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Przybylski R, Meziab O, Gauvreau K, Dionne A, DeWitt ES, Bezzerides VJ, Abrams DJ. Premature ventricular contractions in children and young adults: natural history and clinical implications. Europace 2024; 26:euae052. [PMID: 38441283 PMCID: PMC10927167 DOI: 10.1093/europace/euae052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 02/10/2024] [Indexed: 03/13/2024] Open
Affiliation(s)
- Robert Przybylski
- Department of Cardiology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Omar Meziab
- Department of Cardiology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Audrey Dionne
- Department of Cardiology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Elizabeth S DeWitt
- Department of Cardiology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Vassilios J Bezzerides
- Department of Cardiology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Dominic J Abrams
- Department of Cardiology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
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Przybylski R, Saravu Vijayashankar S, O'Leary ET, Hylind RJ, Noon J, Dionne A, DeWitt ES, Bezzerides VJ, Abrams DJ. Hypertrophic Cardiomyopathy and Ventricular Preexcitation in the Young: Cause and Accessory Pathway Characteristics. Circ Arrhythm Electrophysiol 2023; 16:e012191. [PMID: 37877314 PMCID: PMC10843507 DOI: 10.1161/circep.123.012191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 10/10/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND The cause of hypertrophic cardiomyopathy (HCM) in the young is highly varied. Ventricular preexcitation (preexcitation) is well recognized, yet little is known about the specificity for any cause and the characteristics of the responsible accessory pathways (AP). METHODS Retrospective cohort study of patients <21 years of age with HCM/preexcitation from 2000 to 2022. The cause of HCM was defined as isolated HCM, storage disorder, metabolic disease, or genetic syndrome. Atrioventricular AP (true AP) were distinguished from fasciculoventricular fibers (FVF) using standard invasive electrophysiology study criteria. AP were defined as high risk if any of the following were <250 ms: shortest preexcited RR interval in atrial fibrillation, shortest paced preexcited cycle length, or anterograde AP effective refractory period. RESULTS We identified 345 patients with HCM and 28 (8%) had preexcitation (isolated HCM, 10/220; storage disorder, 8/17; metabolic disease, 5/19; and genetic syndrome, 5/89). Six (21%) patients had clinical atrial fibrillation (1 with shortest preexcited RR interval <250 ms). Twenty-two patients underwent electrophysiology study which identified 23 true AP and 16 FVF. Preexcitation was exclusively FVF mediated in 8 (36%) patients. Five (23%) patients had AP with high-risk conduction properties (including ≥1 patient in each etiologic group). Multiple AP were seen in 8 (36%) and AP plus FVF in 10 (45%) patients. Ablation was acutely successful in 13 of 14 patients with recurrence in 3. One procedure was complicated by complete heart block after ablation of a high-risk midseptal AP. There were significant differences in QRS amplitude and delta wave amplitude between groups. There were no surface ECG features that differentiated AP from FVF. CONCLUSIONS Young patients with HCM and preexcitation have a high likelihood of underlying storage disease or metabolic disease. Nonisolated HCM should be suspected in young patients with large QRS and delta wave amplitudes. Surface ECG is not adequate to discriminate preexcitation from a benign FVF from that secondary to potentially life-threatening AP.
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Affiliation(s)
- Robert Przybylski
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, MA
| | | | - Edward T O'Leary
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, MA
| | - Robyn J Hylind
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, MA
| | - Jennifer Noon
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, MA
| | - Audrey Dionne
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, MA
| | - Elizabeth S DeWitt
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, MA
| | | | - Dominic J Abrams
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, MA
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Abou Alaiwi S, Roston TM, Marstrand P, Claggett BL, Parikh VN, Helms AS, Ingles J, Lampert R, Lakdawala NK, Michels M, Owens AT, Rossano JW, Saberi S, Abrams DJ, Ashley EA, Semsarian C, Stendahl JC, Ware JS, Miller E, Ryan TD, Russell MW, Day SM, Olivotto I, Vissing CR, Ho CY. Left Ventricular Systolic Dysfunction in Patients Diagnosed With Hypertrophic Cardiomyopathy During Childhood: Insights From the SHaRe Registry. Circulation 2023; 148:394-404. [PMID: 37226762 PMCID: PMC10373850 DOI: 10.1161/circulationaha.122.062517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 05/09/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND The development of left ventricular systolic dysfunction (LVSD) in hypertrophic cardiomyopathy (HCM) is rare but serious and associated with poor outcomes in adults. Little is known about the prevalence, predictors, and prognosis of LVSD in patients diagnosed with HCM as children. METHODS Data from patients with HCM in the international, multicenter SHaRe (Sarcomeric Human Cardiomyopathy Registry) were analyzed. LVSD was defined as left ventricular ejection fraction <50% on echocardiographic reports. Prognosis was assessed by a composite of death, cardiac transplantation, and left ventricular assist device implantation. Predictors of developing incident LVSD and subsequent prognosis with LVSD were assessed using Cox proportional hazards models. RESULTS We studied 1010 patients diagnosed with HCM during childhood (<18 years of age) and compared them with 6741 patients with HCM diagnosed as adults. In the pediatric HCM cohort, median age at HCM diagnosis was 12.7 years (interquartile range, 8.0-15.3), and 393 (36%) patients were female. At initial SHaRe site evaluation, 56 (5.5%) patients with childhood-diagnosed HCM had prevalent LVSD, and 92 (9.1%) developed incident LVSD during a median follow-up of 5.5 years. Overall LVSD prevalence was 14.7% compared with 8.7% in patients with adult-diagnosed HCM. Median age at incident LVSD was 32.6 years (interquartile range, 21.3-41.6) for the pediatric cohort and 57.2 years (interquartile range, 47.3-66.5) for the adult cohort. Predictors of developing incident LVSD in childhood-diagnosed HCM included age <12 years at HCM diagnosis (hazard ratio [HR], 1.72 [CI, 1.13-2.62), male sex (HR, 3.1 [CI, 1.88-5.2), carrying a pathogenic sarcomere variant (HR, 2.19 [CI, 1.08-4.4]), previous septal reduction therapy (HR, 2.34 [CI, 1.42-3.9]), and lower initial left ventricular ejection fraction (HR, 1.53 [CI, 1.38-1.69] per 5% decrease). Forty percent of patients with LVSD and HCM diagnosed during childhood met the composite outcome, with higher rates in female participants (HR, 2.60 [CI, 1.41-4.78]) and patients with a left ventricular ejection fraction <35% (HR, 3.76 [2.16-6.52]). CONCLUSIONS Patients with childhood-diagnosed HCM have a significantly higher lifetime risk of developing LVSD, and LVSD emerges earlier than for patients with adult-diagnosed HCM. Regardless of age at diagnosis with HCM or LVSD, the prognosis with LVSD is poor, warranting careful surveillance for LVSD, especially as children with HCM transition to adult care.
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Affiliation(s)
- Sarah Abou Alaiwi
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA (S.A.A., T.M.R., B.L.C., N.K.L., C.Y.H.)
| | - Thomas M. Roston
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA (S.A.A., T.M.R., B.L.C., N.K.L., C.Y.H.)
- University of British Columbia, Vancouver, Canada (T.M.R.)
| | - Peter Marstrand
- Department of Cardiology, Herlev-Gentofte Hospital, Copenhagen University Hospital, Denmark (P.M.)
| | - Brian Lee Claggett
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA (S.A.A., T.M.R., B.L.C., N.K.L., C.Y.H.)
| | - Victoria N. Parikh
- Center for Inherited Cardiovascular Disease, Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (V.N.P., E.A.A.)
| | - Adam S. Helms
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (A.S.H., S.S., M.W.R.)
| | - Jodie Ingles
- Centre for Population Genomics, Garvan Institute of Medical Research and University of New South Wales, Sydney, Australia (J.I.)
| | - Rachel Lampert
- Department of Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (R.L., J.C.S.)
| | - Neal K. Lakdawala
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA (S.A.A., T.M.R., B.L.C., N.K.L., C.Y.H.)
| | - Michelle Michels
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center Rotterdam, the Netherlands (M.M.)
| | - Anjali T. Owens
- Division of Cardiology, University of Pennsylvania, Philadelphia (A.T.O., S.M.D.)
| | - Joseph W. Rossano
- Division of Cardiology, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia (J.W.R.)
| | - Sara Saberi
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (A.S.H., S.S., M.W.R.)
| | - Dominic J. Abrams
- Center for Cardiovascular Genetics, Department of Cardiology, Boston Children’s Hospital & Harvard Medical School, MA (D.J.A.)
| | - Euan A. Ashley
- Center for Inherited Cardiovascular Disease, Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (V.N.P., E.A.A.)
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, University of Sydney, Australia (C.S.)
| | - John C. Stendahl
- Department of Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (R.L., J.C.S.)
| | - James S. Ware
- Royal Brompton & Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London, UK (J.S.W.)
| | - Erin Miller
- Department of Pediatrics, University of Cincinnati College of Medicine, OH (E.M., T.D.R.)
- Division of Cardiology, The Heart Institute, Cincinnati Children’s Hospital Medical Center, OH (E.M., T.D.R.)
| | - Thomas D. Ryan
- Department of Pediatrics, University of Cincinnati College of Medicine, OH (E.M., T.D.R.)
- Division of Cardiology, The Heart Institute, Cincinnati Children’s Hospital Medical Center, OH (E.M., T.D.R.)
| | - Mark W. Russell
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor (A.S.H., S.S., M.W.R.)
| | - Sharlene M. Day
- Division of Cardiology, University of Pennsylvania, Philadelphia (A.T.O., S.M.D.)
| | - Iacopo Olivotto
- Meyer Children Hospital, Department of Experimental and Clinical Medicine, University of Florence, Italy (I.O.)
| | - Christoffer R. Vissing
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Denmark (C.R.V.)
| | - Carolyn Y. Ho
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA (S.A.A., T.M.R., B.L.C., N.K.L., C.Y.H.)
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Przybylski R, Abrams DJ. Current management of inherited arrhythmia syndromes associated with the cardiac ryanodine receptor. Curr Opin Cardiol 2023; 38:390-395. [PMID: 37016946 DOI: 10.1097/hco.0000000000001051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
PURPOSE OF REVIEW Gain-of-function variants in the gene encoding the cardiac ryanodine receptor ( RYR2 ) are associated with catecholaminergic polymorphic ventricular tachycardia (CPVT). The exercise stress test (EST) has long been fundamental in diagnosis and management, but recent work has further explored its role. A new entity termed calcium release deficiency syndrome (CRDS) has been associated with loss-of-function RYR2 variants and a different arrhythmic phenotype. RECENT FINDINGS Standard EST is not perfectly reproducible with regards to provocation of arrhythmia in CPVT. A newly described burst EST protocol may be more sensitive in this regard. Nadolol is the most effective beta blocker in CPVT, though arrhythmic events remain frequent and dual therapy with flecainide and/or left cardiac sympathetic denervation may add protection. A recent report renews debate regarding the use of implantable defibrillator therapy in CPVT. CRDS is characterized by later age of presentation, normal/near normal EST, and ventricular arrhythmia induced by a novel ventricular stimulation protocol. SUMMARY Burst EST may aid in the diagnosis and management of CPVT. Nadolol is the preferred beta blocker in CPVT, and consideration should be given to early dual therapy. CRDS should be suspected in patients with arrhythmic events, rare RYR2 variants, and a phenotype inconsistent with CPVT.
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Affiliation(s)
- Robert Przybylski
- Department of Cardiology, Center for Cardiovascular Genetics, Boston Children's Hospital, Boston, Massachusetts, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 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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O'Leary ET, Harris J, Gauvreau K, Gentry C, Dionne A, Abrams DJ, Alexander ME, Bezzerides VJ, DeWitt ES, Triedman JK, Walsh EP, Mah DY. Radiofrequency Catheter Ablation for Pediatric Atrioventricular Nodal Reentrant Tachycardia: Impact of Age on Procedural Methods and Durable Success. J Am Heart Assoc 2022; 11:e022799. [PMID: 35699163 PMCID: PMC9238659 DOI: 10.1161/jaha.121.022799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Catheter-based slow-pathway modification (SPM) is the treatment of choice for symptomatic atrioventricular nodal reentrant tachycardia (AVNRT). We sought to investigate the interactions between patient age and procedural outcomes in pediatric patients undergoing catheter-based SPM for AVNRT. Methods and Results A retrospective cohort study was performed, including consecutive patients undergoing acutely successful SPM for AVNRT from 2008 to 2017. Those with congenital heart disease, cardiomyopathy, and accessory pathways were excluded. Patients were stratified by age quartile at time of SPM. The primary outcome was AVNRT recurrence. A total of 512 patients underwent successful SPM for AVNRT. Age quartile 1 had 129 patients with a median age and weight of 8.9 years and 30.6 kg, respectively. Radiofrequency energy was used in 98% of cases. Follow-up was available in 447 (87%) patients with a median duration of 0.8 years (interquartile range, 0.2-2.5 years). AVNRT recurred in 22 patients. Multivariable Cox proportional hazard modeling identified atypical AVNRT (hazard ratio [HR], 5.83; 95% CI, 2.01-16.96; P=0.001), dual atrioventricular nodal only (HR, 4.09; 95% CI, 1.39-12.02; P=0.011), total radiofrequency lesions (HR, 1.06 per lesion; 95% CI, 1.01-1.12; P=0.032), and the use of a long sheath (HR, 3.52; 95% CI, 1.23-10.03; P=0.010) as predictors of AVNRT recurrence; quartile 1 patients were not at higher risk of recurrence (HR, 0.45; 95% CI, 0.10-1.97; P=0.29). Complete heart block requiring permanent pacing occurred in one quartile 2 patient at 14.9 years of age. Conclusions Pediatric AVNRT can be treated with radiofrequency-SPM with high procedural efficacy and minimal risk of complications, including heart block. Atypical AVNRT and dual atrioventricular nodal physiology without inducible tachycardia remain challenging substrates.
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Affiliation(s)
- Edward T O'Leary
- Department of Cardiology Boston Children's Hospital Boston MA.,Harvard Medical School Boston MA
| | - Jamie Harris
- Department of Cardiology Boston Children's Hospital Boston MA.,Harvard Medical School Boston MA
| | - Kimberlee Gauvreau
- Department of Cardiology Boston Children's Hospital Boston MA.,Harvard Medical School Boston MA
| | - Courtney Gentry
- Department of Cardiology Boston Children's Hospital Boston MA.,Harvard Medical School Boston MA
| | - Audrey Dionne
- Department of Cardiology Boston Children's Hospital Boston MA.,Harvard Medical School Boston MA
| | - Dominic J Abrams
- Department of Cardiology Boston Children's Hospital Boston MA.,Harvard Medical School Boston MA
| | - Mark E Alexander
- Department of Cardiology Boston Children's Hospital Boston MA.,Harvard Medical School Boston MA
| | - Vassilios J Bezzerides
- Department of Cardiology Boston Children's Hospital Boston MA.,Harvard Medical School Boston MA
| | - Elizabeth S DeWitt
- Department of Cardiology Boston Children's Hospital Boston MA.,Harvard Medical School Boston MA
| | - John K Triedman
- Department of Cardiology Boston Children's Hospital Boston MA.,Harvard Medical School Boston MA
| | - Edward P Walsh
- Department of Cardiology Boston Children's Hospital Boston MA.,Harvard Medical School Boston MA
| | - Douglas Y Mah
- Department of Cardiology Boston Children's Hospital Boston MA.,Harvard Medical School Boston MA
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Hylind RJ, Pereira AC, Quiat D, Chandler SF, Roston TM, Pu WT, Bezzerides VJ, Seidman JG, Seidman CE, Abrams DJ. Population Prevalence of Premature Truncating Variants in Plakophilin-2 and Association With Arrhythmogenic Right Ventricular Cardiomyopathy: A UK Biobank Analysis. Circ Genom Precis Med 2022; 15:e003507. [PMID: 35536239 PMCID: PMC9400410 DOI: 10.1161/circgen.121.003507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Truncating variants in the desmosomal gene PKP2 (PKP2tv) cause arrhythmogenic right ventricular cardiomyopathy (ARVC) yet display varied penetrance and expressivity. METHODS We identified individuals with PKP2tv from the UK Biobank (UKB) and determined the prevalence of an ARVC phenotype and other cardiovascular traits based on clinical and procedural data. The PKP2tv minor allelic frequency in the UKB was compared with a second cohort of probands with a clinical diagnosis of ARVC (ARVC cohort), with a figure of 1:5000 assumed for disease prevalence. In silico predictors of variant pathogenicity (combined annotation-dependent depletion and Splice AI [Illumina, Inc.]) were assessed. RESULTS PKP2tv were identified in 193/200 643 (0.10%) UKB participants, with 47 unique PKP2tv. Features consistent with ARVC were present in 3 (1.6%), leaving 190 with PKP2tv without manifest disease (UKB cohort; minor allelic frequency 4.73×10-4). The ARVC cohort included 487 ARVC probands with 144 distinct PKP2tv, with 25 PKP2tv common to both cohorts. The odds ratio for ARVC for the 25 common PKP2tv was 0.047 (95% CI, 0.001-0.268; P=2.43×10-6), and only favored ARVC (odds ratio >1) for a single variant, p.Arg79*. In silico variant analysis did not differentiate PKP2tv between the 2 cohorts. Atrial fibrillation was over-represented in the UKB cohort in those with PKP2tv (7.9% versus 4.3%; odds ratio, 2.11; P=0.005). CONCLUSIONS PKP2tv are prevalent in the population and associated with ARVC in only a small minority, necessitating a more detailed understanding of how PKP2tv cause ARVC in combination with associated genetic and environmental risk factors.
