the Young Case Registry: Collaborating to Understand and Reduce Mortality. Pediatrics 2017; 139:e20162757. [PMID: 28228502 PMCID: PMC5330401 DOI: 10.1542/peds.2016-2757] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/23/2016] [Indexed: 12/13/2022] Open
Abstract
Knowledge gaps persist about the incidence of and risk factors for sudden death in the young (SDY). The SDY Case Registry is a collaborative effort between the National Institutes of Health, the Centers for Disease Control and Prevention, and the Michigan Public Health Institute. Its goals are to: (1) describe the incidence of SDY in the United States by using population-based surveillance; (2) compile data from SDY cases to create a resource of information and DNA samples for research; (3) encourage standardized approaches to investigation, autopsy, and categorization of SDY cases; (4) develop partnerships between local, state, and federal stakeholders toward a common goal of understanding and preventing SDY; and (5) support families who have lost loved ones to SDY by providing resources on bereavement and medical evaluation of surviving family members. Built on existing Child Death Review programs and as an expansion of the Sudden Unexpected Infant Death Case Registry, the SDY Case Registry achieves its goals by identifying SDY cases, providing guidance to medical examiners/coroners in conducting comprehensive autopsies, evaluating cases through child death review and an advanced review by clinical specialists, and classifying cases according to a standardized algorithm. The SDY Case Registry also includes a process to obtain informed consent from next-of-kin to save DNA for research, banking, and, in some cases, diagnostic genetic testing. The SDY Case Registry will provide valuable incidence data and will enhance understanding of the characteristics of SDY cases to inform the development of targeted prevention efforts.
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Affiliation(s)
- Kristin M Burns
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute and
| | - Lauren Bienemann
- Division of Pediatric Cardiology, University of Michigan Medical School, Ann Arbor, Michigan
| | | | - Carri Cottengim
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Theresa M Covington
- National Center for Fatality Review and Prevention, Michigan Public Health Institute, Okemos, Michigan; and
| | - Heather Dykstra
- National Center for Fatality Review and Prevention, Michigan Public Health Institute, Okemos, Michigan; and
| | - Meghan Faulkner
- National Center for Fatality Review and Prevention, Michigan Public Health Institute, Okemos, Michigan; and
| | - Rosemarie Kobau
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Heather MacLeod
- National Center for Fatality Review and Prevention, Michigan Public Health Institute, Okemos, Michigan; and
| | - Sharyn E Parks
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ellen Rosenberg
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute and
| | - Mark W Russell
- Division of Pediatric Cardiology, University of Michigan Medical School, Ann Arbor, Michigan
| | | | - Esther Shaw
- National Center for Fatality Review and Prevention, Michigan Public Health Institute, Okemos, Michigan; and
| | - Niu Tian
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Vicky Whittemore
- National Institute of Neurologic Disorders and Stroke, National Institutes of Health, Bethesda, Maryland
| | - Jonathan R Kaltman
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute and
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18
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Elhaik E. A "Wear and Tear" Hypothesis to Explain Sudden Infant Death Syndrome. Front Neurol 2016; 7:180. [PMID: 27840622 PMCID: PMC5083856 DOI: 10.3389/fneur.2016.00180] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 10/04/2016] [Indexed: 01/22/2023] Open
Abstract
Sudden infant death syndrome (SIDS) is the leading cause of death among USA infants under 1 year of age accounting for ~2,700 deaths per year. Although formally SIDS dates back at least 2,000 years and was even mentioned in the Hebrew Bible (Kings 3:19), its etiology remains unexplained prompting the CDC to initiate a sudden unexpected infant death case registry in 2010. Due to their total dependence, the ability of the infant to allostatically regulate stressors and stress responses shaped by genetic and environmental factors is severely constrained. We propose that SIDS is the result of cumulative painful, stressful, or traumatic exposures that begin in utero and tax neonatal regulatory systems incompatible with allostasis. We also identify several putative biochemical mechanisms involved in SIDS. We argue that the important characteristics of SIDS, namely male predominance (60:40), the significantly different SIDS rate among USA Hispanics (80% lower) compared to whites, 50% of cases occurring between 7.6 and 17.6 weeks after birth with only 10% after 24.7 weeks, and seasonal variation with most cases occurring during winter, are all associated with common environmental stressors, such as neonatal circumcision and seasonal illnesses. We predict that neonatal circumcision is associated with hypersensitivity to pain and decreased heart rate variability, which increase the risk for SIDS. We also predict that neonatal male circumcision will account for the SIDS gender bias and that groups that practice high male circumcision rates, such as USA whites, will have higher SIDS rates compared to groups with lower circumcision rates. SIDS rates will also be higher in USA states where Medicaid covers circumcision and lower among people that do not practice neonatal circumcision and/or cannot afford to pay for circumcision. We last predict that winter-born premature infants who are circumcised will be at higher risk of SIDS compared to infants who experienced fewer nociceptive exposures. All these predictions are testable experimentally using animal models or cohort studies in humans. Our hypothesis provides new insights into novel risk factors for SIDS that can reduce its risk by modifying current infant care practices to reduce nociceptive exposures.