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Affiliation(s)
- Robyn J Hylind
- Inherited Cardiac Arrhythmia Program, Department of Cardiology, Boston Children's Hospital (R.J.H., D.Q., S.F.C., T.M.R., W.T.P., V.J.B., D.J.A.), Harvard Medical School, Boston MA
| | - Alexandre C Pereira
- Department of Genetics (A.C.P., D.Q., J.G.S., C.E.S.), Harvard Medical School, Boston MA
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Brazil (A.C.P.)
| | - Daniel Quiat
- Inherited Cardiac Arrhythmia Program, Department of Cardiology, Boston Children's Hospital (R.J.H., D.Q., S.F.C., T.M.R., W.T.P., V.J.B., D.J.A.), Harvard Medical School, Boston MA
- Department of Genetics (A.C.P., D.Q., J.G.S., C.E.S.), Harvard Medical School, Boston MA
| | - Stephanie F Chandler
- Inherited Cardiac Arrhythmia Program, Department of Cardiology, Boston Children's Hospital (R.J.H., D.Q., S.F.C., T.M.R., W.T.P., V.J.B., D.J.A.), Harvard Medical School, Boston MA
| | - Thomas M Roston
- Inherited Cardiac Arrhythmia Program, Department of Cardiology, Boston Children's Hospital (R.J.H., D.Q., S.F.C., T.M.R., W.T.P., V.J.B., D.J.A.), Harvard Medical School, Boston MA
| | - William T Pu
- Inherited Cardiac Arrhythmia Program, Department of Cardiology, Boston Children's Hospital (R.J.H., D.Q., S.F.C., T.M.R., W.T.P., V.J.B., D.J.A.), Harvard Medical School, Boston MA
| | - Vassilios J Bezzerides
- Inherited Cardiac Arrhythmia Program, Department of Cardiology, Boston Children's Hospital (R.J.H., D.Q., S.F.C., T.M.R., W.T.P., V.J.B., D.J.A.), Harvard Medical School, Boston MA
| | - Jonathan G Seidman
- Department of Genetics (A.C.P., D.Q., J.G.S., C.E.S.), Harvard Medical School, Boston MA
| | - Christine E Seidman
- Department of Genetics (A.C.P., D.Q., J.G.S., C.E.S.), Harvard Medical School, Boston MA
- Cardiovascular Division, Brigham and Women's Hospital (C.E.S.), Harvard Medical School, Boston MA
- Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.)
| | - Dominic J Abrams
- Inherited Cardiac Arrhythmia Program, Department of Cardiology, Boston Children's Hospital (R.J.H., D.Q., S.F.C., T.M.R., W.T.P., V.J.B., D.J.A.), Harvard Medical School, Boston MA
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Tortigue M, Nield LE, Karakachoff M, McLeod CJ, Belli E, Babu-Narayan SV, Prigent S, Boet A, Conway M, Elder RW, Ladouceur M, Khairy P, Kowalik E, Kalfa DM, Barron DJ, Mussa S, Hiippala A, Temple J, Abadir S, Le Gloan L, Lachaud M, Sanatani S, Thambo JB, Gronier CG, Amedro P, Vaksmann G, Charbonneau A, Koutbi L, Ovaert C, Houeijeh A, Combes N, Maury P, Duthoit G, Hiel B, Erickson CC, Bonnet C, Van Hare GF, Dina C, Karsenty C, Fournier E, Le Bloa M, Pass RH, Liberman L, Happonen JM, Perry JC, Romefort B, Benbrik N, Hauet Q, Fraisse A, Gatzoulis MA, Abrams DJ, Dubin AM, Ho SY, Redon R, Bacha EA, Schott JJ, Baruteau AE. Familial Recurrence Patterns in Congenitally Corrected Transposition of the Great Arteries: An International Study. Circ Genom Precis Med 2022; 15:e003464. [PMID: 35549293 DOI: 10.1161/circgen.121.003464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Congenitally corrected transposition of the great arteries (ccTGA) is a rare disease of unknown cause. We aimed to better understand familial recurrence patterns. METHODS An international, multicentre, retrospective cohort study was conducted in 29 tertiary hospitals in 6 countries between 1990 and 2018, entailing investigation of 1043 unrelated ccTGA probands. RESULTS Laterality defects and atrioventricular block at diagnosis were observed in 29.9% and 9.3%, respectively. ccTGA was associated with primary ciliary dyskinesia in 11 patients. Parental consanguinity was noted in 3.4% cases. A congenital heart defect was diagnosed in 81 relatives from 69 families, 58% of them being first-degree relatives, including 28 siblings. The most prevalent defects in relatives were dextro-transposition of the great arteries (28.4%), laterality defects (13.6%), and ccTGA (11.1%); 36 new familial clusters were described, including 8 pedigrees with concordant familial aggregation of ccTGA, 19 pedigrees with familial co-segregation of ccTGA and dextro-transposition of the great arteries, and 9 familial co-segregation of ccTGA and laterality defects. In one family co-segregation of ccTGA, dextro-transposition of the great arteries and heterotaxy syndrome in 3 distinct relatives was found. In another family, twins both displayed ccTGA and primary ciliary dyskinesia. CONCLUSIONS ccTGA is not always a sporadic congenital heart defect. Familial clusters as well as evidence of an association between ccTGA, dextro-transposition of the great arteries, laterality defects and in some cases primary ciliary dyskinesia, strongly suggest a common pathogenetic pathway involving laterality genes in the pathophysiology of ccTGA.
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Affiliation(s)
- Marine Tortigue
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, France (M.T., L.L.G., C.D., R.R., J.-J.S., A.-E.B.)
- Nantes Université, CHU Nantes, Department of Pediatric Cardiology and Pediatric Cardiac Surgery, France (M.T., S.P., C.G.G., B.R., N.B., Q.H., A.-E.B.)
- Nantes Université, CHU Nantes, INSERM, CIC FEA 1413, France (M.T., S.P., C.G.G., A.-E.B.)
| | - Lynne E Nield
- Division of Pediatric Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Canada (L.E.N., D.J.B.)
| | | | | | - Emre Belli
- Department of Pediatric and Adult Congenital Heart Disase, M3C Marie Lannelongue Hospital, Groupe Hospitalier Saint Joseph, Paris, France (E.B., A.B., N.C., E.F.)
| | - Sonya V Babu-Narayan
- National Heart and Lung Institute, Imperial College London, Royal Brompton and Harefield Hospitals, United Kingdom (S.V.B.-N., M.C., A.F., M.A.G., S.Y.H.)
| | - Solène Prigent
- Nantes Université, CHU Nantes, Department of Pediatric Cardiology and Pediatric Cardiac Surgery, France (M.T., S.P., C.G.G., B.R., N.B., Q.H., A.-E.B.)
- Nantes Université, CHU Nantes, INSERM, CIC FEA 1413, France (M.T., S.P., C.G.G., A.-E.B.)
| | - Angèle Boet
- Department of Pediatric and Adult Congenital Heart Disase, M3C Marie Lannelongue Hospital, Groupe Hospitalier Saint Joseph, Paris, France (E.B., A.B., N.C., E.F.)
| | - Miriam Conway
- National Heart and Lung Institute, Imperial College London, Royal Brompton and Harefield Hospitals, United Kingdom (S.V.B.-N., M.C., A.F., M.A.G., S.Y.H.)
| | - Robert W Elder
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT (R.W.E.)
| | - Magalie Ladouceur
- Department of Adult Congenital Heart Diseases, M3C Hôpital Européen Georges Pompidou, Paris, France (M.L.)
| | - Paul Khairy
- Electrophysiology Service and Adult Congenital Heart Center, Montreal Heart Institute, University of Montreal, Quebec, Canada (P.K., S.A.)
| | - Ewa Kowalik
- Department of Congenital Heart Diseases, National Institute of Cardiology, Warsaw, Poland (E.K.)
| | - David M Kalfa
- Department of Pediatric and Congenital Cardiac Surgery, Morgan Stanley Children's Hospital - New York Presbyterian, Columbia University Medical Center, NY (D.M.K., L.L., E.A.B.)
| | - David J Barron
- Division of Pediatric Cardiology, Labatt Family Heart Centre, The Hospital for Sick Children, University of Toronto, Canada (L.E.N., D.J.B.)
| | - Shafi Mussa
- Department of Congenital Cardiac Surgery, University Hospitals Bristol NHS Foundation Trust, United Kingdom (S.M.)
| | - Anita Hiippala
- Department of Pediatric Cardiology, New Children's Hospital, Helsinki University Hospital, Finland (A.H., J.-M.H.)
| | - Joel Temple
- Department of Pediatrics, Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, DE (J.T.)
| | - Sylvia Abadir
- Electrophysiology Service and Adult Congenital Heart Center, Montreal Heart Institute, University of Montreal, Quebec, Canada (P.K., S.A.)
- Division of Cardiology, CHU Mère-Enfant Sainte-Justine, University of Montreal, Quebec, Canada (S.A.)
| | - Laurianne Le Gloan
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, France (M.T., L.L.G., C.D., R.R., J.-J.S., A.-E.B.)
- Department of Cardiology, CHU Nantes, Nantes, France (L.L.G.)
| | | | - Shubhayan Sanatani
- Division of Cardiology, British Columbia Children's Hospital, University of British Columbia, Vancouver, Canada (S.S.)
| | | | - Céline Grunenwald Gronier
- Nantes Université, CHU Nantes, Department of Pediatric Cardiology and Pediatric Cardiac Surgery, France (M.T., S.P., C.G.G., B.R., N.B., Q.H., A.-E.B.)
- Nantes Université, CHU Nantes, INSERM, CIC FEA 1413, France (M.T., S.P., C.G.G., A.-E.B.)
| | - Pascal Amedro
- Department of Cardiology, CHU Bordeaux, France (J.-B.T., P.A.)
- PhyMedExp, CNRS, INSERM, University of Montpellier, France (P.A.)
| | - Guy Vaksmann
- Department of Pediatric Cardiology, Hôpital Privé de La Louvière, Lille, France (G.V.)
| | - Anne Charbonneau
- Department of Pediatric and Congenital Cardiology, American Memorial Hospital, CHU Reims, France (A.C.)
| | - Linda Koutbi
- Department of Cardiology (L.K.), La Timone Hospital, CHU Marseille, France
| | - Caroline Ovaert
- Department of Pediatric Cardiology (C.O.), La Timone Hospital, CHU Marseille, France
- Marseille Medical Genetics, Inserm UMR 1251, Aix-Marseille University, France (C.O.)
| | - Ali Houeijeh
- Department of Pediatric Cardiology, CHRU Lille, France (A.H.)
| | - Nicolas Combes
- Department of Pediatric and Adult Congenital Heart Disase, M3C Marie Lannelongue Hospital, Groupe Hospitalier Saint Joseph, Paris, France (E.B., A.B., N.C., E.F.)
- Department of Cardiology, Pasteur Clinic, Toulouse, France (N.C.)
| | | | - Guillaume Duthoit
- Department of Cardiology, Groupe Hospitalier Pitié Salpétrière, Sorbonne Université, Paris, France (G.D.)
| | - Bérengère Hiel
- Department of Pediatric Cardiology, CHU Amiens, France (B.H.)
| | - Christopher C Erickson
- UDivision of Pediatric Cardiology, University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha, NE (C.C.E.)
| | | | - George F Van Hare
- Division of Pediatric Cardiology, St Louis Children's Hospital, Washington University School of Medicine (G.F.V.H.)
| | - Christian Dina
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, France (M.T., L.L.G., C.D., R.R., J.-J.S., A.-E.B.)
| | - Clément Karsenty
- Department of Pediatric and Congenital Cardiology, Children's Hospital (C.K.), CHU Toulouse, France
- Institut des Maladies Métaboliques et Cardiovasculaires, Inserm UMR 1048, Université de Toulouse, France (C.K.)
| | - Emmanuelle Fournier
- Department of Pediatric and Adult Congenital Heart Disase, M3C Marie Lannelongue Hospital, Groupe Hospitalier Saint Joseph, Paris, France (E.B., A.B., N.C., E.F.)
| | - Mathieu Le Bloa
- Department of Cardiology, Lausanne University Hospital, University of Lausanne, Switzerland (M.L.B.)
| | - Robert H Pass
- Department of Pediatric Cardiology, Mount Sinai Kravis Children's Hospital, NY (R.H.P.)
| | - Leonardo Liberman
- Department of Pediatric and Congenital Cardiac Surgery, Morgan Stanley Children's Hospital - New York Presbyterian, Columbia University Medical Center, NY (D.M.K., L.L., E.A.B.)
| | - Juha-Matti Happonen
- Department of Pediatric Cardiology, New Children's Hospital, Helsinki University Hospital, Finland (A.H., J.-M.H.)
| | - James C Perry
- Department of Pediatrics, Rady Children's Hospital, University of California San Diego (J.C.P.)
| | - Bénédicte Romefort
- Nantes Université, CHU Nantes, Department of Pediatric Cardiology and Pediatric Cardiac Surgery, France (M.T., S.P., C.G.G., B.R., N.B., Q.H., A.-E.B.)
| | - Nadir Benbrik
- Nantes Université, CHU Nantes, Department of Pediatric Cardiology and Pediatric Cardiac Surgery, France (M.T., S.P., C.G.G., B.R., N.B., Q.H., A.-E.B.)
| | - Quentin Hauet
- Nantes Université, CHU Nantes, Department of Pediatric Cardiology and Pediatric Cardiac Surgery, France (M.T., S.P., C.G.G., B.R., N.B., Q.H., A.-E.B.)
| | - Alain Fraisse
- National Heart and Lung Institute, Imperial College London, Royal Brompton and Harefield Hospitals, United Kingdom (S.V.B.-N., M.C., A.F., M.A.G., S.Y.H.)
| | - Michael A Gatzoulis
- National Heart and Lung Institute, Imperial College London, Royal Brompton and Harefield Hospitals, United Kingdom (S.V.B.-N., M.C., A.F., M.A.G., S.Y.H.)
| | - Dominic J Abrams
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, MA (D.J.A.)
| | - Anne M Dubin
- Division of Pediatric Cardiology, Stanford University, Palo Alto, CA (A.M.D.)
| | - Siew Yen Ho
- National Heart and Lung Institute, Imperial College London, Royal Brompton and Harefield Hospitals, United Kingdom (S.V.B.-N., M.C., A.F., M.A.G., S.Y.H.)
| | - Richard Redon
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, France (M.T., L.L.G., C.D., R.R., J.-J.S., A.-E.B.)
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart (R.R., J.-J.S., A.-E.B.)
| | - Emile A Bacha
- Department of Pediatric and Congenital Cardiac Surgery, Morgan Stanley Children's Hospital - New York Presbyterian, Columbia University Medical Center, NY (D.M.K., L.L., E.A.B.)
| | - Jean-Jacques Schott
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, France (M.T., L.L.G., C.D., R.R., J.-J.S., A.-E.B.)
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart (R.R., J.-J.S., A.-E.B.)
| | - Alban-Elouen Baruteau
- Nantes Université, CHU Nantes, CNRS, INSERM, l'institut du thorax, France (M.T., L.L.G., C.D., R.R., J.-J.S., A.-E.B.)
- Nantes Université, CHU Nantes, Department of Pediatric Cardiology and Pediatric Cardiac Surgery, France (M.T., S.P., C.G.G., B.R., N.B., Q.H., A.-E.B.)
- Nantes Université, CHU Nantes, INSERM, CIC FEA 1413, France (M.T., S.P., C.G.G., A.-E.B.)
- European Reference Network for Rare, Low Prevalence and Complex Diseases of the Heart-ERN GUARD-Heart (R.R., J.-J.S., A.-E.B.)
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9
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Franciosi S, Abrams DJ, Ingles J, Sanatani S. Sudden Cardiac Arrest in the Paediatric Population. CJC Pediatr Congenit Heart Dis 2022; 1:45-59. [PMID: 37969243 PMCID: PMC10642157 DOI: 10.1016/j.cjcpc.2022.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/03/2022] [Indexed: 11/17/2023]
Abstract
Sudden cardiac arrest in the young is a rare event with a range of potential causes including cardiomyopathies, ion channelopathies, and autonomic nervous system dysfunction. Investigations into the cause involve a multidisciplinary team, including cardiologists, geneticists, and psychologists. In addition to a detailed medical history, family history and circumstances surrounding the event are important in determining the cause. Clinical investigations including an electrocardiogram are fundamental in diagnosis and should be interpreted cautiously because some children may have atypical presentations and an evolving phenotype. The potential for misdiagnosis exists that could lead to incorrect long-term management strategies. If an inherited condition is suspected, genetic testing of the patient and cascade screening of family members is recommended with genetic counselling and psychological support. Medical management is left to the treating physician acknowledging that a clear diagnosis cannot be made in approximately half of cases. Secondary prevention implantable defibrillators are widely deployed but can be associated with complications in young patients. A plan for safe return to activity is recommended along with a proper transition of care into adulthood. Broad screening of the general population for arrhythmia syndromes is not recommended; preventative measures include screening paediatric patients for risk factors by their primary care physician. Several milestone events or activities that take place in youth could be used as opportunities to promote safety. Further work into risk stratification of this paediatric population through patient registries and greater awareness of cardiopulmonary resuscitation and automated external defibrillator use in saving lives is warranted.
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Affiliation(s)
- Sonia Franciosi
- BC Children’s Hospital Heart Centre, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dominic J. Abrams
- Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Jodie Ingles
- Centre for Population Genomics, Garvan Institute of Medical Research, and UNSW Sydney, Sydney, New South Wales, Australia
- Centre for Population Genomics, Murdoch Children’s Research Institute, Melbourne, Victoria, Australia
| | - Shubhayan Sanatani
- BC Children’s Hospital Heart Centre, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
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10
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Whitehill RD, Balaji S, Kelleman M, Chandler SF, Abrams DJ, Mao C, Fischbach P, Campbell R. Exercise Recommendations in Pediatric HCM: Variation and Influence of Provider Characteristics. Pediatr Cardiol 2022; 43:132-141. [PMID: 34406429 DOI: 10.1007/s00246-021-02703-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 08/04/2021] [Indexed: 11/29/2022]
Abstract
Pediatric Hypertrophic Cardiomyopathy (HCM) is associated with sudden cardiac death (SCD) that can be related to physical activity. Without pediatric specific guidelines, recommendations for activity restriction may be varied. Therefore, our aim is to determine the current practice and variability surrounding exercise clearance recommendations (ER) in pediatric HCM referral centers as well as provider and patient characteristics that influence them. We designed a survey that was distributed to the Pediatric Heart Transplant Study (PHTS) providers and members of the Pediatric and Adult Congenital Electrophysiology Society (PACES) querying provider demographics and patient variables from 2 patient vignettes. The study is a multicenter survey of current practice of specialized providers caring for pediatric HCM patients. Survey of PHTS and PACES providers via email to the respective listservs with a response rate of 28% and 91 overall completing the entire survey after self-identifying as providers for pediatric HCM patients at their center. ER varies for pediatric HCM and is associated with provider training background as well as personal and professional history. Of the 91 providers who completed the survey, 42% (N = 38) trained in pediatric electrophysiology (EP), and 40% (N = 36) in pediatric heart failure (HF). Responses varied and only 53% of providers cleared for mild to moderate activity for the patient in Vignette 1, which is more in line with recent published adult guidelines. ER in both vignettes was significantly associated with type of training background. EP providers were more likely to recommend no restriction (27.8% vs 5.9%) than HF providers even when controlling for provider age and time out of training. Syncope with exercise was deemed "Most Important" by 81% of providers when making ER. ER for pediatric HCM are variable and the majority of providers make ER outside of previously published adult guidelines. Furthermore, ER are influenced by provider background and experience. Further study is needed for risks and benefits of physical activity in this population to inform the development of pediatric specific guidelines.
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Affiliation(s)
- Robert D Whitehill
- Department of Pediatrics, Emory University School of Medicine, Atlanta, USA. .,Department of Cardiology, Children's Healthcare of Atlanta, Atlanta, USA.
| | - Seshadri Balaji
- Department of Pediatrics, Oregon Health and Science University, Portland, USA
| | - Michael Kelleman
- Department of Pediatrics, Emory University School of Medicine, Atlanta, USA.,Department of Cardiology, Children's Healthcare of Atlanta, Atlanta, USA
| | - Stephanie F Chandler
- Division of Cardiology, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, USA
| | - Dominic J Abrams
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, USA
| | - Chad Mao
- Department of Pediatrics, Emory University School of Medicine, Atlanta, USA.,Department of Cardiology, Children's Healthcare of Atlanta, Atlanta, USA
| | - Peter Fischbach
- Department of Pediatrics, Emory University School of Medicine, Atlanta, USA.,Department of Cardiology, Children's Healthcare of Atlanta, Atlanta, USA
| | - Robert Campbell
- Department of Pediatrics, Emory University School of Medicine, Atlanta, USA.,Department of Cardiology, Children's Healthcare of Atlanta, Atlanta, USA
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11
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Przybylski R, Abrams DJ. Clinical and genetic features of arrhythmogenic cardiomyopathy: the electrophysiology perspective. Progress in Pediatric Cardiology 2021. [DOI: 10.1016/j.ppedcard.2021.101463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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12
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Hylind RJ, Roston TM, Jay KS, Coggins MP, Channaoui N, Tahir UA, Bezzerides VJ, Lakdawala NK, Abrams DJ. Proband and family member disease penetrance in cardiac genetic secondary findings. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Broad genomic screening including whole exome sequencing (ES) is increasingly used in clinical care. Families may elect to receive pathogenic and likely pathogenic genetic variants in 30 genes associated with inherited cardiac disorders recommended as reportable by the ACMG, termed cardiac secondary findings (CSF). Most families (91%) opt to receive CSF for the proband, and 73% of parents opt to receive CSF for themselves1.
Our initial experience of 33 patients with 22 different CSF identified a low diagnostic yield and high proportion of patients referred for evaluation with non-reportable findings, with only 4 CSF classified as P/LP (4/22; 18%). Three patients (9%) had concordant clinical findings but none met diagnostic criteria2.
Purpose
The purpose of this analysis was to evaluate the genetic and clinical findings in a secondary cohort.
Methods
All patients who presented to a joint familial cardiogenetic clinic were included. Identified CSF were categorized by 2015 ACMG criteria for variant classification. Clinical evaluation was performed using contemporaneous diagnostic criteria based on potential phenotypes associated with identified CSF. Variant classification and clinical findings were compared in the initial and secondary cohorts. The study was approved by the Institutional Review Board.
Results
Forty patients (20 male; age 19.5±15.9 years) from 20 families were evaluated with 19 different CSF. The variant consequence was missense (12), frameshift (6) and premature stop codon (1), and ACMG classification was pathogenic/likely pathogenic in 15/19 (79%) (p<0.01).
Complete clinical evaluation was performed in 35 (88%) individuals and is ongoing in 5. Concordant findings were identified in 12/35 (34%) (p<0.04) including 5 adults and 7 children. CSF and associated phenotype included TTN – LV dilatation (1); KCNQ1 – LQTS (5); DSP – arrhythmogenic cardiomyopathy (ACM) (4); RYR2 – CPVT (1); SCN5A – 1st degree AV block (1).
Two patients were symptomatic prior to diagnosis; a 16-year-old female with palpitations and ventricular ectopy considered benign (DSP), and a 41-year-old female with syncope and documented torsade de pointes experienced before cascade screening (KCNQ1).
Three patients received defibrillators on primary (ACM) or secondary (LQTS) prevention indications and 2 received ILRs (ACM). Beta-blockers were prescribed for 5 with LQTS (3), CPVT (1) and KCNQ1 CSF but no phenotype (2). Avoidance of provocative medication was recommended for 11. Ten patients with pathogenic CSF (MYBPC3 (2), RYR2 (1), SCN5A (4), KCNH2 (3)) had no discernable phenotype.
Conclusions
In this secondary analysis there was a marked increase in the proportion of pathogenic/likely pathogenic CSF and associated clinical findings, including those necessitating significant management strategies. This data may help inform results disclosure and referral streams for patients with CSF.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): The Mannion and Roberts Families Table 1
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Affiliation(s)
- R J Hylind
- Boston Children's Hospital, Boston, United States of America
| | - T M Roston
- Boston Children's Hospital, Boston, United States of America
| | - K S Jay
- Boston Children's Hospital, Boston, United States of America
| | - M P Coggins
- Brigham and Women's Hospital, Boston, United States of America
| | - N Channaoui
- Brigham and Women's Hospital, Boston, United States of America
| | - U A Tahir
- Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, United States of America
| | - V J Bezzerides
- Boston Children's Hospital, Boston, United States of America
| | - N K Lakdawala
- Brigham and Women's Hospital, Boston, United States of America
| | - D J Abrams
- Boston Children's Hospital, Boston, United States of America
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13
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El-Assaad I, DeWitt ES, Mah DY, Gauvreau K, Abrams DJ, Alexander ME, Triedman JK, Walsh EP. Accessory pathway ablation in Ebstein anomaly: A challenging substrate. Heart Rhythm 2021; 18:1844-1851. [PMID: 34126268 DOI: 10.1016/j.hrthm.2021.06.1171] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/26/2021] [Accepted: 06/03/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Catheter ablation of accessory pathways (APs) in Ebstein anomaly (EA) has been associated with a high recurrence risk. OBJECTIVE The purpose of this study was to compare outcomes of AP ablation in EA in an early (1990-2004) vs a recent (2005-2019) era and identify variables associated with recurrence. METHODS A retrospective review of all catheter ablations for supraventricular tachycardia in EA at our institution was performed. RESULTS We identified 76 patients with median (25th-75th quartiles) age 9 (2.6-13.3) years. Of these patients, 52 had AP alone, 12 had atrial flutter, 3 had atrioventricular nodal reentrant tachycardia, and 9 had AP plus at least 1 additional arrhythmia. Of the 61 patients with APs, a total of 78 separate APs were identified: 40 right-sided, 37 septal, and 1 left-sided. Acute success for AP first procedure was 89% and did not differ between early and recent eras (89% vs 88%; P = .48). However, 19 patients (31%) required repeat procedures (average 1.4 per patient) due to AP recurrence or ablation failure at first attempt. In comparison to early era, recent era ablations had significantly lower recurrence rates at 1 year (62% vs 19%; P = .005). At median follow-up of 2.5 (0.2-7) years, ultimate AP elimination after all procedures was 93%. Younger age at time of electrophysiological study (<2 vs 12-47 years: hazard ratio [HR] 7.3; P = .003) and ablation era (early era vs recent era: HR 3.65; P = .009) predicted recurrence. CONCLUSION Outcomes for AP ablation in patients with EA have improved, but there is still a relatedly high recurrence risk requiring repeat procedures.
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Affiliation(s)
- Iqbal El-Assaad
- Electrophysiology Division, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Elizabeth S DeWitt
- Electrophysiology Division, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Douglas Y Mah
- Electrophysiology Division, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Kimberly Gauvreau
- Electrophysiology Division, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Dominic J Abrams
- Electrophysiology Division, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Mark E Alexander
- Electrophysiology Division, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - John K Triedman
- Electrophysiology Division, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Edward P Walsh
- Electrophysiology Division, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
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14
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Stiles MK, Wilde AAM, Abrams DJ, Ackerman MJ, Albert CM, Behr ER, Chugh SS, Cornel MC, Gardner K, Ingles J, James CA, Juang JMJ, Kääb S, Kaufman ES, Krahn AD, Lubitz SA, MacLeod H, Morillo CA, Nademanee K, Probst V, Saarel EV, Sacilotto L, Semsarian C, Sheppard MN, Shimizu W, Skinner JR, Tfelt-Hansen J, Wang DW. 2020 APHRS/HRS expert consensus statement on the investigation of decedents with sudden unexplained death and patients with sudden cardiac arrest, and of their families. J Arrhythm 2021; 37:481-534. [PMID: 34141003 PMCID: PMC8207384 DOI: 10.1002/joa3.12449] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 10/14/2020] [Indexed: 12/26/2022] Open
Abstract
This international multidisciplinary document intends to provide clinicians with evidence-based practical patient-centered recommendations for evaluating patients and decedents with (aborted) sudden cardiac arrest and their families. The document includes a framework for the investigation of the family allowing steps to be taken, should an inherited condition be found, to minimize further events in affected relatives. Integral to the process is counseling of the patients and families, not only because of the emotionally charged subject, but because finding (or not finding) the cause of the arrest may influence management of family members. The formation of multidisciplinary teams is essential to provide a complete service to the patients and their families, and the varied expertise of the writing committee was formulated to reflect this need. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by Class of Recommendation and Level of Evidence. The recommendations were opened for public comment and reviewed by the relevant scientific and clinical document committees of the Asia Pacific Heart Rhythm Society (APHRS) and the Heart Rhythm Society (HRS); the document underwent external review and endorsement by the partner and collaborating societies. While the recommendations are for optimal care, it is recognized that not all resources will be available to all clinicians. Nevertheless, this document articulates the evaluation that the clinician should aspire to provide for patients with sudden cardiac arrest, decedents with sudden unexplained death, and their families.
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Affiliation(s)
- Martin K Stiles
- Waikato Clinical School Faculty of Medicine and Health Science The University of Auckland Hamilton New Zealand
| | - Arthur A M Wilde
- Heart Center Department of Clinical and Experimental Cardiology Amsterdam University Medical Center University of Amsterdam Amsterdam the Netherlands
| | | | | | | | - Elijah R 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
| | | | - Martina C Cornel
- Amsterdam University Medical Center Vrije Universiteit Amsterdam Clinical Genetics Amsterdam Public Health Research Institute Amsterdam the Netherlands
| | | | - Jodie Ingles
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute The University of Sydney Sydney Australia
| | | | - Jyh-Ming Jimmy Juang
- Cardiovascular Center and Division of Cardiology Department of Internal Medicine National Taiwan University Hospital and National Taiwan University College of Medicine Taipei Taiwan
| | - Stefan Kääb
- Department of Medicine I University Hospital LMU Munich Munich Germany
| | | | | | | | - Heather MacLeod
- Data Coordinating Center for the Sudden Death in the Young Case Registry Okemos MI USA
| | | | - Koonlawee Nademanee
- Chulalongkorn University Faculty of Medicine, and Pacific Rim Electrophysiology Research Institute at Bumrungrad Hospital Bangkok Thailand
| | | | - Elizabeth V Saarel
- Cleveland Clinic Lerner College of Cardiology at Case Western Reserve University Cleveland OH USA
- St Luke's Medical Center Boise ID USA
| | - Luciana Sacilotto
- Heart Institute University of São Paulo Medical School São Paulo Brazil
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute The University of Sydney Sydney Australia
| | - Mary N Sheppard
- 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
| | - Wataru Shimizu
- Department of Cardiovascular Medicine Nippon Medical School Tokyo Japan
| | | | - Jacob Tfelt-Hansen
- Department of Forensic Medicine Faculty of Medical Sciences Rigshospitalet Copenhagen Denmark
| | - Dao Wu Wang
- The First Affiliated Hospital of Nanjing Medical University Nanjing China
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15
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Whitehill RD, Chandler SF, DeWitt E, Abrams DJ, Walsh EP, Kelleman M, Mah DY. Lead age as a predictor for failure in pediatrics and congenital heart disease. Pacing Clin Electrophysiol 2021; 44:586-594. [PMID: 33432629 DOI: 10.1111/pace.14166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/30/2020] [Accepted: 12/13/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pediatric and congenital heart disease (CHD) patients have a high rate of transvenous (TV) lead failure. OBJECTIVE To determine whether TV lead age can aid risk assessment for lead failure to guide the decision of whether a lead should be replaced or reused at the time of a generator change. METHODS Retrospective cohort study of patients <21 years old undergoing TV device implant from 2000 to 2014 at our institution. Patient, device, and lead variables were collected. Leads were compared in groups based on how many generator changes were completed. RESULTS A total of 393 leads in 257 patients met inclusion criteria, 60 leads failed (15%). Failed leads were more likely to have not yet undergone generator change (p = .048). CHD (p = .045), Tendril lead type (p = .02) and silicone insulation (p = .02) were associated with failure. In multivariate analysis, younger leads (p = .022), number of generator changes (p = .003), CHD (p = .005) and silicone insulation (p = .004) remained significant while Tendril lead type did not (p = .052). Survival curves show an early decline around 4 years. CONCLUSIONS Lead failure rate in pediatric and CHD patients is high. Leads that have not yet undergone a generator change were more likely to fail in this cohort. The strategy of serial replacement based on lead age needs further research to justify in this population.
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Affiliation(s)
- Robert D Whitehill
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Cardiology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Stephanie F Chandler
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Elizabeth DeWitt
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Dominic J Abrams
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Edward P Walsh
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael Kelleman
- Department of Cardiology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Douglas Y Mah
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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16
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Stiles MK, Wilde AAM, Abrams DJ, Ackerman MJ, Albert CM, Behr ER, Chugh SS, Cornel MC, Gardner K, Ingles J, James CA, Jimmy Juang JM, Kääb S, Kaufman ES, Krahn AD, Lubitz SA, MacLeod H, Morillo CA, Nademanee K, Probst V, Saarel EV, Sacilotto L, Semsarian C, Sheppard MN, Shimizu W, Skinner JR, Tfelt-Hansen J, Wang DW. 2020 APHRS/HRS expert consensus statement on the investigation of decedents with sudden unexplained death and patients with sudden cardiac arrest, and of their families. Heart Rhythm 2021; 18:e1-e50. [PMID: 33091602 PMCID: PMC8194370 DOI: 10.1016/j.hrthm.2020.10.010] [Citation(s) in RCA: 130] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 10/09/2020] [Indexed: 12/13/2022]
Abstract
This international multidisciplinary document intends to provide clinicians with evidence-based practical patient-centered recommendations for evaluating patients and decedents with (aborted) sudden cardiac arrest and their families. The document includes a framework for the investigation of the family allowing steps to be taken, should an inherited condition be found, to minimize further events in affected relatives. Integral to the process is counseling of the patients and families, not only because of the emotionally charged subject, but because finding (or not finding) the cause of the arrest may influence management of family members. The formation of multidisciplinary teams is essential to provide a complete service to the patients and their families, and the varied expertise of the writing committee was formulated to reflect this need. The document sections were divided up and drafted by the writing committee members according to their expertise. The recommendations represent the consensus opinion of the entire writing committee, graded by Class of Recommendation and Level of Evidence. The recommendations were opened for public comment and reviewed by the relevant scientific and clinical document committees of the Asia Pacific Heart Rhythm Society (APHRS) and the Heart Rhythm Society (HRS); the document underwent external review and endorsement by the partner and collaborating societies. While the recommendations are for optimal care, it is recognized that not all resources will be available to all clinicians. Nevertheless, this document articulates the evaluation that the clinician should aspire to provide for patients with sudden cardiac arrest, decedents with sudden unexplained death, and their families.
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Affiliation(s)
- Martin K Stiles
- Waikato Clinical School, Faculty of Medicine and Health Science, The University of Auckland, Hamilton, New Zealand
| | - Arthur A M Wilde
- Amsterdam University Medical Center, University of Amsterdam, Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam, the Netherlands
| | | | | | | | - Elijah R 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, United Kingdom
| | - Sumeet S Chugh
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Martina C Cornel
- Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Clinical Genetics, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | | | - Jodie Ingles
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, Australia
| | | | - Jyh-Ming Jimmy Juang
- Cardiovascular Center and Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Stefan Kääb
- Department of Medicine I, University Hospital, LMU Munich, Munich, Germany
| | | | - Andrew D Krahn
- The University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Heather MacLeod
- Data Coordinating Center for the Sudden Death in the Young Case Registry, Okemos, Michigan, USA
| | | | - Koonlawee Nademanee
- Chulalongkorn University, Faculty of Medicine, and Pacific Rim Electrophysiology Research Institute at Bumrungrad Hospital, Bangkok, Thailand
| | | | - Elizabeth V Saarel
- Cleveland Clinic Lerner College of Cardiology at Case Western Reserve University, Cleveland, Ohio, and St Luke's Medical Center, Boise, Idaho, USA
| | - Luciana Sacilotto
- Heart Institute, University of São Paulo Medical School, São Paulo, Brazil
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, Australia
| | - Mary N Sheppard
- 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, United Kingdom
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Jonathan R Skinner
- Cardiac Inherited Disease Group, Starship Hospital, Auckland, New Zealand
| | - Jacob Tfelt-Hansen
- Department of Forensic Medicine, Faculty of Medical Sciences, Rigshospitalet, Copenhagen, Denmark
| | - Dao Wu Wang
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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17
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Roston TM, Hylind RJ, Abrams DJ. Causal Genetic Variants in Stillbirth. N Engl J Med 2020; 383:2687. [PMID: 33382937 DOI: 10.1056/nejmc2032136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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18
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Towbin JA, McKenna WJ, Abrams DJ, Ackerman MJ, Calkins H, Darrieux FCC, Daubert JP, de Chillou C, DePasquale EC, Desai MY, Estes NAM, Hua W, Indik JH, Ingles J, James CA, John RM, Judge DP, Keegan R, Krahn AD, Link MS, Marcus FI, McLeod CJ, Mestroni L, Priori SG, Saffitz JE, Sanatani S, Shimizu W, van Tintelen JP, Wilde AAM, Zareba W. 2019 HRS expert consensus statement on evaluation, risk stratification, and management of arrhythmogenic cardiomyopathy: Executive summary. Heart Rhythm 2020; 16:e373-e407. [PMID: 31676023 DOI: 10.1016/j.hrthm.2019.09.019] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Indexed: 01/14/2023]
Abstract
Arrhythmogenic cardiomyopathy (ACM) is an arrhythmogenic disorder of the myocardium not secondary to ischemic, hypertensive, or valvular heart disease. ACM incorporates a broad spectrum of genetic, systemic, infectious, and inflammatory disorders. This designation includes, but is not limited to, arrhythmogenic right/left ventricular cardiomyopathy, cardiac amyloidosis, sarcoidosis, Chagas disease, and left ventricular noncompaction. The ACM phenotype overlaps with other cardiomyopathies, particularly dilated cardiomyopathy with arrhythmia presentation that may be associated with ventricular dilatation and/or impaired systolic function. This expert consensus statement provides the clinician with guidance on evaluation and management of ACM and includes clinically relevant information on genetics and disease mechanisms. PICO questions were utilized to evaluate contemporary evidence and provide clinical guidance related to exercise in arrhythmogenic right ventricular cardiomyopathy. Recommendations were developed and approved by an expert writing group, after a systematic literature search with evidence tables, and discussion of their own clinical experience, to present the current knowledge in the field. Each recommendation is presented using the Class of Recommendation and Level of Evidence system formulated by the American College of Cardiology and the American Heart Association and is accompanied by references and explanatory text to provide essential context. The ongoing recognition of the genetic basis of ACM provides the opportunity to examine the diverse triggers and potential common pathway for the development of disease and arrhythmia.