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Affiliation(s)
- Eran Elhaik
- Department of Animal and Plant Sciences, University of Sheffield, Sheffield, UK
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19
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Sauer CW, Marc-Aurele KL. A Neonate with Susceptibility to Long QT Syndrome Type 6 who Presented with Ventricular Fibrillation and Sudden Unexpected Infant Death. AMERICAN JOURNAL OF CASE REPORTS 2016; 17:544-8. [PMID: 27465075 PMCID: PMC4968432 DOI: 10.12659/ajcr.898327] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Patient: Female, 19-day Final Diagnosis: 19 day old neonate with susceptibility to Long QT syndrome • ventricular fibrillation Symptoms: Cardiac arrest • cardiac arrhythmia • encephalopathy Medication: — Clinical Procedure: Cardioversion Specialty: Pediatrics and Neonatology
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Affiliation(s)
- Charles W Sauer
- Department of Pediatrics, University of California, San Diego, CA, USA
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20
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Abstract
Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a highly malignant inheritable cardiac channelopathy. The past decade and a half has provided exciting new discoveries elucidating the genetic etiology and pathophysiology of CPVT. This review of the current literature on CPVT aims to summarize the state of the art in our understanding of the genetic etiology and the molecular pathogenesis of CPVT, and how these relate to our current approach to diagnosis and management. We will also shed light on groundbreaking new work that will continue to refine the management of CPVT in the future. As our knowledge of CPVT continues to grow, further studies will yield a better understanding of the efficacy and pitfalls of established diagnostic approaches and therapies as well as help shape newer diagnostic and treatment strategies. Two separate searches were run on the National Center for Biotechnology Information's (NCBI) website. The first used the medical subject headings (MeSH) database using the term “catecholaminergic polymorphic ventricular tachycardia” that was run on the PubMed database using the age filter (birth to 18 years), and it yielded 58 results. The second search using the MeSH database with the search term “catecholaminergic polymorphic ventricular tachycardia,” applying no filters yielded 178 results. The abstracts of all these articles were studied and the articles were categorized and organized. Articles of relevance were read in full. As and where applicable, relevant references and citations from the primary articles were further explored and read in full.