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Affiliation(s)
- Jeffrey A Towbin
- Le Bonheur Children's Hospital, Memphis, Tennessee; University of Tennessee Health Science Center, Memphis, Tennessee
| | - William J McKenna
- University College London, Institute of Cardiovascular Science, London, United Kingdom
| | | | | | | | | | | | | | | | | | - N A Mark Estes
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Wei Hua
- Fu Wai Hospital, Beijing, China
| | - Julia H Indik
- University of Arizona, Sarver Heart Center, Tucson, Arizona
| | - Jodie Ingles
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, Australia
| | | | - Roy M John
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Daniel P Judge
- Medical University of South Carolina, Charleston, South Carolina
| | - Roberto Keegan
- Hospital Privado Del Sur, Buenos Aires, Argentina; Hospital Español, Bahia Blanca, Argentina
| | | | - Mark S Link
- UT Southwestern Medical Center, Dallas, Texas
| | - Frank I Marcus
- University of Arizona, Sarver Heart Center, Tucson, Arizona
| | | | - Luisa Mestroni
- University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Silvia G Priori
- University of Pavia, Pavia, Italy; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart); ICS Maugeri, IRCCS, Pavia, Italy
| | | | | | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - J Peter van Tintelen
- University of Amsterdam, Academic Medical Center, Amsterdam, the Netherlands; Utrecht University Medical Center Utrecht, University of Utrecht, Department of Genetics, Utrecht, the Netherlands
| | - Arthur A M Wilde
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart); University of Amsterdam, Academic Medical Center, Amsterdam, the Netherlands; Department of Medicine, Columbia University Irving Medical Center, New York, New York
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19
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Hylind R, Beauséjour-Ladouceur V, Plovanich ME, Helms A, Smith E, Joyce E, Granter S, Stevenson LW, Cirino AL, McDonough BA, Mostaghimi A, Abrams DJ, Lakdawala NK. Cardiocutaneous Features of Autosomal Dominant Desmoplakin-Associated Arrhythmogenic Cardiomyopathy. Circ Genom Precis Med 2020; 13:e003081. [PMID: 33191767 DOI: 10.1161/circgen.120.003081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Robyn Hylind
- Inherited Cardiac Arrhythmia Program, Children's Hospital Boston (R.H., V.B.-L., D.J.A.)
| | - Virginie Beauséjour-Ladouceur
- Inherited Cardiac Arrhythmia Program, Children's Hospital Boston (R.H., V.B.-L., D.J.A.).,Harvard Medical School, Boston, MA (V.B.-L., M.E.P., B.A.M., A.M., D.J.A., N.K.L.)
| | - Molly Elizabeth Plovanich
- Department of Dermatology (M.E.P., A.M.), Brigham and Women's Hospital.,Harvard Medical School, Boston, MA (V.B.-L., M.E.P., B.A.M., A.M., D.J.A., N.K.L.)
| | - Adam Helms
- Department of Medicine, Frankel Cardiovascular Center, University of Michigan Medical Center, Ann Arbor, MI (A.D., E.S.)
| | - Eric Smith
- Department of Medicine, Frankel Cardiovascular Center, University of Michigan Medical Center, Ann Arbor, MI (A.D., E.S.)
| | - Emer Joyce
- Department of Cardiovascular Medicine, Mater University Hospital, Dublin, Ireland (E.J.)
| | - Scott Granter
- Department of Pathology (S.C.), Brigham and Women's Hospital
| | | | - Allison L Cirino
- Department of Cardiovascular Medicine (A.L.C., N.K.L.), Brigham and Women's Hospital
| | - Barbara A McDonough
- Harvard Medical School, Boston, MA (V.B.-L., M.E.P., B.A.M., A.M., D.J.A., N.K.L.)
| | - Arash Mostaghimi
- Department of Dermatology (M.E.P., A.M.), Brigham and Women's Hospital.,Harvard Medical School, Boston, MA (V.B.-L., M.E.P., B.A.M., A.M., D.J.A., N.K.L.)
| | - Dominic J Abrams
- Inherited Cardiac Arrhythmia Program, Children's Hospital Boston (R.H., V.B.-L., D.J.A.).,Harvard Medical School, Boston, MA (V.B.-L., M.E.P., B.A.M., A.M., D.J.A., N.K.L.)
| | - Neal K Lakdawala
- Department of Cardiovascular Medicine (A.L.C., N.K.L.), Brigham and Women's Hospital.,Harvard Medical School, Boston, MA (V.B.-L., M.E.P., B.A.M., A.M., D.J.A., N.K.L.)
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20
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Dionne A, Gauvreau K, O'Leary E, Mah DY, Abrams DJ, Alexander ME, DeWitt ES, Bezzerides VJ, Triedman JK, Walsh EP. Risk Factors for Early Recurrence Following Ablation for Accessory Pathways: The Role of Consolidation Lesions. Circ Arrhythm Electrophysiol 2020; 13:e008848. [PMID: 33017181 DOI: 10.1161/circep.120.008848] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Atrioventricular reentrant tachycardia is common in children. Catheter ablation is increasingly used as a first-line therapy with a high acute success rate, but recurrence during follow-up remains a concern. The aim of this study was to identify risk factors for recurrence after accessory pathway (AP) ablation. METHODS Retrospective cohort study including patients who underwent AP ablation between 2013 and 2018. Cox proportional hazards model was used to examine the association between patient and procedural characteristics and recurrence during follow-up. RESULTS From 558 AP ablation procedure, 542 (97%) were acutely successful. During a median follow-up of 0.4 (interquartile range, 0.1-1.4) years, there were 42 (8%) patients with documented recurrence. On univariate analysis, early recurrence was associated with younger age, congenital heart disease, multiple AP, AP location (right sided and posteroseptal versus left sided), cryoablation (versus radiofrequency), empirical ablation, the lack of full power radiofrequency lesions (<50 W), radiofrequency consolidation time <90 seconds and the use of fluoroscopy without a 3-dimensional electroanatomic mapping system. On multivariable analysis, only multiple AP (hazard ratio, 2.78 [95% CI, 1.063-4.74]) and radiofrequency consolidation time < 90 seconds (hazard ratio, 4.38 [95% CI, 1.92-9.51]) remained significantly associated with early recurrence; this association remained true when analyzed in subgroups by pathway location for right and left free wall AP. CONCLUSIONS In our institutional experience, radiofrequency consolidation time <90 seconds after ablation of AP was associated with an increased risk of early recurrence.
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Affiliation(s)
- Audrey Dionne
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, MA
| | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, MA
| | - Edward O'Leary
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, MA
| | - Douglas Y Mah
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, MA
| | - Dominic J Abrams
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, MA
| | - Mark E Alexander
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, MA
| | - Elizabeth S DeWitt
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, MA
| | - Vassilios J Bezzerides
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, MA
| | - John K Triedman
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, MA
| | - Edward P Walsh
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, MA
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21
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Ng K, Titus EW, Lieve KV, Roston TM, Mazzanti A, Deiter FH, Denjoy I, Ingles J, Till J, Robyns T, Connors SP, Steinberg C, Abrams DJ, Pang B, Scheinman MM, Bos JM, Duffett SA, van der Werf C, Maltret A, Green MS, Rutberg J, Balaji S, Cadrin-Tourigny J, Orland KM, Knight LM, Brateng C, Wu J, Tang AS, Skanes AC, Manlucu J, Healey JS, January CT, Krahn AD, Collins KK, Maginot KR, Fischbach P, Etheridge SP, Eckhardt LL, Hamilton RM, Ackerman MJ, Noguer FRI, Semsarian C, Jura N, Leenhardt A, Gollob MH, Priori SG, Sanatani S, Wilde AAM, Deo RC, Roberts JD. An International Multicenter Evaluation of Inheritance Patterns, Arrhythmic Risks, and Underlying Mechanisms of CASQ2-Catecholaminergic Polymorphic Ventricular Tachycardia. Circulation 2020; 142:932-947. [PMID: 32693635 PMCID: PMC7484339 DOI: 10.1161/circulationaha.120.045723] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Genetic variants in calsequestrin-2 (CASQ2) cause an autosomal recessive form of catecholaminergic polymorphic ventricular tachycardia (CPVT), although isolated reports have identified arrhythmic phenotypes among heterozygotes. Improved insight into the inheritance patterns, arrhythmic risks, and molecular mechanisms of CASQ2-CPVT was sought through an international multicenter collaboration. METHODS Genotype-phenotype segregation in CASQ2-CPVT families was assessed, and the impact of genotype on arrhythmic risk was evaluated using Cox regression models. Putative dominant CASQ2 missense variants and the established recessive CASQ2-p.R33Q variant were evaluated using oligomerization assays and their locations mapped to a recent CASQ2 filament structure. RESULTS A total of 112 individuals, including 36 CPVT probands (24 homozygotes/compound heterozygotes and 12 heterozygotes) and 76 family members possessing at least 1 presumed pathogenic CASQ2 variant, were identified. Among CASQ2 homozygotes and compound heterozygotes, clinical penetrance was 97.1% and 26 of 34 (76.5%) individuals had experienced a potentially fatal arrhythmic event with a median age of onset of 7 years (95% CI, 6-11). Fifty-one of 66 CASQ2 heterozygous family members had undergone clinical evaluation, and 17 of 51 (33.3%) met diagnostic criteria for CPVT. Relative to CASQ2 heterozygotes, CASQ2 homozygote/compound heterozygote genotype status in probands was associated with a 3.2-fold (95% CI, 1.3-8.0; P=0.013) increased hazard of a composite of cardiac syncope, aborted cardiac arrest, and sudden cardiac death, but a 38.8-fold (95% CI, 5.6-269.1; P<0.001) increased hazard in genotype-positive family members. In vitro turbidity assays revealed that p.R33Q and all 6 candidate dominant CASQ2 missense variants evaluated exhibited filamentation defects, but only p.R33Q convincingly failed to dimerize. Structural analysis revealed that 3 of these 6 putative dominant negative missense variants localized to an electronegative pocket considered critical for back-to-back binding of dimers. CONCLUSIONS This international multicenter study of CASQ2-CPVT redefines its heritability and confirms that pathogenic heterozygous CASQ2 variants may manifest with a CPVT phenotype, indicating a need to clinically screen these individuals. A dominant mode of inheritance appears intrinsic to certain missense variants because of their location and function within the CASQ2 filament structure.
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Affiliation(s)
- Kevin Ng
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada
- Cairns Hospital, Queensland, Australia
| | - Erron W. Titus
- Cardiovascular Research Institute, University of California, San Francisco, San Francisco, California, USA
| | - Krystien V. Lieve
- Amsterdam University Medical Centre, University of Amsterdam, Heart Centre, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart
| | - Thomas M. Roston
- Heart Rhythm Services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrea Mazzanti
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart
- Molecular Cardiology, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico and Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Frederick H. Deiter
- Cardiovascular Research Institute, University of California, San Francisco, San Francisco, California, USA
| | - Isabelle Denjoy
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart
- Service de Cardiologie et CNMR Maladies Cardiacques Héréditaires Rares, Hôpital Bichat, Paris, France
| | - Jodie Ingles
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, Australia
| | - Jan Till
- Department of Cardiology, Royal Brompton Hospital, London, United Kingdom
| | - Tomas Robyns
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart
- Department of Cardiovascular Disease, University Hospitals Leuven, Leuven, Belgium
| | - Sean P. Connors
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Memorial University, St. John’s, Newfoundland and Labrador, Canada
| | | | - Dominic J. Abrams
- Inherited Cardiac Arrhythmia Program, Boston Children’s Hospital, Harvard Medical School, Massachusetts, USA
| | - Benjamin Pang
- Arrhythmia Service, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Melvin M. Scheinman
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - J. Martijn Bos
- Departments of Cardiovascular Medicine (Division of Heart Rhythm Services), Pediatric and Adolescent Medicine (Division of Pediatric Cardiology), and Molecular Pharmacology & Experimental Therapeutics (Windland Smith Rice Sudden Death Genomics Laboratory), Mayo Clinic, Rochester, Minnesota, USA
| | - Stephen A. Duffett
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Memorial University, St. John’s, Newfoundland and Labrador, Canada
| | - Christian van der Werf
- Amsterdam University Medical Centre, University of Amsterdam, Heart Centre, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart
| | - Alice Maltret
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart
- Service de Cardiologie et CNMR Maladies Cardiacques Héréditaires Rares, Hôpital Bichat, Paris, France
| | - Martin S. Green
- Arrhythmia Service, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Julie Rutberg
- Arrhythmia Service, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Seshadri Balaji
- Department of Pediatrics, Division of Cardiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Julia Cadrin-Tourigny
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, Montréal, Canada
| | - Kate M. Orland
- University of Wisconsin-Madison Inherited Arrhythmia Clinic, Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Linda M. Knight
- Children’s Healthcare of Atlanta, Sibley Heart Center Cardiology, Atlanta, Georgia, USA
| | - Caitlin Brateng
- Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jeremy Wu
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada
| | - Anthony S. Tang
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada
| | - Allan C. Skanes
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada
| | - Jaimie Manlucu
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada
| | - Jeff S. Healey
- Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Craig T. January
- University of Wisconsin-Madison Inherited Arrhythmia Clinic, Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Cellular and Molecular Arrhythmia Research Program, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Andrew D. Krahn
- Heart Rhythm Services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kathryn K. Collins
- Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Kathleen R. Maginot
- Department of Pediatrics, University of Wisconsin School of Medicine & Public Health, Madison, Wisconsin, USA
| | - Peter Fischbach
- Children’s Healthcare of Atlanta, Sibley Heart Center Cardiology, Atlanta, Georgia, USA
| | - Susan P. Etheridge
- Department of Pediatrics, University of Utah, and Primary Children’s Hospital, Salt Lake City, Utah, USA
| | - Lee L. Eckhardt
- University of Wisconsin-Madison Inherited Arrhythmia Clinic, Division of Cardiovascular Medicine, Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Cellular and Molecular Arrhythmia Research Program, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Robert M. Hamilton
- The Labatt Family Heart Centre (Department of Pediatrics) and Translational Medicine, The Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada
| | - Michael J. Ackerman
- Departments of Cardiovascular Medicine (Division of Heart Rhythm Services), Pediatric and Adolescent Medicine (Division of Pediatric Cardiology), and Molecular Pharmacology & Experimental Therapeutics (Windland Smith Rice Sudden Death Genomics Laboratory), Mayo Clinic, Rochester, Minnesota, USA
| | | | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, Australia
| | - Natalia Jura
- Cardiovascular Research Institute, University of California, San Francisco, San Francisco, California, USA
- Department of Cellular and Molecular Pharmacology, University of California San Francisco, San Francisco, California, USA
| | - Antoine Leenhardt
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart
- Service de Cardiologie et CNMR Maladies Cardiacques Héréditaires Rares, Hôpital Bichat, Paris, France
| | - Michael H. Gollob
- Department of Physiology and Department of Medicine, Toronto General Hospital, University of Toronto, Ontario, Canada
| | - Silvia G. Priori
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart
- Molecular Cardiology, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico and Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Shubhayan Sanatani
- Department of Pediatrics, Children’s Heart Centre, BC Children’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Arthur A. M. Wilde
- Amsterdam University Medical Centre, University of Amsterdam, Heart Centre, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart
| | - Rahul C. Deo
- Cardiovascular Research Institute, University of California, San Francisco, San Francisco, California, USA
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
- One Brave Idea and Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Harvard University, Boston, Massachusetts, USA
| | - Jason D. Roberts
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada
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Chandler SF, Chu E, Whitehill RD, Bevilacqua LM, Bezzerides VJ, DeWitt ES, Alexander ME, Abrams DJ, Triedman JK, Walsh EP, Mah DY. Adverse event rate during inpatient sotalol initiation for the management of supraventricular and ventricular tachycardia in the pediatric and young adult population. Heart Rhythm 2020; 17:984-990. [DOI: 10.1016/j.hrthm.2020.01.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 01/24/2020] [Indexed: 01/08/2023]
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23
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DeWitt ES, Chandler SF, Hylind RJ, Beausejour Ladouceur V, Blume ED, VanderPluym C, Powell AJ, Fynn-Thompson F, Roberts AE, Sanders SP, Bezzerides V, Lakdawala NK, MacRae CA, Abrams DJ. Phenotypic Manifestations of Arrhythmogenic Cardiomyopathy in Children and Adolescents. J Am Coll Cardiol 2020; 74:346-358. [PMID: 31319917 DOI: 10.1016/j.jacc.2019.05.022] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 05/07/2019] [Accepted: 05/10/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Arrhythmogenic cardiomyopathy (ACM) is a variably penetrant disease increasingly identified in young patients. OBJECTIVES This study sought to describe the diverse phenotype, genotype, and outcomes in pediatric and adolescent patients. METHODS Records from 1999 to 2016 were reviewed for individuals age <21 years with a consistent personal or family history. Patients were categorized by right ventricular (RV), left dominant (LD), or biventricular subtypes using 2010 Task Force Criteria or proposed features of LD disease, encompassing electrocardiographic, structural, histological, and arrhythmic characteristics. Genetic variants classified as pathogenic and/or likely pathogenic by 2015 American College of Medical Genetics and Genomics criteria in recognized disease-associated genes were included. RESULTS Manifest disease was evident in 32 patients (age 15.1 ± 3.8 years), of whom 22 were probands, including 16 RV, 7 LD, and 9 biventricular ACM. Nondiagnostic features were seen in 5 of 15 family members. RV disease was associated with cardiac arrest and ventricular tachycardia (p = 0.02) and prevalence of PKP2 variants (p < 0.01), whereas biventricular disease was associated with a younger age of onset (p = 0.02). LD ACM was associated with variants in DSP and LMNA, and biventricular ACM with more a diverse etiology in desmosomal genes. Cardiac arrest was observed in 5 probands (age 15.3 ± 1.9 years) and ventricular tachycardia in 10 (age 16.6 ± 2.7 years), 6 probands, and 4 family members. Features suggestive of myocardial inflammation were seen in 6 patients, with ventricular tachycardia and/or cardiac arrest in 3 patients. Cardiac transplantation was performed in 10 patients. There were no deaths. In RV and biventricular disease, electrocardiographic preceded imaging features, whereas the reverse was seen in LD disease. CONCLUSIONS ACM in the young has highly varied phenotypic expression incorporating life-threatening arrhythmia, heart failure, and myocardial inflammation. Increased awareness of early onset, aggressive disease has important implications for patient management and familial screening.
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Affiliation(s)
- Elizabeth S DeWitt
- Inherited Cardiac Arrhythmia Program, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stephanie F Chandler
- Inherited Cardiac Arrhythmia Program, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Robyn J Hylind
- Inherited Cardiac Arrhythmia Program, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Virginie Beausejour Ladouceur
- Inherited Cardiac Arrhythmia Program, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Elizabeth D Blume
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christina VanderPluym
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrew J Powell
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Francis Fynn-Thompson
- Department of Cardiovascular Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Amy E Roberts
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Stephen P Sanders
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Pathology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Vassilios Bezzerides
- Inherited Cardiac Arrhythmia Program, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Neal K Lakdawala
- Cardiovascular Genetics Program, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Calum A MacRae
- Cardiovascular Genetics Program, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dominic J Abrams
- Inherited Cardiac Arrhythmia Program, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
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24
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Hylind RJ, Chandler SF, Beausejour Ladouceur V, Jamal SM, Alexander ME, Mah DY, Phaneuf EA, DeWitt ES, Bezzerides VJ, Abrams DJ. Clinical and Genetic Findings in Children Presenting With Ventricular Fibrillation as the First Manifestation of Cardiovascular Disease. J Am Heart Assoc 2020; 9:e016322. [PMID: 32389048 PMCID: PMC7660843 DOI: 10.1161/jaha.119.016322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Robyn J Hylind
- Inherited Cardiac Arrhythmia Program Boston Children's Hospital Harvard Medical School Boston MA.,Department of Cardiology Boston Children's Hospital Harvard Medical School Boston MA
| | - Stephanie F Chandler
- Inherited Cardiac Arrhythmia Program Boston Children's Hospital Harvard Medical School Boston MA.,Department of Cardiology Boston Children's Hospital Harvard Medical School Boston MA
| | - Virginie Beausejour Ladouceur
- Inherited Cardiac Arrhythmia Program Boston Children's Hospital Harvard Medical School Boston MA.,Department of Cardiology Boston Children's Hospital Harvard Medical School Boston MA
| | - Shelina M Jamal
- Department of Cardiology Boston Children's Hospital Harvard Medical School Boston MA
| | - Mark E Alexander
- Department of Cardiology Boston Children's Hospital Harvard Medical School Boston MA
| | - Douglas Y Mah
- Department of Cardiology Boston Children's Hospital Harvard Medical School Boston MA
| | - Emily A Phaneuf
- Inherited Cardiac Arrhythmia Program Boston Children's Hospital Harvard Medical School Boston MA.,Department of Cardiology Boston Children's Hospital Harvard Medical School Boston MA
| | - Elizabeth S DeWitt
- Inherited Cardiac Arrhythmia Program Boston Children's Hospital Harvard Medical School Boston MA.,Department of Cardiology Boston Children's Hospital Harvard Medical School Boston MA
| | - Vassilios J Bezzerides
- Inherited Cardiac Arrhythmia Program Boston Children's Hospital Harvard Medical School Boston MA.,Department of Cardiology Boston Children's Hospital Harvard Medical School Boston MA
| | - Dominic J Abrams
- Inherited Cardiac Arrhythmia Program Boston Children's Hospital Harvard Medical School Boston MA.,Department of Cardiology Boston Children's Hospital Harvard Medical School Boston MA
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Kovach JR, Mah DY, Abrams DJ, Alexander ME, Cecchin F, Triedman JK, Walsh EP. Outcomes of catheter ablation of anteroseptal and midseptal accessory pathways in pediatric patients. Heart Rhythm 2020; 17:759-767. [DOI: 10.1016/j.hrthm.2019.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Indexed: 10/25/2022]
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26
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Dionne A, Kheir JN, Gauvreau K, Triedman JK, Abrams DJ, Alexander ME, DeWitt ES, Mah DY, Walsh EP, Bezzerides VJ. Value of provocative electrophysiology testing in the management of pediatric patients after congenital heart surgery. Pacing Clin Electrophysiol 2020; 43:901-907. [PMID: 32329521 DOI: 10.1111/pace.13925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/30/2020] [Accepted: 04/19/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the impact of provocative electrophysiology testing in postoperative congenital heart disease (CHD) patients on the management of supraventricular tachycardia (SVT) and clinical outcomes. METHODS This is a retrospective study including patients <18 years of age with surgery for CHD who had postoperative SVT between 2006 and 2017. Postoperative outcomes were compared between patients with and without postoperative electrophysiology testing using the Wilcoxon rank sum test, Fisher's exact test, Kaplan-Meier method with the log-rank test, and Cox proportional hazard model. RESULTS From 341 patients who had SVT after surgery for CHD, 65 (19%) had postoperative electrophysiology testing. There was no significant difference in baseline patient characteristics or surgical complexity between patients with and without electrophysiology testing. Patients with inducible SVT on electrophysiology testing were more likely to have recurrence of SVT prior to hospital discharge with an odds ratio 4.0 (95% confidence interval 1.3, 12.0). Patients who underwent postoperative electrophysiology testing had shorter intensive care unit (12 [6, 20] vs 16 [9, 32] days, HR 2.1 [95% CI 1.6, 2.8], P < .001) and hospital (25 [13, 38] vs 31 [18, 54] days, HR 1.8 [95% CI 1.4, 2.4], P < .001) length of stay. CONCLUSION Postoperative electrophysiology testing was associated with improved postoperative outcomes, likely related to the ability to predict recurrence of arrhythmia and tailored antiarrhythmic management.