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Affiliation(s)
- Shashank P Behere
- Nemours Cardiac Center, Nemours/Alfred I duPont Hospital for Children, Wilmington, Delaware, USA
| | - Steven N Weindling
- The Pediatric Specialty Clinic, Overland Park Regional Medical Center, Overland Park, Kansas, USA
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21
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Takiguchi M, Knight T, Nguyen TT, Limm B, Hayes D, Reddy V, Bratincsak A. Underdiagnosis of Conditions Associated with Sudden Cardiac Death in Children--Is it the Absence of a Comprehensive Screening Program or a True Low Prevalence? HAWAI'I JOURNAL OF MEDICINE & PUBLIC HEALTH : A JOURNAL OF ASIA PACIFIC MEDICINE & PUBLIC HEALTH 2016; 75:42-5. [PMID: 26918207 PMCID: PMC4755066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This study aimed to assess the prevalence of conditions associated with sudden cardiac death (SCD) among all children and children with sudden infant death syndrome (SIDS) in the State of Hawai'i, where no comprehensive screening program is conducted for such conditions. A retrospective chart review was conducted from the single tertiary pediatric hospital in Hawai'i, from offices of all pediatric cardiologists in Hawai'i, and the Hawai'i State Department of Health from 1/1/2000 to 12/31/2013. Children aged 0-18 years were included in the study. A subset of the study analyzed records of infants aged 0-12 months. SIDS rate was calculated and compared to national data. Prevalence was calculated for known conditions associated with SCD. The identified prevalence was compared to the established prevalence of conditions associated with SCD. In Hawai'i, the infant SIDS rate (66.4/100,000) was similar to the national rate (54.4/100,000). Over 14 years, only 51 children were diagnosed with a condition associated with SCD; 28 with a cardiomyopathy and 21 with a channelopathy. A 14-year retrospective analysis in the State of Hawai'i revealed that less than 1 in 30 children, who are expected to harbor a SCD-associated condition, had been appropriately diagnosed. The underdiagnosis of conditions associated with SCD reflects that in the absence of a comprehensive screening program, conditions without obvious signs and symptoms are difficult to diagnose. Many children with these conditions will remain at risk of SCD.
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Affiliation(s)
- Marisa Takiguchi
- Hawai'i Pacific Health Research Institute, Hawai'i Pacific Health, Honolulu, HI (MT)
| | - Tristan Knight
- Hawai'i Pacific Health Research Institute, Hawai'i Pacific Health, Honolulu, HI (MT)
| | - Tin Toan Nguyen
- Hawai'i Pacific Health Research Institute, Hawai'i Pacific Health, Honolulu, HI (MT)
| | - Blair Limm
- Hawai'i Pacific Health Research Institute, Hawai'i Pacific Health, Honolulu, HI (MT)
| | - Donald Hayes
- Hawai'i Pacific Health Research Institute, Hawai'i Pacific Health, Honolulu, HI (MT)
| | - Venu Reddy
- Hawai'i Pacific Health Research Institute, Hawai'i Pacific Health, Honolulu, HI (MT)
| | - Andras Bratincsak
- Hawai'i Pacific Health Research Institute, Hawai'i Pacific Health, Honolulu, HI (MT)
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22
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Fleming PJ, Blair PS, Pease A. Sudden unexpected death in infancy: aetiology, pathophysiology, epidemiology and prevention in 2015. Arch Dis Child 2015; 100:984-8. [PMID: 25699563 DOI: 10.1136/archdischild-2014-306424] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 01/28/2015] [Indexed: 11/04/2022]
Abstract
Despite the fall in numbers of unexpected infant deaths that followed the 'Back to Sleep' campaigns in the early 1990 s in the UK and many other countries, such deaths remain one of the largest single groups of deaths in the postneonatal period in many Western countries. Changes in the ways in which unexpected infant deaths are categorised by pathologists and coroners, and increasing reluctance to use the term 'sudden infant death syndrome', make assessment of nationally and internationally collected data on incidence potentially inaccurate and confusing. In this paper, we review current understanding of the epidemiology and aetiology of unexpected deaths in infancy, and current hypotheses on the pathophysiology of the processes that may lead to death. We also review interventions that have been adopted, with variable degrees of effectiveness in efforts to reduce the numbers of deaths, and new approaches that offer the possibility of prevention in the future.
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Affiliation(s)
- Peter J Fleming
- Centre for Child and Adolescent Health, University of Bristol. St Michaels Hospital, Bristol, UK
| | - Peter S Blair
- Centre for Child and Adolescent Health, University of Bristol. St Michaels Hospital, Bristol, UK
| | - Anna Pease
- Centre for Child and Adolescent Health, University of Bristol. St Michaels Hospital, Bristol, UK
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23
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Santori M, Blanco-Verea A, Gil R, Cortis J, Becker K, Schneider PM, Carracedo A, Brion M. Broad-based molecular autopsy: a potential tool to investigate the involvement of subtle cardiac conditions in sudden unexpected death in infancy and early childhood. Arch Dis Child 2015; 100:952-6. [PMID: 26272908 DOI: 10.1136/archdischild-2015-308200] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 07/01/2015] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Sudden unexplained death in children is a tragic and traumatic event, often worsened when the cause of death cannot be determined. This work aimed to investigate the presence of putative pathogenic genetic variants in a broad spectrum of cardiomyopathy, channelopathy and aortic disease associated genes that may have increased these children's vulnerability to sudden cardiac death. DESIGN We performed molecular autopsy of 41 cases of sudden unexplained death in infants and children through massive parallel sequencing of up to 86 sudden cardiac death-related genes. Multiple in silico analyses were conducted together with a thorough review of the literature in order to prioritise the putative pathogenic variants. RESULTS A total of 63 variants in 35 cases were validated. The largest proportion of these variants is located within cardiomyopathy genes although this would have been more expected of channelopathy gene variants. Subtle microscopic features of heart tissue may indicate the presence of an early onset cardiomyopathy as a predisposing condition to sudden unexpected death in some individuals. CONCLUSIONS Next-generation sequencing technologies reveal the existence of a wide spectrum of rare and novel genetic variants in sarcomere genes, compared with that of cardiac ion channels, in sudden unexplained death in infants and children. Our findings encourage further investigation of the role of early onset inherited cardiomyopathies and other diseases involving myocardial dysfunction in these deaths. Early detection of variants in these individuals could help to unmask subtle forms of disease within their relatives, who would eventually benefit from better counselling about their genetic history.
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Affiliation(s)
- Montserrat Santori
- Xenética de Enfermidades Cardiovasculares, Instituto de Investigación Sanitaria de Santiago, Red de Investigación Cardiovascular (RIC), Santiago De Compostela, Spain Grupo de Medicina Xenómica, University of Santiago de Compostela, Santiago de Compostela, Spain Fundación Pública Galega de Medicina Xenómica, SERGAS, Santiago de Compostela, Spain
| | - Alejandro Blanco-Verea
- Xenética de Enfermidades Cardiovasculares, Instituto de Investigación Sanitaria de Santiago, Red de Investigación Cardiovascular (RIC), Santiago De Compostela, Spain Grupo de Medicina Xenómica, University of Santiago de Compostela, Santiago de Compostela, Spain Fundación Pública Galega de Medicina Xenómica, SERGAS, Santiago de Compostela, Spain
| | - Rocio Gil
- Xenética de Enfermidades Cardiovasculares, Instituto de Investigación Sanitaria de Santiago, Red de Investigación Cardiovascular (RIC), Santiago De Compostela, Spain Grupo de Medicina Xenómica, University of Santiago de Compostela, Santiago de Compostela, Spain Fundación Pública Galega de Medicina Xenómica, SERGAS, Santiago de Compostela, Spain
| | - Judith Cortis
- Faculty of Medicine, Institute of Legal Medicine, University of Cologne, Cologne, Germany
| | - Katrin Becker
- Faculty of Medicine, Institute of Legal Medicine, University of Cologne, Cologne, Germany
| | - Peter M Schneider
- Faculty of Medicine, Institute of Legal Medicine, University of Cologne, Cologne, Germany
| | - Angel Carracedo
- Grupo de Medicina Xenómica, University of Santiago de Compostela, Santiago de Compostela, Spain Fundación Pública Galega de Medicina Xenómica, SERGAS, Santiago de Compostela, Spain Center of Excellence in Genomic Medicine Research, King Abdulaziz University Jeddah, Kingdom of Saudi Arabia
| | - Maria Brion
- Xenética de Enfermidades Cardiovasculares, Instituto de Investigación Sanitaria de Santiago, Red de Investigación Cardiovascular (RIC), Santiago De Compostela, Spain Grupo de Medicina Xenómica, University of Santiago de Compostela, Santiago de Compostela, Spain Fundación Pública Galega de Medicina Xenómica, SERGAS, Santiago de Compostela, Spain