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Affiliation(s)
- Audrey Dionne
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - John N Kheir
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - John K Triedman
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Dominic J Abrams
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Mark E Alexander
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Elizabeth S DeWitt
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Douglas Y Mah
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Edward P Walsh
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Vassilios J Bezzerides
- Department of Cardiology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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Clemens DJ, Tester DJ, Giudicessi JR, Bos JM, Rohatgi RK, Abrams DJ, Balaji S, Crotti L, Faure J, Napolitano C, Priori SG, Probst V, Rooryck-Thambo C, Roux-Buisson N, Sacher F, Schwartz PJ, Silka MJ, Walsh MA, Ackerman MJ. International Triadin Knockout Syndrome Registry. Circ Genom Precis Med 2020; 12:e002419. [PMID: 30649896 DOI: 10.1161/circgen.118.002419] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Triadin knockout syndrome (TKOS) is a rare, inherited arrhythmia syndrome caused by recessive null mutations in TRDN-encoded cardiac triadin. Based previously on 5 triadin null patients, TKOS has been characterized by extensive T-wave inversions, transient QT prolongation, and severe disease expression of exercise-induced cardiac arrest in early childhood refractory to conventional therapy. METHODS We have established the International Triadin Knockout Syndrome Registry to include patients who have genetically proven homozygous/compound heterozygous TRDN null mutations. Clinical/genetic data were collected using an online survey generated through REDCap. RESULTS Currently, the International Triadin Knockout Syndrome Registry includes 21 patients (11 males, average age of 18 years) from 16 families. Twenty patients (95%) presented with either cardiac arrest (15, 71%) or syncope (5, 24%) at an average age of 3 years. Mild skeletal myopathy/proximal muscle weakness was noted in 6 (29%) patients. Of the 19 surviving patients, 16 (84%) exhibit T-wave inversions, and 10 (53%) have transient QT prolongation > 480 ms. Eight of 9 patients had ventricular ectopy on exercise stress testing. Thirteen (68%) patients have received implantable defibrillators. Despite various treatment strategies, 14 (74%) patients have had recurrent breakthrough cardiac events. CONCLUSION TKOS is a potentially lethal disease characterized by T-wave inversions in the precordial leads, transient QT prolongation in some, and recurrent ventricular arrhythmias at a young age despite aggressive treatment. Patients displaying this phenotype should undergo TRDN genetic testing as TKOS may be a cause for otherwise unexplained cardiac arrest in young children. As gene therapy advances, enrollment into the International Triadin Knockout Syndrome Registry is encouraged to better understand TKOS and to ready a well-characterized cohort for future TRDN gene therapy trials.
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Affiliation(s)
- Daniel J Clemens
- Windland Smith Rice Sudden Death Genomics Laboratory, Department of Molecular Pharmacology and Experimental Therapeutics, Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, and Division of Heart Rhythm Services, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (D.J.C., D.J.T., J.R.G., J.M.B., R.K.R., M.J.A.)
| | - David J Tester
- Department of Cardiology, Boston Children's Hospital and Harvard Medical School, MA (D.J.A.)
| | - John R Giudicessi
- Windland Smith Rice Sudden Death Genomics Laboratory, Department of Molecular Pharmacology and Experimental Therapeutics, Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, and Division of Heart Rhythm Services, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (D.J.C., D.J.T., J.R.G., J.M.B., R.K.R., M.J.A.)
| | - J Martijn Bos
- Windland Smith Rice Sudden Death Genomics Laboratory, Department of Molecular Pharmacology and Experimental Therapeutics, Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, and Division of Heart Rhythm Services, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (D.J.C., D.J.T., J.R.G., J.M.B., R.K.R., M.J.A.)
| | - Ram K Rohatgi
- Windland Smith Rice Sudden Death Genomics Laboratory, Department of Molecular Pharmacology and Experimental Therapeutics, Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, and Division of Heart Rhythm Services, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (D.J.C., D.J.T., J.R.G., J.M.B., R.K.R., M.J.A.)
| | - Dominic J Abrams
- Department of Cardiology, Boston Children's Hospital and Harvard Medical School, MA (D.J.A.)
| | - Seshadri Balaji
- Doernbecher Children's Hospital, Oregon Health and Science University, Portland (S.B.)
| | - Lia Crotti
- Center for Cardiac Arrhythmias of Genetic Origin & Laboratory of Cardiovascular Genetics, Istituto Auxologico Italiano, IRCCS, Milan (L.C., P.J.S.).,IRCCS Department of Cardiovascular, Neural & Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano (L.C.).,Department of Medicine and Surgery University of Milano-Bicocca, Italy (L.C.)
| | - Julien Faure
- Centre Hospitalier Universitaire de Grenoble Alpes (J.F., N.R.-B.).,Institut des Neurosciences de Grenoble, INSERM U1216, Grenoble, France (J.F., N.R.-B.)
| | - Carlo Napolitano
- Molecular Cardiology and Medicine Division, Istituti Clinici Scientifici Maugeri, IRCCS (C.N., S.G.P.).,Department of Molecular Medicine, University of Pavia, Italy (C.N., S.G.P.)
| | - Silvia G Priori
- Molecular Cardiology and Medicine Division, Istituti Clinici Scientifici Maugeri, IRCCS (C.N., S.G.P.).,Department of Molecular Medicine, University of Pavia, Italy (C.N., S.G.P.)
| | - Vincent Probst
- Reference Center for Rare Arrhythmic Disorders, Cardiologic Department, Nantes University Hospital, France (V.P.).,L'institut du thorax, INSERM 1087, Nantes, France (V.P.)
| | - Caroline Rooryck-Thambo
- Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital, IHU Liryc, University of Bordeaux, Pessac-Bordeaux, France (C.R.-T., F.S.)
| | - Nathalie Roux-Buisson
- Centre Hospitalier Universitaire de Grenoble Alpes (J.F., N.R.-B.).,Institut des Neurosciences de Grenoble, INSERM U1216, Grenoble, France (J.F., N.R.-B.)
| | - Frederic Sacher
- Electrophysiology and Heart Modeling Institute, Bordeaux University Hospital, IHU Liryc, University of Bordeaux, Pessac-Bordeaux, France (C.R.-T., F.S.)
| | - Peter J Schwartz
- Center for Cardiac Arrhythmias of Genetic Origin & Laboratory of Cardiovascular Genetics, Istituto Auxologico Italiano, IRCCS, Milan (L.C., P.J.S.)
| | - Michael J Silka
- Children's Hospital Los Angeles, University of Southern California (M.J.S.)
| | - Mark A Walsh
- Paediatric Cardiology, University Hospital Bristol, United Kingdom (M.A.W.)
| | - Michael J Ackerman
- Windland Smith Rice Sudden Death Genomics Laboratory, Department of Molecular Pharmacology and Experimental Therapeutics, Division of Pediatric Cardiology, Department of Pediatric and Adolescent Medicine, and Division of Heart Rhythm Services, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (D.J.C., D.J.T., J.R.G., J.M.B., R.K.R., M.J.A.)
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Bezzerides VJ, Walsh A, Martuscello M, Escudero CA, Gauvreau K, Lam G, Abrams DJ, Triedman JK, Alexander ME, Bevilacqua L, Mah DY. The Real-World Utility of the LINQ Implantable Loop Recorder in Pediatric and Adult Congenital Heart Patients. JACC Clin Electrophysiol 2020; 5:245-251. [PMID: 30784698 DOI: 10.1016/j.jacep.2018.09.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/11/2018] [Accepted: 09/19/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES This study sought to determine the practical use of the recently introduced LINQ implantable loop recorder (LINQ-ILR) in a cohort of pediatric and adult congenital arrhythmia patients. BACKGROUND Correlating symptoms to a causative arrhythmia is a key aspect of diagnosis and management in clinical electrophysiology. METHODS Retrospective review of clinical data, implantation indications, findings, and therapeutic decisions in patients who underwent LINQ-ILR implantation from April 1st, 2014 to January 30th, 2017 at Boston Children's Hospital. RESULTS A total of 133 patients were included, of which 76 (57%) were male. The mean age at implantation was 15.7 ± 9.1 years with a duration of follow-up of 11.8 months. Congenital heart disease was present in 34 patients (26%), a confirmed genetic diagnosis in 50 (38%), and cardiomyopathy in 22 (26%), and the remainder were without a previous diagnosis. Syncope was the most common indication for LINQ-ILR implantation, occurring in 59 patients (44%). The median time to diagnosis was 4.5 months, occurring in 78 patients (59%). Cardiac device placement occurred in 17 patients (22%), a medication change in 9 (12%), electrophysiology study/ablation in 5 (6%), or LINQ-ILR explantation in 42 (54%). Infection or erosion occurred in 5 patients. Syncope was correlated with a diagnostic transmission (54% vs. 31%, p = 0.01). CONCLUSIONS The LINQ-ILR is an important diagnostic tool, providing useful data in more than one-half of patients in <6 months. Adverse events are low. Patient selection is critical and undiagnosed syncope represents an important presenting indication for which a LINQ-ILR implant should be considered.
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Affiliation(s)
- Vassilios J Bezzerides
- Electrophysiology Division, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Amy Walsh
- Electrophysiology Division, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Maria Martuscello
- Electrophysiology Division, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | | | - Kimberlee Gauvreau
- Electrophysiology Division, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Geralyn Lam
- Electrophysiology Division, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Dominic J Abrams
- Electrophysiology Division, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - John K Triedman
- Electrophysiology Division, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Mark E Alexander
- Electrophysiology Division, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Laura Bevilacqua
- Electrophysiology Division, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Douglas Y Mah
- Electrophysiology Division, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.
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29
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Affiliation(s)
- Robyn J Hylind
- Inherited Cardiac Arrhythmia Program Boston Children's Hospital Harvard Medical School Boston MA.,Department of Cardiology Boston Children's Hospital Harvard Medical School Boston MA
| | - Dominic J Abrams
- Inherited Cardiac Arrhythmia Program Boston Children's Hospital Harvard Medical School Boston MA.,Department of Cardiology Boston Children's Hospital Harvard Medical School Boston MA
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30
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Roberts JD, Asaki SY, Mazzanti A, Bos JM, Tuleta I, Muir AR, Crotti L, Krahn AD, Kutyifa V, Shoemaker MB, Johnsrude CL, Aiba T, Marcondes L, Baban A, Udupa S, Dechert B, Fischbach P, Knight LM, Vittinghoff E, Kukavica D, Stallmeyer B, Giudicessi JR, Spazzolini C, Shimamoto K, Tadros R, Cadrin-Tourigny J, Duff HJ, Simpson CS, Roston TM, Wijeyeratne YD, El Hajjaji I, Yousif MD, Gula LJ, Leong-Sit P, Chavali N, Landstrom AP, Marcus GM, Dittmann S, Wilde AAM, Behr ER, Tfelt-Hansen J, Scheinman MM, Perez MV, Kaski JP, Gow RM, Drago F, Aziz PF, Abrams DJ, Gollob MH, Skinner JR, Shimizu W, Kaufman ES, Roden DM, Zareba W, Schwartz PJ, Schulze-Bahr E, Etheridge SP, Priori SG, Ackerman MJ. An International Multicenter Evaluation of Type 5 Long QT Syndrome: A Low Penetrant Primary Arrhythmic Condition. Circulation 2020; 141:429-439. [PMID: 31941373 DOI: 10.1161/circulationaha.119.043114] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Insight into type 5 long QT syndrome (LQT5) has been limited to case reports and small family series. Improved understanding of the clinical phenotype and genetic features associated with rare KCNE1 variants implicated in LQT5 was sought through an international multicenter collaboration. METHODS Patients with either presumed autosomal dominant LQT5 (N = 229) or the recessive Type 2 Jervell and Lange-Nielsen syndrome (N = 19) were enrolled from 22 genetic arrhythmia clinics and 4 registries from 9 countries. KCNE1 variants were evaluated for ECG penetrance (defined as QTc >460 ms on presenting ECG) and genotype-phenotype segregation. Multivariable Cox regression was used to compare the associations between clinical and genetic variables with a composite primary outcome of definite arrhythmic events, including appropriate implantable cardioverter-defibrillator shocks, aborted cardiac arrest, and sudden cardiac death. RESULTS A total of 32 distinct KCNE1 rare variants were identified in 89 probands and 140 genotype positive family members with presumed LQT5 and an additional 19 Type 2 Jervell and Lange-Nielsen syndrome patients. Among presumed LQT5 patients, the mean QTc on presenting ECG was significantly longer in probands (476.9±38.6 ms) compared with genotype positive family members (441.8±30.9 ms, P<0.001). ECG penetrance for heterozygous genotype positive family members was 20.7% (29/140). A definite arrhythmic event was experienced in 16.9% (15/89) of heterozygous probands in comparison with 1.4% (2/140) of family members (adjusted hazard ratio [HR] 11.6 [95% CI, 2.6-52.2]; P=0.001). Event incidence did not differ significantly for Type 2 Jervell and Lange-Nielsen syndrome patients relative to the overall heterozygous cohort (10.5% [2/19]; HR 1.7 [95% CI, 0.3-10.8], P=0.590). The cumulative prevalence of the 32 KCNE1 variants in the Genome Aggregation Database, which is a human database of exome and genome sequencing data from now over 140 000 individuals, was 238-fold greater than the anticipated prevalence of all LQT5 combined (0.238% vs 0.001%). CONCLUSIONS The present study suggests that putative/confirmed loss-of-function KCNE1 variants predispose to QT prolongation, however, the low ECG penetrance observed suggests they do not manifest clinically in the majority of individuals, aligning with the mild phenotype observed for Type 2 Jervell and Lange-Nielsen syndrome patients.
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Affiliation(s)
- Jason D Roberts
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada (J.D.R., I.E.H., M.D.Y., L.J.G., P.L.-S.)
| | - S Yukiko Asaki
- Department of Pediatrics, University of Utah, and Primary Children's Hospital, Salt Lake City (S.Y.A., S.P.E.)
| | - Andrea Mazzanti
- Molecular Cardiology, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico and Department of Molecular Medicine, University of Pavia, Italy (A.M., D.K., S.G.P.).,European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (A.M., I.T., L.C., A.B., D.K., B.S., C.S., Y.D.W., S.D., A.A.M.W., E.R.B., J.T.-H., J.P.K., F.D., P.J.S., E.S.-B., S.G.P.)
| | | | - Izabela Tuleta
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (A.M., I.T., L.C., A.B., D.K., B.S., C.S., Y.D.W., S.D., A.A.M.W., E.R.B., J.T.-H., J.P.K., F.D., P.J.S., E.S.-B., S.G.P.).,Department of Cardiology I (I.T.), University Hospital Muenster, Germany
| | - Alison R Muir
- Northern Ireland Inherited Cardiac Conditions Service, Belfast City Hospital, United Kingdom (A.R.M.)
| | - Lia Crotti
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (A.M., I.T., L.C., A.B., D.K., B.S., C.S., Y.D.W., S.D., A.A.M.W., E.R.B., J.T.-H., J.P.K., F.D., P.J.S., E.S.-B., S.G.P.).,Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, Milan, Italy (L.C., C.S., P.J.S.).,Department of Medicine and Surgery, University of Milano-Bicocca, Italy (L.C.).,Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy (L.C.)
| | - Andrew D Krahn
- Heart Rhythm Services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, Canada (A.D.K., T.M.R.)
| | - Valentina Kutyifa
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, NY (V.K., W.Z.)
| | - M Benjamin Shoemaker
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Department of Molecular Pharmacology & Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN (M.B., J.R.G., M.J.A.).,Departments of Medicine (M.B.S., N.C., D.M.R.), Vanderbilt University Medical Center, Nashville, TN
| | - Christopher L Johnsrude
- Division of Pediatric Cardiology, Department of Pediatrics, University of Louisville, KY (C.L.J.)
| | - Takeshi Aiba
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (T.A., K.S., W.S.)
| | - Luciana Marcondes
- Cardiac Inherited Disease Group New Zealand, Paediatric and Congenital Cardiac Services, Starship Children's Hospital, Auckland (L.M., J.R.S.)
| | - Anwar Baban
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (A.M., I.T., L.C., A.B., D.K., B.S., C.S., Y.D.W., S.D., A.A.M.W., E.R.B., J.T.-H., J.P.K., F.D., P.J.S., E.S.-B., S.G.P.).,Pediatric Cardiology and Cardiac Arrhythmias Complex Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy (A.B., F.D.)
| | - Sharmila Udupa
- Children's Hospital of Eastern Ontario, Department of Pediatrics, University of Ottawa, Canada (S.U., R.M.G.)
| | - Brynn Dechert
- Division of Cardiology, Department of Pediatrics, University of Michigan Children's Hospital, University of Michigan, Ann Arbor (B.D.)
| | - Peter Fischbach
- Children's Healthcare of Atlanta, Sibley Heart Center Cardiology, GA (P.F., L.M.K.)
| | - Linda M Knight
- Children's Healthcare of Atlanta, Sibley Heart Center Cardiology, GA (P.F., L.M.K.)