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24
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Bergman NJ. Proposal for mechanisms of protection of supine sleep against sudden infant death syndrome: an integrated mechanism review. Pediatr Res 2015; 77:10-9. [PMID: 25268147 DOI: 10.1038/pr.2014.140] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 07/11/2014] [Indexed: 02/06/2023]
Abstract
UNLABELLED Supine sleep decreases sudden infant death syndrome (SIDS) incidence, however the mechanisms for this are unclear. The triple risk model for SIDS requires that one or more underlying abnormalities of breathing or autonomic control are present; these are rare, but brainstem defects are found in most SIDS cases. Supine sleep increases sympathetic nervous system tone, and level of state organization, and may therefore act as a stressor. This is evidenced by physiological arousal, and by delayed neurodevelopment in supine compared to prone sleepers. It is argued here that prone sleep position is the biological normative standard in healthy infants, supporting autonomic regulation. During rapid eye movement (REM) sleep (and other circumstances), a parasympathetic-mediated adverse autonomic event (AAE) may be spontaneously triggered. In healthy infants, gasping initiates autoresuscitation and recovery. HYPOTHESIS The underlying vulnerability to SIDS is specific to autoresuscitation from an AAE, the initial serotonin-dependent gasp is commonly compromised. Serotonin metabolism defects also influence sleep architecture, increasing the likelihood of AAE. The mechanism whereby supine sleep decreases SIDS may therefore be a stressor effect, disturbing sleep architecture to decrease REM and AAEs, and increasing sympathetic tone, which may prevent and counteract the purely parasympathetic-mediated AAE, thereby decreasing the risk of SIDS.
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Affiliation(s)
- Nils J Bergman
- Department of Human Biology, University of Cape Town, Western Cape, South Africa
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25
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The role of clinical, genetic and segregation evaluation in sudden infant death. Forensic Sci Int 2014; 242:9-15. [PMID: 25016126 DOI: 10.1016/j.forsciint.2014.06.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 04/19/2014] [Accepted: 06/05/2014] [Indexed: 12/12/2022]
Abstract
Sudden infant death syndrome (SIDS) is the leading cause of death in the first year of life. Several arrhythmogenic genes have been associated with cardiac pathologies leading to infant sudden cardiac death (SCD). Our aim was to take advantage of next generation sequencing (NGS) technology to perform a thorough genetic analysis of a SIDS case. A SIDS case was referred to our institution after negative autopsy. We performed a genetic analysis of 104 SCD-related genes using a custom panel. Confirmed variants in index case were also analyzed in relatives. Clinical evaluation of first-degree family members was performed. Relatives did not show pathology. NGS identified seven variants. Two previously described as pathogenic. Four previously catalogued without clinical significance. The seventh variation was novel. Familial segregation showed that the index case's mother carried all same genetic variations except one, which was inherited from the father. The sister of the index case carried three variants. We believe that molecular autopsy should be included in current forensic protocols after negative autopsy. In addition to NGS technologies, familial genetic testing should be also performed to clarify potential pathogenic role of new variants and to identify genetic carriers at risk of SCD.
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26
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Campuzano O, Allegue C, Partemi S, Iglesias A, Oliva A, Brugada R. Negative autopsy and sudden cardiac death. Int J Legal Med 2014; 128:599-606. [PMID: 24532175 DOI: 10.1007/s00414-014-0966-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 01/15/2014] [Indexed: 12/20/2022]
Abstract
Forensic medicine defines the unexplained sudden death as a death with a non-conclusive diagnosis after autopsy. Molecular diagnosis is being progressively incorporated in forensics, mainly due to improvement in genetics. New genetic technologies may help to identify the genetic cause of death, despite clinical interpretation of genetic data remains the current challenge. The identification of an inheritable defect responsible for arrhythmogenic syndromes could help to adopt preventive measures in family members, many of them asymptomatic but at risk of sudden death. This multidisciplinary translational research requires a specialized team.