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics (E.V.), University of California San Francisco
| | - Deni Kukavica
- Molecular Cardiology, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico and Department of Molecular Medicine, University of Pavia, Italy (A.M., D.K., S.G.P.).,European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (A.M., I.T., L.C., A.B., D.K., B.S., C.S., Y.D.W., S.D., A.A.M.W., E.R.B., J.T.-H., J.P.K., F.D., P.J.S., E.S.-B., S.G.P.)
| | - Birgit Stallmeyer
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (A.M., I.T., L.C., A.B., D.K., B.S., C.S., Y.D.W., S.D., A.A.M.W., E.R.B., J.T.-H., J.P.K., F.D., P.J.S., E.S.-B., S.G.P.).,Institute for Genetics of Heart Disease (B.S., S.D., E.S.-B.), University Hospital Muenster, Germany
| | - John R Giudicessi
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Department of Molecular Pharmacology & Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN (M.B., J.R.G., M.J.A.)
| | - Carla Spazzolini
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (A.M., I.T., L.C., A.B., D.K., B.S., C.S., Y.D.W., S.D., A.A.M.W., E.R.B., J.T.-H., J.P.K., F.D., P.J.S., E.S.-B., S.G.P.).,Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, Milan, Italy (L.C., C.S., P.J.S.)
| | - Keiko Shimamoto
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (T.A., K.S., W.S.)
| | - Rafik Tadros
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, Quebec, Canada (R.T., J., C.-T.)
| | - Julia Cadrin-Tourigny
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, Quebec, Canada (R.T., J., C.-T.)
| | - Henry J Duff
- Department of Cardiac Sciences, Libin Cardiovascular Institute of Alberta, Cumming School of Medicine, University of Calgary, Canada (H.J.D.)
| | | | - Thomas M Roston
- Heart Rhythm Services, Division of Cardiology, Department of Medicine, University of British Columbia, Vancouver, Canada (A.D.K., T.M.R.)
| | - Yanushi D Wijeyeratne
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (A.M., I.T., L.C., A.B., D.K., B.S., C.S., Y.D.W., S.D., A.A.M.W., E.R.B., J.T.-H., J.P.K., F.D., P.J.S., E.S.-B., S.G.P.).,Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St. George's University of London, and St. George's University Hospitals NHS Foundation Trust, United Kingdom (Y.D.W., E.R.B.)
| | - Imane El Hajjaji
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada (J.D.R., I.E.H., M.D.Y., L.J.G., P.L.-S.)
| | - Maisoon D Yousif
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada (J.D.R., I.E.H., M.D.Y., L.J.G., P.L.-S.)
| | - Lorne J Gula
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada (J.D.R., I.E.H., M.D.Y., L.J.G., P.L.-S.)
| | - Peter Leong-Sit
- Section of Cardiac Electrophysiology, Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada (J.D.R., I.E.H., M.D.Y., L.J.G., P.L.-S.)
| | - Nikhil Chavali
- Departments of Medicine (M.B.S., N.C., D.M.R.), Vanderbilt University Medical Center, Nashville, TN
| | - Andrew P Landstrom
- Department of Pediatrics, Division of Pediatric Cardiology, and Department of Cell Biology, Duke University School of Medicine, Durham, NC (A.P.L.)
| | - Gregory M Marcus
- Amsterdam University Medical Centre, location AMC, Heart Center, Department of Clinical and Experimental Cardiology, The Netherlands (G.M.M., A.A.M.W.)
| | - Sven Dittmann
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (A.M., I.T., L.C., A.B., D.K., B.S., C.S., Y.D.W., S.D., A.A.M.W., E.R.B., J.T.-H., J.P.K., F.D., P.J.S., E.S.-B., S.G.P.).,Institute for Genetics of Heart Disease (B.S., S.D., E.S.-B.), University Hospital Muenster, Germany
| | - Arthur A M Wilde
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (A.M., I.T., L.C., A.B., D.K., B.S., C.S., Y.D.W., S.D., A.A.M.W., E.R.B., J.T.-H., J.P.K., F.D., P.J.S., E.S.-B., S.G.P.).,Amsterdam University Medical Centre, location AMC, Heart Center, Department of Clinical and Experimental Cardiology, The Netherlands (G.M.M., A.A.M.W.)
| | - Elijah R Behr
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (A.M., I.T., L.C., A.B., D.K., B.S., C.S., Y.D.W., S.D., A.A.M.W., E.R.B., J.T.-H., J.P.K., F.D., P.J.S., E.S.-B., S.G.P.).,Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St. George's University of London, and St. George's University Hospitals NHS Foundation Trust, United Kingdom (Y.D.W., E.R.B.)
| | - Jacob Tfelt-Hansen
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (A.M., I.T., L.C., A.B., D.K., B.S., C.S., Y.D.W., S.D., A.A.M.W., E.R.B., J.T.-H., J.P.K., F.D., P.J.S., E.S.-B., S.G.P.).,The Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Denmark (J.T.-H.)
| | - Melvin M Scheinman
- Department of Medicine, Division of Cardiology, Section of Cardiac Electrophysiology M.M.S.), University of California San Francisco
| | - Marco V Perez
- Division of Cardiovascular Medicine, Stanford University School of Medicine, CA (M.V.P.)
| | - Juan Pablo Kaski
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (A.M., I.T., L.C., A.B., D.K., B.S., C.S., Y.D.W., S.D., A.A.M.W., E.R.B., J.T.-H., J.P.K., F.D., P.J.S., E.S.-B., S.G.P.).,Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital and UCL Institute of Cardiovascular Science, London, United Kingdom (J.P.K.)
| | - Robert M Gow
- Children's Hospital of Eastern Ontario, Department of Pediatrics, University of Ottawa, Canada (S.U., R.M.G.)
| | - Fabrizio Drago
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (A.M., I.T., L.C., A.B., D.K., B.S., C.S., Y.D.W., S.D., A.A.M.W., E.R.B., J.T.-H., J.P.K., F.D., P.J.S., E.S.-B., S.G.P.).,Pediatric Cardiology and Cardiac Arrhythmias Complex Unit, Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy (A.B., F.D.)
| | - Peter F Aziz
- Department of Pediatric Cardiology, Cleveland Clinic, OH (P.F.A.)
| | - Dominic J Abrams
- Inherited Cardiac Arrhythmia Program, Boston Children's Hospital, Harvard Medical School, MA (D.J.A.)
| | - Michael H Gollob
- Department of Physiology and Department of Medicine, Toronto General Hospital, University of Toronto, Ontario, Canada (M.H.G.)
| | - Jonathan R Skinner
- Cardiac Inherited Disease Group New Zealand, Paediatric and Congenital Cardiac Services, Starship Children's Hospital, Auckland (L.M., J.R.S.)
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (T.A., K.S., W.S.).,Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan (W.S.)
| | - Elizabeth S Kaufman
- The Heart and Vascular Research Center, Metro-Health Campus, Case Western Reserve University, Cleveland, OH (E.S.K.)
| | - Dan M Roden
- Departments of Medicine (M.B.S., N.C., D.M.R.), Vanderbilt University Medical Center, Nashville, TN.,Pharmacology (D.M.R.), Vanderbilt University Medical Center, Nashville, TN.,Biomedical Informatics (D.M.R.), Vanderbilt University Medical Center, Nashville, TN
| | - Wojciech Zareba
- Clinical Cardiovascular Research Center, University of Rochester Medical Center, NY (V.K., W.Z.)
| | - Peter J Schwartz
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (A.M., I.T., L.C., A.B., D.K., B.S., C.S., Y.D.W., S.D., A.A.M.W., E.R.B., J.T.-H., J.P.K., F.D., P.J.S., E.S.-B., S.G.P.).,Istituto Auxologico Italiano, IRCCS, Center for Cardiac Arrhythmias of Genetic Origin and Laboratory of Cardiovascular Genetics, Milan, Italy (L.C., C.S., P.J.S.)
| | - Eric Schulze-Bahr
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (A.M., I.T., L.C., A.B., D.K., B.S., C.S., Y.D.W., S.D., A.A.M.W., E.R.B., J.T.-H., J.P.K., F.D., P.J.S., E.S.-B., S.G.P.).,Institute for Genetics of Heart Disease (B.S., S.D., E.S.-B.), University Hospital Muenster, Germany
| | - Susan P Etheridge
- Department of Pediatrics, University of Utah, and Primary Children's Hospital, Salt Lake City (S.Y.A., S.P.E.)
| | - Silvia G Priori
- Molecular Cardiology, Istituti Clinici Scientifici Maugeri, Istituto di Ricovero e Cura a Carattere Scientifico and Department of Molecular Medicine, University of Pavia, Italy (A.M., D.K., S.G.P.).,European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (A.M., I.T., L.C., A.B., D.K., B.S., C.S., Y.D.W., S.D., A.A.M.W., E.R.B., J.T.-H., J.P.K., F.D., P.J.S., E.S.-B., S.G.P.)
| | - Michael J Ackerman
- Department of Cardiovascular Medicine, Division of Heart Rhythm Services, Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Department of Molecular Pharmacology & Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN (M.B., J.R.G., M.J.A.)
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Houck CA, Chandler SF, Bogers AJJC, Triedman JK, Walsh EP, de Groot NMS, Abrams DJ. Arrhythmia Mechanisms and Outcomes of Ablation in Pediatric Patients With Congenital Heart Disease. Circ Arrhythm Electrophysiol 2019; 12:e007663. [PMID: 31722541 DOI: 10.1161/circep.119.007663] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In contrast to the adult population with congenital heart disease (CHD), arrhythmia mechanisms and outcomes of ablation in pediatric patients with CHD in recent era have not been studied in detail. Aims of this study were to determine arrhythmia mechanisms and to evaluate procedural and long-term outcomes in pediatric patients with CHD undergoing catheter ablation. METHODS Consecutive patients <18 years of age with CHD undergoing catheter ablation over an 11-year period (2007-2018) were included. Procedural outcome included complete or partial success, failure or empirical ablation. Long-term outcome included arrhythmia recurrence and burden according to a 12-point clinical arrhythmia severity score. RESULTS The study population consisted of 232 patients (11.7 years [0.01-17.8], 33.5 kg [2.2-130.1]). The most common diagnoses were Ebstein's anomaly (n=44), septal defects (n=39), and single ventricle (n=36). Arrhythmia mechanisms included atrioventricular reentry tachycardia (n=104, 90 patients), atrioventricular nodal reentry tachycardia (n=33, 29 patients), twin atrioventricular nodal tachycardia (n=3, 2 patients), macroreentrant atrial tachycardia (n=59, 56 patients), focal atrial tachycardia (n=33, 25 patients), ventricular ectopy (n=10, 8 patients), and ventricular tachycardia (n=15, 13 patients). Fifty-six arrhythmias (39 patients) were undefined. Outcomes included complete success (n=189, 81%), partial success (n=7, 3%), failure (n=16, 7%), or empirical ablation (n=20, 9%). Over 3.6 years (0.3-10.7) arrhythmia recurred in 49%. Independent of arrhythmia recurrence, arrhythmia scores decreased from 4 (0-10) at baseline to 0.5 (0-8) at 4 years follow-up (P<0.001). In 23/51 repeat procedures (45%), a different arrhythmia substrate was found. Overall adverse event rate was 9.4%, although only 1.6% (n=4) were of major severity and 0.8% (n=2) of moderate severity. CONCLUSIONS Pediatric patients with CHD demonstrate a broad spectrum of arrhythmia mechanisms. Despite recurrence and emergence of novel mechanisms after a successful procedure, ablation can be performed safely and successfully resulting in decreased arrhythmia burden.
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Affiliation(s)
- Charlotte A Houck
- Department of Cardiology (C.A.H., N.M.S.d.G.), Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Cardio-Thoracic Surgery (C.A.H., A.J.J.C.B.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Stephanie F Chandler
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA (S.F.C., J.K.T., E.P.W., D.J.A.)
| | - Ad J J C Bogers
- Department of Cardio-Thoracic Surgery (C.A.H., A.J.J.C.B.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - John K Triedman
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA (S.F.C., J.K.T., E.P.W., D.J.A.)
| | - Edward P Walsh
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA (S.F.C., J.K.T., E.P.W., D.J.A.)
| | - Natasja M S de Groot
- Department of Cardiology (C.A.H., N.M.S.d.G.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Dominic J Abrams
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA (S.F.C., J.K.T., E.P.W., D.J.A.)
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32
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Park SJ, Zhang D, Qi Y, Li Y, Lee KY, Bezzerides VJ, Yang P, Xia S, Kim SL, Liu X, Lu F, Pasqualini FS, Campbell PH, Geva J, Roberts AE, Kleber AG, Abrams DJ, Pu WT, Parker KK. Insights Into the Pathogenesis of Catecholaminergic Polymorphic Ventricular Tachycardia From Engineered Human Heart Tissue. Circulation 2019; 140:390-404. [PMID: 31311300 PMCID: PMC6750809 DOI: 10.1161/circulationaha.119.039711] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Modeling of human arrhythmias with induced pluripotent stem cell-derived cardiomyocytes has focused on single-cell phenotypes. However, arrhythmias are the emergent properties of cells assembled into tissues, and the impact of inherited arrhythmia mutations on tissue-level properties of human heart tissue has not been reported. METHODS Here, we report an optogenetically based, human engineered tissue model of catecholaminergic polymorphic ventricular tachycardia (CPVT), an inherited arrhythmia caused by mutation of the cardiac ryanodine channel and triggered by exercise. We developed a human induced pluripotent stem cell-derived cardiomyocyte-based platform to study the tissue-level properties of engineered human myocardium. We investigated pathogenic mechanisms in CPVT by combining this novel platform with genome editing. RESULTS In our model, CPVT tissues were vulnerable to developing reentrant rhythms when stimulated by rapid pacing and catecholamine, recapitulating hallmark features of the disease. These conditions elevated diastolic Ca2+ levels and increased temporal and spatial dispersion of Ca2+ wave speed, creating a vulnerable arrhythmia substrate. Using Cas9 genome editing, we pinpointed a single catecholamine-driven phosphorylation event, ryanodine receptor-serine 2814 phosphorylation by Ca2+/calmodulin-dependent protein kinase II, that is required to unmask the arrhythmic potential of CPVT tissues. CONCLUSIONS Our study illuminates the molecular and cellular pathogenesis of CPVT and reveals a critical role of calmodulin-dependent protein kinase II-dependent reentry in the tissue-scale mechanism of this disease. We anticipate that this approach will be useful for modeling other inherited and acquired cardiac arrhythmias.
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Affiliation(s)
- Sung-Jin Park
- Disease Biophysics Group, Wyss Institute for Biologically Inspired Engineering, John A. Paulson School of Engineering and Applied Sciences (S.-J.P., K.Y.L., S.L.K., F.S.P., P.H.C., K.K.P.), Harvard University, Cambridge, MA
| | - Donghui Zhang
- State Key Laboratory of Biocatalysis and Enzyme Engineering, School of Life Science, Hubei University, Wuhan, China (D.Z., Y.Q., P.Y., S.X.).,Department of Cardiology, Boston Children's Hospital, MA (D.Z., Y.L., V.J.B., X.L., F.L., J.G., A.E.R., D.J.A., W.T.P., K.K.P.)
| | - Yan Qi
- State Key Laboratory of Biocatalysis and Enzyme Engineering, School of Life Science, Hubei University, Wuhan, China (D.Z., Y.Q., P.Y., S.X.)
| | - Yifei Li
- Department of Cardiology, Boston Children's Hospital, MA (D.Z., Y.L., V.J.B., X.L., F.L., J.G., A.E.R., D.J.A., W.T.P., K.K.P.).,Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu (Y.L.)
| | - Keel Yong Lee
- Disease Biophysics Group, Wyss Institute for Biologically Inspired Engineering, John A. Paulson School of Engineering and Applied Sciences (S.-J.P., K.Y.L., S.L.K., F.S.P., P.H.C., K.K.P.), Harvard University, Cambridge, MA
| | - Vassilios J Bezzerides
- Department of Cardiology, Boston Children's Hospital, MA (D.Z., Y.L., V.J.B., X.L., F.L., J.G., A.E.R., D.J.A., W.T.P., K.K.P.)
| | - Pengcheng Yang
- State Key Laboratory of Biocatalysis and Enzyme Engineering, School of Life Science, Hubei University, Wuhan, China (D.Z., Y.Q., P.Y., S.X.)
| | - Shutao Xia
- State Key Laboratory of Biocatalysis and Enzyme Engineering, School of Life Science, Hubei University, Wuhan, China (D.Z., Y.Q., P.Y., S.X.)
| | - Sean L Kim
- Disease Biophysics Group, Wyss Institute for Biologically Inspired Engineering, John A. Paulson School of Engineering and Applied Sciences (S.-J.P., K.Y.L., S.L.K., F.S.P., P.H.C., K.K.P.), Harvard University, Cambridge, MA
| | - Xujie Liu
- Department of Cardiology, Boston Children's Hospital, MA (D.Z., Y.L., V.J.B., X.L., F.L., J.G., A.E.R., D.J.A., W.T.P., K.K.P.)
| | - Fujian Lu
- Department of Cardiology, Boston Children's Hospital, MA (D.Z., Y.L., V.J.B., X.L., F.L., J.G., A.E.R., D.J.A., W.T.P., K.K.P.)
| | - Francesco S Pasqualini
- Disease Biophysics Group, Wyss Institute for Biologically Inspired Engineering, John A. Paulson School of Engineering and Applied Sciences (S.-J.P., K.Y.L., S.L.K., F.S.P., P.H.C., K.K.P.), Harvard University, Cambridge, MA
| | - Patrick H Campbell
- Disease Biophysics Group, Wyss Institute for Biologically Inspired Engineering, John A. Paulson School of Engineering and Applied Sciences (S.-J.P., K.Y.L., S.L.K., F.S.P., P.H.C., K.K.P.), Harvard University, Cambridge, MA
| | - Judith Geva
- Department of Cardiology, Boston Children's Hospital, MA (D.Z., Y.L., V.J.B., X.L., F.L., J.G., A.E.R., D.J.A., W.T.P., K.K.P.)
| | - Amy E Roberts
- Department of Cardiology, Boston Children's Hospital, MA (D.Z., Y.L., V.J.B., X.L., F.L., J.G., A.E.R., D.J.A., W.T.P., K.K.P.)
| | - Andre G Kleber
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (A.G.K.)
| | - Dominic J Abrams
- Department of Cardiology, Boston Children's Hospital, MA (D.Z., Y.L., V.J.B., X.L., F.L., J.G., A.E.R., D.J.A., W.T.P., K.K.P.)
| | - William T Pu
- Harvard Stem Cell Institute (W.T.P., K.K.P.), Harvard University, Cambridge, MA.,Department of Cardiology, Boston Children's Hospital, MA (D.Z., Y.L., V.J.B., X.L., F.L., J.G., A.E.R., D.J.A., W.T.P., K.K.P.)
| | - Kevin Kit Parker
- Disease Biophysics Group, Wyss Institute for Biologically Inspired Engineering, John A. Paulson School of Engineering and Applied Sciences (S.-J.P., K.Y.L., S.L.K., F.S.P., P.H.C., K.K.P.), Harvard University, Cambridge, MA.,Harvard Stem Cell Institute (W.T.P., K.K.P.), Harvard University, Cambridge, MA.,Department of Cardiology, Boston Children's Hospital, MA (D.Z., Y.L., V.J.B., X.L., F.L., J.G., A.E.R., D.J.A., W.T.P., K.K.P.).,Sogang-Harvard Research Center for Disease Biophysics, Sogang University, Seoul, South Korea (K.K.P.). Dr Park is currently at the Coulter Department of Biomedical Engineering, Georgia Institute of Technology, and Emory University School of Medicine, Atlanta
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33
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Bezzerides VJ, Caballero A, Wang S, Ai Y, Hylind RJ, Lu F, Heims-Waldron DA, Chambers KD, Zhang D, Abrams DJ, Pu WT. Gene Therapy for Catecholaminergic Polymorphic Ventricular Tachycardia by Inhibition of Ca 2+/Calmodulin-Dependent Kinase II. Circulation 2019; 140:405-419. [PMID: 31155924 PMCID: PMC7274838 DOI: 10.1161/circulationaha.118.038514] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Catecholaminergic polymorphic ventricular tachycardia (CPVT), an inherited cardiac arrhythmia characterized by adrenergically triggered arrhythmias, is inadequately treated by current standard of care. Ca2+/calmodulin-dependent protein kinase II (CaMKII), an adrenergically activated kinase that contributes to arrhythmogenesis in heart disease models, is a candidate therapeutic target in CPVT. However, translation of CaMKII inhibition has been limited by the need for selective CaMKII inhibition in cardiomyocytes. Here, we tested the hypothesis that CaMKII inhibition with a cardiomyocyte-targeted gene therapy strategy would suppress arrhythmia in CPVT mouse models. METHODS We developed AAV9-GFP-AIP, an adeno-associated viral vector in which a potent CaMKII inhibitory peptide, autocamtide-2-related inhibitory peptide [AIP], is fused to green fluorescent protein (GFP) and expressed from a cardiomyocyte selective promoter. The vector was delivered systemically. Arrhythmia burden was evaluated with invasive electrophysiology testing in adult mice. AIP was also tested on induced pluripotent stem cells derived from patients with CPVT with different disease-causing mutations to determine the effectiveness of our proposed therapy on human induced pluripotent stem cell-derived cardiomyocytes and different pathogenic genotypes. RESULTS AAV9-GFP-AIP was robustly expressed in the heart without significant expression in extracardiac tissues, including the brain. Administration of AAV9-GFP-AIP to neonatal mice with a known CPVT mutation (RYR2R176Q/+) effectively suppressed ventricular arrhythmias induced by either β-adrenergic stimulation or programmed ventricular pacing, without significant proarrhythmic effect. Intravascular delivery of AAV9-GFP-AIP to adolescent mice transduced ≈50% of cardiomyocytes and was effective in suppressing arrhythmia in CPVT mice. Induced pluripotent stem cell-derived cardiomyocytes derived from 2 different patients with CPVT with different pathogenic mutations demonstrated increased frequency of abnormal calcium release events, which was suppressed by a cell-permeable form of AIP. CONCLUSIONS This proof-of-concept study showed that AAV-mediated delivery of a CaMKII peptide inhibitor to the heart was effective in suppressing arrhythmias in a murine model of CPVT. CaMKII inhibition also reversed the arrhythmia phenotype in human CPVT induced pluripotent stem cell-derived cardiomyocyte models with different pathogenic mutations.