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Affiliation(s)
- Oscar Campuzano
- Cardiovascular Genetic Center, University of Girona-IDIBGI, Girona, Spain
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27
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Abstract
Channelopathies are a heterogeneous group of disorders resulting from the dysfunction of ion channels located in the membranes of all cells and many cellular organelles. These include diseases of the nervous system (e.g., generalized epilepsy with febrile seizures plus, familial hemiplegic migraine, episodic ataxia, and hyperkalemic and hypokalemic periodic paralysis), the cardiovascular system (e.g., long QT syndrome, short QT syndrome, Brugada syndrome, and catecholaminergic polymorphic ventricular tachycardia), the respiratory system (e.g., cystic fibrosis), the endocrine system (e.g., neonatal diabetes mellitus, familial hyperinsulinemic hypoglycemia, thyrotoxic hypokalemic periodic paralysis, and familial hyperaldosteronism), the urinary system (e.g., Bartter syndrome, nephrogenic diabetes insipidus, autosomal-dominant polycystic kidney disease, and hypomagnesemia with secondary hypocalcemia), and the immune system (e.g., myasthenia gravis, neuromyelitis optica, Isaac syndrome, and anti-NMDA [N-methyl-D-aspartate] receptor encephalitis). The field of channelopathies is expanding rapidly, as is the utility of molecular-genetic and electrophysiological studies. This review provides a brief overview and update of channelopathies, with a focus on recent advances in the pathophysiological mechanisms that may help clinicians better understand, diagnose, and develop treatments for these diseases.
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Affiliation(s)
- June-Bum Kim
- Department of Pediatrics, Seoul Children's Hospital, Seoul, Korea
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28
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Abstract
PURPOSE OF REVIEW To assess the relevance of perinatal and pediatric autopsies in genetic and metabolic diseases. RECENT FINDINGS Genetic investigations are an important component of fetal autopsies. Despite the advances in imaging diagnosis, the autopsy can identify abnormalities not seen on ultrasound or MRI, as confirmed in recent comparative studies. This is crucial in the diagnosis of syndromic conditions in which the information may be essential to determine the syndrome. Genetic tests may also have a role in the investigation of intrauterine growth restriction and unexplained stillbirth. New techniques have increased the diagnostic yield, even in cases of macerated fetuses.The genetic autopsy is not limited to fetal loss. Genetic abnormalities underlie many cases presenting as sudden unexpected death in infancy, childhood and adolescence, and the need to obtain appropriate samples for genetic analysis applies not only to fetal autopsies. SUMMARY Fetal autopsies are still the gold standard in diagnosis of fetal abnormalities. Genetic studies are an important component, not only in cases of congenital malformations, but also in unexplained intrauterine death and sudden unexpected death in infancy, as well as in children and adults.
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Affiliation(s)
- Irene Scheimberg
- Department of Cellular Pathology, The Royal London Hospital, Barts Health NHS Trust, London, UK
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29
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Franco E, Dias A, Teresa D, Hebert K. EKG pattern of Brugada syndrome and sudden infant death syndrome--is it time to review the diagnostic criteria? Case report and review of literature. Ann Noninvasive Electrocardiol 2013; 19:198-202. [PMID: 24620847 DOI: 10.1111/anec.12086] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Brugada Syndrome (BrS) is a cardiac disorder characterized by incomplete right bundle-branch block and ST elevations in the anterior precordial leads especially V1 -V3 , associated with an increased risk for sudden cardiac death (SCD) in young adults. Our case describes a patient with family history of sudden infant death syndrome (SIDS) who presented with a Brugada pattern unmasked by severe hyperkalemia and diabetic ketoacidosis. Several studies have concluded there may be a genetic link among SIDS, SDC, and BrS resulting from mutations in cardiac ion channel-related genes. Recognizing SIDS as part of the diagnostic criteria for BrS would help us identifying a significant number of families susceptible to develop SCD (as well as SIDS).
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