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Affiliation(s)
- Vassilios J Bezzerides
- Basic and Translational Cardiovascular Research and Inherited Cardiac Arrhythmias Programs, Department of Cardiology, Boston Children's Hospital, Harvard Medical School, MA (V.J.B., A.C., S.W., Y.A., R.J.H., F.L., D.A.H.-W., K.D.C., D.Z., D.J.A., W.T.P.)
| | - Ana Caballero
- Basic and Translational Cardiovascular Research and Inherited Cardiac Arrhythmias Programs, Department of Cardiology, Boston Children's Hospital, Harvard Medical School, MA (V.J.B., A.C., S.W., Y.A., R.J.H., F.L., D.A.H.-W., K.D.C., D.Z., D.J.A., W.T.P.)
| | - Suya Wang
- Basic and Translational Cardiovascular Research and Inherited Cardiac Arrhythmias Programs, Department of Cardiology, Boston Children's Hospital, Harvard Medical School, MA (V.J.B., A.C., S.W., Y.A., R.J.H., F.L., D.A.H.-W., K.D.C., D.Z., D.J.A., W.T.P.)
| | - Yulan Ai
- Basic and Translational Cardiovascular Research and Inherited Cardiac Arrhythmias Programs, Department of Cardiology, Boston Children's Hospital, Harvard Medical School, MA (V.J.B., A.C., S.W., Y.A., R.J.H., F.L., D.A.H.-W., K.D.C., D.Z., D.J.A., W.T.P.)
| | - Robyn J Hylind
- Basic and Translational Cardiovascular Research and Inherited Cardiac Arrhythmias Programs, Department of Cardiology, Boston Children's Hospital, Harvard Medical School, MA (V.J.B., A.C., S.W., Y.A., R.J.H., F.L., D.A.H.-W., K.D.C., D.Z., D.J.A., W.T.P.)
| | - Fujian Lu
- Basic and Translational Cardiovascular Research and Inherited Cardiac Arrhythmias Programs, Department of Cardiology, Boston Children's Hospital, Harvard Medical School, MA (V.J.B., A.C., S.W., Y.A., R.J.H., F.L., D.A.H.-W., K.D.C., D.Z., D.J.A., W.T.P.)
| | - Danielle A Heims-Waldron
- Basic and Translational Cardiovascular Research and Inherited Cardiac Arrhythmias Programs, Department of Cardiology, Boston Children's Hospital, Harvard Medical School, MA (V.J.B., A.C., S.W., Y.A., R.J.H., F.L., D.A.H.-W., K.D.C., D.Z., D.J.A., W.T.P.)
| | - Kristina D Chambers
- Basic and Translational Cardiovascular Research and Inherited Cardiac Arrhythmias Programs, Department of Cardiology, Boston Children's Hospital, Harvard Medical School, MA (V.J.B., A.C., S.W., Y.A., R.J.H., F.L., D.A.H.-W., K.D.C., D.Z., D.J.A., W.T.P.)
| | - Donghui Zhang
- Basic and Translational Cardiovascular Research and Inherited Cardiac Arrhythmias Programs, Department of Cardiology, Boston Children's Hospital, Harvard Medical School, MA (V.J.B., A.C., S.W., Y.A., R.J.H., F.L., D.A.H.-W., K.D.C., D.Z., D.J.A., W.T.P.)
| | - Dominic J Abrams
- Basic and Translational Cardiovascular Research and Inherited Cardiac Arrhythmias Programs, Department of Cardiology, Boston Children's Hospital, Harvard Medical School, MA (V.J.B., A.C., S.W., Y.A., R.J.H., F.L., D.A.H.-W., K.D.C., D.Z., D.J.A., W.T.P.)
| | - William T Pu
- Basic and Translational Cardiovascular Research and Inherited Cardiac Arrhythmias Programs, Department of Cardiology, Boston Children's Hospital, Harvard Medical School, MA (V.J.B., A.C., S.W., Y.A., R.J.H., F.L., D.A.H.-W., K.D.C., D.Z., D.J.A., W.T.P.).,Harvard Stem Cell Institute, Cambridge, MA (W.T.P.)
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Towbin JA, McKenna WJ, Abrams DJ, Ackerman MJ, Calkins H, Darrieux FCC, Daubert JP, de Chillou C, DePasquale EC, Desai MY, Estes NAM, Hua W, Indik JH, Ingles J, James CA, John RM, Judge DP, Keegan R, Krahn AD, Link MS, Marcus FI, McLeod CJ, Mestroni L, Priori SG, Saffitz JE, Sanatani S, Shimizu W, van Tintelen JP, Wilde AAM, Zareba W. 2019 HRS expert consensus statement on evaluation, risk stratification, and management of arrhythmogenic cardiomyopathy. Heart Rhythm 2019; 16:e301-e372. [PMID: 31078652 DOI: 10.1016/j.hrthm.2019.05.007] [Citation(s) in RCA: 406] [Impact Index Per Article: 81.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Indexed: 02/08/2023]
Abstract
Arrhythmogenic cardiomyopathy (ACM) is an arrhythmogenic disorder of the myocardium not secondary to ischemic, hypertensive, or valvular heart disease. ACM incorporates a broad spectrum of genetic, systemic, infectious, and inflammatory disorders. This designation includes, but is not limited to, arrhythmogenic right/left ventricular cardiomyopathy, cardiac amyloidosis, sarcoidosis, Chagas disease, and left ventricular noncompaction. The ACM phenotype overlaps with other cardiomyopathies, particularly dilated cardiomyopathy with arrhythmia presentation that may be associated with ventricular dilatation and/or impaired systolic function. This expert consensus statement provides the clinician with guidance on evaluation and management of ACM and includes clinically relevant information on genetics and disease mechanisms. PICO questions were utilized to evaluate contemporary evidence and provide clinical guidance related to exercise in arrhythmogenic right ventricular cardiomyopathy. Recommendations were developed and approved by an expert writing group, after a systematic literature search with evidence tables, and discussion of their own clinical experience, to present the current knowledge in the field. Each recommendation is presented using the Class of Recommendation and Level of Evidence system formulated by the American College of Cardiology and the American Heart Association and is accompanied by references and explanatory text to provide essential context. The ongoing recognition of the genetic basis of ACM provides the opportunity to examine the diverse triggers and potential common pathway for the development of disease and arrhythmia.
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Affiliation(s)
- Jeffrey A Towbin
- Le Bonheur Children's Hospital, Memphis, Tennessee; University of Tennessee Health Science Center, Memphis, Tennessee
| | - William J McKenna
- University College London, Institute of Cardiovascular Science, London, United Kingdom
| | | | | | | | | | | | | | | | | | - N A Mark Estes
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Wei Hua
- Fu Wai Hospital, Beijing, China
| | - Julia H Indik
- University of Arizona, Sarver Heart Center, Tucson, Arizona
| | - Jodie Ingles
- Agnes Ginges Centre for Molecular Cardiology at Centenary Institute, The University of Sydney, Sydney, Australia
| | | | - Roy M John
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Daniel P Judge
- Medical University of South Carolina, Charleston, South Carolina
| | - Roberto Keegan
- Hospital Privado Del Sur, Buenos Aires, Argentina; Hospital Español, Bahia Blanca, Argentina
| | | | - Mark S Link
- UT Southwestern Medical Center, Dallas, Texas
| | - Frank I Marcus
- University of Arizona, Sarver Heart Center, Tucson, Arizona
| | | | - Luisa Mestroni
- University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Silvia G Priori
- University of Pavia, Pavia, Italy; European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart); ICS Maugeri, IRCCS, Pavia, Italy
| | | | | | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - J Peter van Tintelen
- University of Amsterdam, Academic Medical Center, Amsterdam, the Netherlands; Utrecht University Medical Center Utrecht, University of Utrecht, Department of Genetics, Utrecht, the Netherlands
| | - Arthur A M Wilde
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN GUARD-Heart); University of Amsterdam, Academic Medical Center, Amsterdam, the Netherlands; Department of Medicine, Columbia University Irving Medical Center, New York, New York
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Hylind RJ, Chandler SF, Beausejour Ladouceur V, Roberts AE, Bezzerides V, Christensen KD, Coggins M, Lakdawala NK, MacRae CA, Abrams DJ. Phenotypic Characterization of Individuals With Variants in Cardiovascular Genes in the Absence of a Primary Cardiovascular Indication for Testing. Circ Genom Precis Med 2019; 12:e002463. [PMID: 30919684 DOI: 10.1161/circgen.119.002463] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Robyn J Hylind
- Inherited Cardiac Arrhythmia Program (R.J.H., S.F.C., V.B.L., V.B., D.J.A.), Boston Children's Hospital, Harvard Medical School, MA.,Department of Cardiology (R.J.H., S.F.C., V.B.L., A.E.R., V.B., D.J.A.), Boston Children's Hospital, Harvard Medical School, MA
| | - Stephanie F Chandler
- Inherited Cardiac Arrhythmia Program (R.J.H., S.F.C., V.B.L., V.B., D.J.A.), Boston Children's Hospital, Harvard Medical School, MA.,Department of Cardiology (R.J.H., S.F.C., V.B.L., A.E.R., V.B., D.J.A.), Boston Children's Hospital, Harvard Medical School, MA
| | - Virginie Beausejour Ladouceur
- Inherited Cardiac Arrhythmia Program (R.J.H., S.F.C., V.B.L., V.B., D.J.A.), Boston Children's Hospital, Harvard Medical School, MA.,Department of Cardiology (R.J.H., S.F.C., V.B.L., A.E.R., V.B., D.J.A.), Boston Children's Hospital, Harvard Medical School, MA
| | - Amy E Roberts
- Department of Cardiology (R.J.H., S.F.C., V.B.L., A.E.R., V.B., D.J.A.), Boston Children's Hospital, Harvard Medical School, MA
| | - Vassilios Bezzerides
- Inherited Cardiac Arrhythmia Program (R.J.H., S.F.C., V.B.L., V.B., D.J.A.), Boston Children's Hospital, Harvard Medical School, MA.,Department of Cardiology (R.J.H., S.F.C., V.B.L., A.E.R., V.B., D.J.A.), Boston Children's Hospital, Harvard Medical School, MA
| | - Kurt D Christensen
- Division of Genetics, Department of Medicine (K.D.C.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Matthew Coggins
- Cardiovascular Genetics Program, Division of Cardiovascular Medicine (M.C., N.K.L., C.A.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Neal K Lakdawala
- Cardiovascular Genetics Program, Division of Cardiovascular Medicine (M.C., N.K.L., C.A.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Calum A MacRae
- Cardiovascular Genetics Program, Division of Cardiovascular Medicine (M.C., N.K.L., C.A.M.), Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Dominic J Abrams
- Inherited Cardiac Arrhythmia Program (R.J.H., S.F.C., V.B.L., V.B., D.J.A.), Boston Children's Hospital, Harvard Medical School, MA.,Department of Cardiology (R.J.H., S.F.C., V.B.L., A.E.R., V.B., D.J.A.), Boston Children's Hospital, Harvard Medical School, MA
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Hylind RJ, Chandler SF, Skinner JR, Abrams DJ. Genetic Testing for Inherited Cardiac Arrhythmias: Current State-of-the-Art and Future Avenues. J Innov Card Rhythm Manag 2018; 9:3406-3416. [PMID: 32494476 PMCID: PMC7252877 DOI: 10.19102/icrm.2018.091102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 03/14/2018] [Indexed: 12/24/2022] Open
Abstract
The seminal discovery that sequence variation in genes encoding cardiac ion channels was behind the inherited cardiac arrhythmic syndromes has led to major advances in understanding the functional biological mechanisms of cardiomyocyte depolarization and repolarization. The cost and speed with which these genes can now be sequenced have allowed for genetic testing to become a major component of clinical care and have led to important ramifications, yet interpretation of specific variants needs to be performed within the context of the clinical findings in the proband and extended family. As technology continues to advance, the promise of therapeutic manipulation of certain genetic pathways grows ever more real.
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Affiliation(s)
- Robyn J. Hylind
- Inherited Cardiac Arrhythmia Program, Department of Cardiology, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Stephanie F. Chandler
- Inherited Cardiac Arrhythmia Program, Department of Cardiology, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Jonathan R. Skinner
- Green Lane Paediatric and Congenital Cardiac Services, Starship Children’s Hospital, Auckland, New Zealand
- Department of Paediatrics, Child and Youth Health, The University of Auckland, Auckland, New Zealand
| | - Dominic J. Abrams
- Inherited Cardiac Arrhythmia Program, Department of Cardiology, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
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Baruteau AE, Kyndt F, Behr ER, Vink AS, Lachaud M, Joong A, Schott JJ, Horie M, Denjoy I, Crotti L, Shimizu W, Bos JM, Stephenson EA, Wong L, Abrams DJ, Davis AM, Winbo A, Dubin AM, Sanatani S, Liberman L, Kaski JP, Rudic B, Kwok SY, Rieubland C, Tfelt-Hansen J, Van Hare GF, Guyomarc’h-Delasalle B, Blom NA, Wijeyeratne YD, Gourraud JB, Le Marec H, Ozawa J, Fressart V, Lupoglazoff JM, Dagradi F, Spazzolini C, Aiba T, Tester DJ, Zahavich LA, Beauséjour-Ladouceur V, Jadhav M, Skinner JR, Franciosi S, Krahn AD, Abdelsayed M, Ruben PC, Yung TC, Ackerman MJ, Wilde AA, Schwartz PJ, Probst V. SCN5A mutations in 442 neonates and children: genotype–phenotype correlation and identification of higher-risk subgroups. Eur Heart J 2018; 39:2879-2887. [DOI: 10.1093/eurheartj/ehy412] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 07/01/2018] [Indexed: 01/20/2023] Open
Affiliation(s)
- Alban-Elouen Baruteau
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George’s University of London, London, UK
- Department of Congenital Cardiology, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- M3C CHU de Nantes, Fédération des Cardiopathies Congénitales, Nantes, F-44000, France
- L’institut du thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, Nantes, France
| | - Florence Kyndt
- L’institut du thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, Nantes, France
| | - Elijah R Behr
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George’s University of London, London, UK
| | - Arja S Vink
- Department of Pediatric Cardiology, Academic Medical Center, Amsterdam, The Netherlands
- Department of Clinical and Experimental Cardiology, Heart Centre, Academic Medical Center, Amsterdam, The Netherlands
| | - Matthias Lachaud
- L’institut du thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, Nantes, France
| | - Anna Joong
- Division of Pediatric Cardiology, Morgan Stanley Children’s Hospital, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | | | - Minoru Horie
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Sciences, Otsu, Japan
| | - Isabelle Denjoy
- AP-HP, Hôpital Bichat, Service de Cardiologie, Université Denis Diderot, Paris, France
| | - Lia Crotti
- Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Istituto Auxologico Italiano, Milano, Italy
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Johan M Bos
- Division of Heart Rhythm Services, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
- Division of Pediatric Cardiology, Department of Pediatrics, Mayo Clinic, Rochester, MN, USA
- Department of Molecular Pharmacology & Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Elizabeth A Stephenson
- The Hospital for Sick Children, Labbatt Family, Heart Centre, University of Toronto, Toronto, Canada
| | - Leonie Wong
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George’s University of London, London, UK
| | - Dominic J Abrams
- Inherited Cardiac Arrhythmia Program, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Andrew M Davis
- Department of Cardiology, The Royal Children's Hospital, Melbourne, Australia
- Murdoch Children’s Research Institute and University of Melbourne, Melbourne, Australia
| | - Annika Winbo
- Greenlane Paediatric and Congenital Cardiac Services, Starship Childrens Hospital, Auckland, New Zealand
- Department of Congenital Cardiology, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George’s University of London, London, UK
| | - Anne M Dubin
- Division of Pediatric Electrophysiology, Lucile Packard Children’s Hospital, Stanford University, Palo Alto, CA, USA
| | - Shubhayan Sanatani
- Divisions of Cardiology, Department of Pediatrics and Medicine, British Columbia Children’s Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Leonardo Liberman
- Division of Pediatric Cardiology, Morgan Stanley Children’s Hospital, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Juan Pablo Kaski
- Department of Cardiology, Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital for Children, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Boris Rudic
- Medical Faculty Mannheim of the University of Heidelberg, 1st Department of Medicine, Mannheim, Germany
- DZHK (German Centre for Cardiovascular Research), Mannheim, Germany
| | - Sit Yee Kwok
- Department of Paediatric Cardiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Claudine Rieubland
- Division of Human Genetics, Department of Pediatrics, Inselspital, University of Bern, Switzerland
| | - Jacob Tfelt-Hansen
- Faculty of Health and Medical Science, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Denmark
| | - George F Van Hare
- Division of Cardiology, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
| | | | - Nico A Blom
- Department of Pediatric Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Yanushi D Wijeyeratne
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Institute, St George’s University of London, London, UK
| | | | - Hervé Le Marec
- L’institut du thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, Nantes, France
| | - Junichi Ozawa
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Sciences, Otsu, Japan
| | - Véronique Fressart
- AP-HP, Hôpital Pitié Salpétrière, Service de Biologie Moléculaire, Paris, France
| | | | - Federica Dagradi
- Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Istituto Auxologico Italiano, Milano, Italy
| | - Carla Spazzolini
- Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Istituto Auxologico Italiano, Milano, Italy
| | - Takeshi Aiba
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - David J Tester
- Division of Heart Rhythm Services, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
- Division of Pediatric Cardiology, Department of Pediatrics, Mayo Clinic, Rochester, MN, USA
- Department of Molecular Pharmacology & Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Laura A Zahavich
- The Hospital for Sick Children, Labbatt Family, Heart Centre, University of Toronto, Toronto, Canada
| | | | - Mangesh Jadhav
- Department of Cardiology, The Royal Children's Hospital, Melbourne, Australia
| | - Jonathan R Skinner
- Greenlane Paediatric and Congenital Cardiac Services, Starship Childrens Hospital, Auckland, New Zealand
- Department of Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Sonia Franciosi
- Divisions of Cardiology, Department of Pediatrics and Medicine, British Columbia Children’s Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Andrew D Krahn
- Divisions of Cardiology, Department of Pediatrics and Medicine, British Columbia Children’s Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Mena Abdelsayed
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, Canada
| | - Peter C Ruben
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, Canada
| | - Tak-Cheung Yung
- Department of Paediatric Cardiology, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Michael J Ackerman
- Division of Heart Rhythm Services, Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
- Division of Pediatric Cardiology, Department of Pediatrics, Mayo Clinic, Rochester, MN, USA
- Department of Molecular Pharmacology & Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Arthur A Wilde
- Department of Clinical and Experimental Cardiology, Heart Centre, Academic Medical Center, Amsterdam, The Netherlands
- Princess Al-Jawhara Al-Brahim Centre of Excellence in Research of Hereditary Disorders, Jeddah, Kingdom of Saudi Arabia
| | - Peter J Schwartz
- Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Istituto Auxologico Italiano, Milano, Italy
| | - Vincent Probst
- L’institut du thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, Nantes, France
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Meziab O, Abrams DJ, Alexander ME, Bevilacqua L, Bezzerides V, Mah DY, Walsh EP, Triedman JK. Utility of incomplete right bundle branch block as an isolated ECG finding in children undergoing initial cardiac evaluation. CONGENIT HEART DIS 2018; 13:419-427. [PMID: 29431296 DOI: 10.1111/chd.12589] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 01/19/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVE This study evaluates the ability of experienced pediatric electrophysiologists (EPs) to reliably classify incomplete right bundle branch block (IRBBB) and assesses its clinical utility as an isolated ECG finding in a group of healthy outpatient children without prior cardiac evaluation. DESIGN We performed a retrospective analysis of all electrocardiographic and echocardiographic records at Boston Children's Hospital between January 1, 2005, and December 31, 2014. Echocardiographic diagnoses were identified if registered between the date of the index electrocardiogram and the ensuing year. A selected subset of 473 ECGs was subsequently reanalyzed in a blinded manner by six pediatric EPs to determine the consistency with which the finding of IRBBB could be assigned. RESULTS Of the 331 278 ECGs registered in the BCH database, 32 127 (9.7%) met inclusion criteria and were analyzed for the prevalence of isolated right bundle conduction disturbance findings. The mean age was 12.1 ± 4.0 years, and the population was 49% male. Of the 32 127 ECGs, 72.5% were coded normal, 3.0% were coded IRBBB, and 0.5% were coded complete right bundle branch block (CRBBB). A total of 7.3% of patients coded as normal had an ensuing echocardiogram, compared to 12.5% coded IRBBB. Echo findings were recorded in 0.1% of normal and 0.2% of IRBBB. Patients with ASD-secundum type were no more likely to have isolated IRBBB on previous ECG than the general population (2.5% vs 3.0%). Analysis of inter-reader variability in ECG findings and conduction disturbance identification was high (range of IRBBB prevalence 1-20% among readers). Reinterpretation of ECGs using explicit diagnostic criteria did not demonstrate consistent discrimination of IRBBB and Normal ECGs. CONCLUSIONS IRBBB is not uncommon in a healthy school age population and is observed to have high inter-reader variability. It was associated with increased use of echocardiographic exam but was not associated with increased rate of echocardiographic findings when compared with rates for normal ECGs.
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Affiliation(s)
- Omar Meziab
- Boston Children's Hospital, Boston, Massachusetts, USA
| | | | | | | | | | - Doug Y Mah
- Boston Children's Hospital, Boston, Massachusetts, USA
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Hylind RJ, Ladouceur VB, Fynn-Thompson F, Hourigan SE, Bezzerides VJ, Abrams DJ. Genotype-phenotype-guided medical and surgical intervention in long QT syndrome. HeartRhythm Case Rep 2018; 4:14-17. [PMID: 29379719 PMCID: PMC5775440 DOI: 10.1016/j.hrcr.2017.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Robyn J Hylind
- Inherited Cardiac Arrhythmia Program, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | | | - Francis Fynn-Thompson
- Department of Cardiovascular Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Shannon E Hourigan
- Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts
| | - Vassilios J Bezzerides
- Inherited Cardiac Arrhythmia Program, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Dominic J Abrams
- Inherited Cardiac Arrhythmia Program, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
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Munroe PB, Addison S, Abrams DJ, Sebire NJ, Cartwright J, Donaldson I, Cohen MM, Mein C, Tinker A, Harmer SC, Aziz Q, Terry A, Struebig M, Warren HR, Vadgama B, Fowler DJ, Peebles D, Taylor AM, Lally PJ, Thayyil S. Postmortem Genetic Testing for Cardiac Ion Channelopathies in Stillbirths. Circ Genom Precis Med 2018; 11:e001817. [PMID: 29874177 DOI: 10.1161/circgen.117.001817] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 11/07/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although stillbirth is a significant health problem worldwide, the definitive cause of death remains elusive in many cases, despite detailed autopsy. In this study of partly explained and unexplained stillbirths, we used next-generation sequencing to examine an extended panel of 35 candidate genes known to be associated with ion channel disorders and sudden cardiac death. METHODS AND RESULTS We examined tissue from 242 stillbirths (≥22 weeks), including those where no definite cause of death could be confirmed after a full autopsy. We obtained high-quality DNA from 70 cases, which were then sequenced for a custom panel of 35 genes, 12 for inherited long- and short-QT syndrome genes (LQT1-LQT12 and SQT1-3), and 23 additional candidate genes derived from genome-wide association studies. We examined the functional significance of a selected variant by patch-clamp electrophysiological recording. No predicted damaging variants were identified in KCNQ1 (LQT1) or KCNH2 (LQT2). A rare putative pathogenic variant was found in KCNJ2(LQT7) in 1 case, and several novel variants of uncertain significance were observed. The KCNJ2 variant (p. R40Q), when assessed by whole-cell patch clamp, affected the function of the channel. There was no significant evidence of enrichment of rare predicted damaging variants within any of the candidate genes. CONCLUSIONS Although a causative link is unclear, 1 putative pathogenic and variants of uncertain significance variant resulting in cardiac channelopathies was identified in some cases of otherwise unexplained stillbirth, and these variants may have a role in fetal demise. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT01120886.
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Affiliation(s)
- Patricia B Munroe
- From the Clinical Pharmacology (P.B.M., S.A., J.C., A.T., S.C.H., Q.A., H.R.W.) and National Institute for Health Research Barts Cardiovascular Biomedical Research Unit (P.B.M., A.T., H.R.W.), William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, United Kingdom; Genome Centre, Queen Mary University of London, United Kingdom (I.D., C.M., A.T., M.S., B.V.); Centre for Perinatal Neuroscience, Imperial College London, United Kingdom (S.A., P.J.L., S.T.); Paediatric Cardiology, Children's Hospital Boston, MA (D.J.A.); Histopathology, Great Ormond Street Hospital, London, United Kingdom (N.J.S.); Histopathology, Sheffield Children's Hospital, United Kingdom (M.M.C.); Histopathology, Southampton General Hospital, United Kingdom (D.J.F.); Institute for Women's Health, San Antonio, TX (D.P.); and Institute for Cardiovascular Science, University College London, United Kingdom (A.M.T.).
| | - Shea Addison
- From the Clinical Pharmacology (P.B.M., S.A., J.C., A.T., S.C.H., Q.A., H.R.W.) and National Institute for Health Research Barts Cardiovascular Biomedical Research Unit (P.B.M., A.T., H.R.W.), William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, United Kingdom; Genome Centre, Queen Mary University of London, United Kingdom (I.D., C.M., A.T., M.S., B.V.); Centre for Perinatal Neuroscience, Imperial College London, United Kingdom (S.A., P.J.L., S.T.); Paediatric Cardiology, Children's Hospital Boston, MA (D.J.A.); Histopathology, Great Ormond Street Hospital, London, United Kingdom (N.J.S.); Histopathology, Sheffield Children's Hospital, United Kingdom (M.M.C.); Histopathology, Southampton General Hospital, United Kingdom (D.J.F.); Institute for Women's Health, San Antonio, TX (D.P.); and Institute for Cardiovascular Science, University College London, United Kingdom (A.M.T.)
| | - Dominic J Abrams
- From the Clinical Pharmacology (P.B.M., S.A., J.C., A.T., S.C.H., Q.A., H.R.W.) and National Institute for Health Research Barts Cardiovascular Biomedical Research Unit (P.B.M., A.T., H.R.W.), William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, United Kingdom; Genome Centre, Queen Mary University of London, United Kingdom (I.D., C.M., A.T., M.S., B.V.); Centre for Perinatal Neuroscience, Imperial College London, United Kingdom (S.A., P.J.L., S.T.); Paediatric Cardiology, Children's Hospital Boston, MA (D.J.A.); Histopathology, Great Ormond Street Hospital, London, United Kingdom (N.J.S.); Histopathology, Sheffield Children's Hospital, United Kingdom (M.M.C.); Histopathology, Southampton General Hospital, United Kingdom (D.J.F.); Institute for Women's Health, San Antonio, TX (D.P.); and Institute for Cardiovascular Science, University College London, United Kingdom (A.M.T.)
| | - Neil J Sebire
- From the Clinical Pharmacology (P.B.M., S.A., J.C., A.T., S.C.H., Q.A., H.R.W.) and National Institute for Health Research Barts Cardiovascular Biomedical Research Unit (P.B.M., A.T., H.R.W.), William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, United Kingdom; Genome Centre, Queen Mary University of London, United Kingdom (I.D., C.M., A.T., M.S., B.V.); Centre for Perinatal Neuroscience, Imperial College London, United Kingdom (S.A., P.J.L., S.T.); Paediatric Cardiology, Children's Hospital Boston, MA (D.J.A.); Histopathology, Great Ormond Street Hospital, London, United Kingdom (N.J.S.); Histopathology, Sheffield Children's Hospital, United Kingdom (M.M.C.); Histopathology, Southampton General Hospital, United Kingdom (D.J.F.); Institute for Women's Health, San Antonio, TX (D.P.); and Institute for Cardiovascular Science, University College London, United Kingdom (A.M.T.)
| | - James Cartwright
- From the Clinical Pharmacology (P.B.M., S.A., J.C., A.T., S.C.H., Q.A., H.R.W.) and National Institute for Health Research Barts Cardiovascular Biomedical Research Unit (P.B.M., A.T., H.R.W.), William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, United Kingdom; Genome Centre, Queen Mary University of London, United Kingdom (I.D., C.M., A.T., M.S., B.V.); Centre for Perinatal Neuroscience, Imperial College London, United Kingdom (S.A., P.J.L., S.T.); Paediatric Cardiology, Children's Hospital Boston, MA (D.J.A.); Histopathology, Great Ormond Street Hospital, London, United Kingdom (N.J.S.); Histopathology, Sheffield Children's Hospital, United Kingdom (M.M.C.); Histopathology, Southampton General Hospital, United Kingdom (D.J.F.); Institute for Women's Health, San Antonio, TX (D.P.); and Institute for Cardiovascular Science, University College London, United Kingdom (A.M.T.)
| | - Ian Donaldson
- From the Clinical Pharmacology (P.B.M., S.A., J.C., A.T., S.C.H., Q.A., H.R.W.) and National Institute for Health Research Barts Cardiovascular Biomedical Research Unit (P.B.M., A.T., H.R.W.), William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, United Kingdom; Genome Centre, Queen Mary University of London, United Kingdom (I.D., C.M., A.T., M.S., B.V.); Centre for Perinatal Neuroscience, Imperial College London, United Kingdom (S.A., P.J.L., S.T.); Paediatric Cardiology, Children's Hospital Boston, MA (D.J.A.); Histopathology, Great Ormond Street Hospital, London, United Kingdom (N.J.S.); Histopathology, Sheffield Children's Hospital, United Kingdom (M.M.C.); Histopathology, Southampton General Hospital, United Kingdom (D.J.F.); Institute for Women's Health, San Antonio, TX (D.P.); and Institute for Cardiovascular Science, University College London, United Kingdom (A.M.T.)
| | - Marta M Cohen
- From the Clinical Pharmacology (P.B.M., S.A., J.C., A.T., S.C.H., Q.A., H.R.W.) and National Institute for Health Research Barts Cardiovascular Biomedical Research Unit (P.B.M., A.T., H.R.W.), William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, United Kingdom; Genome Centre, Queen Mary University of London, United Kingdom (I.D., C.M., A.T., M.S., B.V.); Centre for Perinatal Neuroscience, Imperial College London, United Kingdom (S.A., P.J.L., S.T.); Paediatric Cardiology, Children's Hospital Boston, MA (D.J.A.); Histopathology, Great Ormond Street Hospital, London, United Kingdom (N.J.S.); Histopathology, Sheffield Children's Hospital, United Kingdom (M.M.C.); Histopathology, Southampton General Hospital, United Kingdom (D.J.F.); Institute for Women's Health, San Antonio, TX (D.P.); and Institute for Cardiovascular Science, University College London, United Kingdom (A.M.T.)
| | - Charles Mein
- From the Clinical Pharmacology (P.B.M., S.A., J.C., A.T., S.C.H., Q.A., H.R.W.) and National Institute for Health Research Barts Cardiovascular Biomedical Research Unit (P.B.M., A.T., H.R.W.), William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, United Kingdom; Genome Centre, Queen Mary University of London, United Kingdom (I.D., C.M., A.T., M.S., B.V.); Centre for Perinatal Neuroscience, Imperial College London, United Kingdom (S.A., P.J.L., S.T.); Paediatric Cardiology, Children's Hospital Boston, MA (D.J.A.); Histopathology, Great Ormond Street Hospital, London, United Kingdom (N.J.S.); Histopathology, Sheffield Children's Hospital, United Kingdom (M.M.C.); Histopathology, Southampton General Hospital, United Kingdom (D.J.F.); Institute for Women's Health, San Antonio, TX (D.P.); and Institute for Cardiovascular Science, University College London, United Kingdom (A.M.T.)
| | - Andrew Tinker
- From the Clinical Pharmacology (P.B.M., S.A., J.C., A.T., S.C.H., Q.A., H.R.W.) and National Institute for Health Research Barts Cardiovascular Biomedical Research Unit (P.B.M., A.T., H.R.W.), William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, United Kingdom; Genome Centre, Queen Mary University of London, United Kingdom (I.D., C.M., A.T., M.S., B.V.); Centre for Perinatal Neuroscience, Imperial College London, United Kingdom (S.A., P.J.L., S.T.); Paediatric Cardiology, Children's Hospital Boston, MA (D.J.A.); Histopathology, Great Ormond Street Hospital, London, United Kingdom (N.J.S.); Histopathology, Sheffield Children's Hospital, United Kingdom (M.M.C.); Histopathology, Southampton General Hospital, United Kingdom (D.J.F.); Institute for Women's Health, San Antonio, TX (D.P.); and Institute for Cardiovascular Science, University College London, United Kingdom (A.M.T.)
| | - Stephen C Harmer
- From the Clinical Pharmacology (P.B.M., S.A., J.C., A.T., S.C.H., Q.A., H.R.W.) and National Institute for Health Research Barts Cardiovascular Biomedical Research Unit (P.B.M., A.T., H.R.W.), William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, United Kingdom; Genome Centre, Queen Mary University of London, United Kingdom (I.D., C.M., A.T., M.S., B.V.); Centre for Perinatal Neuroscience, Imperial College London, United Kingdom (S.A., P.J.L., S.T.); Paediatric Cardiology, Children's Hospital Boston, MA (D.J.A.); Histopathology, Great Ormond Street Hospital, London, United Kingdom (N.J.S.); Histopathology, Sheffield Children's Hospital, United Kingdom (M.M.C.); Histopathology, Southampton General Hospital, United Kingdom (D.J.F.); Institute for Women's Health, San Antonio, TX (D.P.); and Institute for Cardiovascular Science, University College London, United Kingdom (A.M.T.)
| | - Qadeer Aziz
- From the Clinical Pharmacology (P.B.M., S.A., J.C., A.T., S.C.H., Q.A., H.R.W.) and National Institute for Health Research Barts Cardiovascular Biomedical Research Unit (P.B.M., A.T., H.R.W.), William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, United Kingdom; Genome Centre, Queen Mary University of London, United Kingdom (I.D., C.M., A.T., M.S., B.V.); Centre for Perinatal Neuroscience, Imperial College London, United Kingdom (S.A., P.J.L., S.T.); Paediatric Cardiology, Children's Hospital Boston, MA (D.J.A.); Histopathology, Great Ormond Street Hospital, London, United Kingdom (N.J.S.); Histopathology, Sheffield Children's Hospital, United Kingdom (M.M.C.); Histopathology, Southampton General Hospital, United Kingdom (D.J.F.); Institute for Women's Health, San Antonio, TX (D.P.); and Institute for Cardiovascular Science, University College London, United Kingdom (A.M.T.)
| | - Anna Terry
- From the Clinical Pharmacology (P.B.M., S.A., J.C., A.T., S.C.H., Q.A., H.R.W.) and National Institute for Health Research Barts Cardiovascular Biomedical Research Unit (P.B.M., A.T., H.R.W.), William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, United Kingdom; Genome Centre, Queen Mary University of London, United Kingdom (I.D., C.M., A.T., M.S., B.V.); Centre for Perinatal Neuroscience, Imperial College London, United Kingdom (S.A., P.J.L., S.T.); Paediatric Cardiology, Children's Hospital Boston, MA (D.J.A.); Histopathology, Great Ormond Street Hospital, London, United Kingdom (N.J.S.); Histopathology, Sheffield Children's Hospital, United Kingdom (M.M.C.); Histopathology, Southampton General Hospital, United Kingdom (D.J.F.); Institute for Women's Health, San Antonio, TX (D.P.); and Institute for Cardiovascular Science, University College London, United Kingdom (A.M.T.)
| | - Monika Struebig
- From the Clinical Pharmacology (P.B.M., S.A., J.C., A.T., S.C.H., Q.A., H.R.W.) and National Institute for Health Research Barts Cardiovascular Biomedical Research Unit (P.B.M., A.T., H.R.W.), William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, United Kingdom; Genome Centre, Queen Mary University of London, United Kingdom (I.D., C.M., A.T., M.S., B.V.); Centre for Perinatal Neuroscience, Imperial College London, United Kingdom (S.A., P.J.L., S.T.); Paediatric Cardiology, Children's Hospital Boston, MA (D.J.A.); Histopathology, Great Ormond Street Hospital, London, United Kingdom (N.J.S.); Histopathology, Sheffield Children's Hospital, United Kingdom (M.M.C.); Histopathology, Southampton General Hospital, United Kingdom (D.J.F.); Institute for Women's Health, San Antonio, TX (D.P.); and Institute for Cardiovascular Science, University College London, United Kingdom (A.M.T.)
| | - Helen R Warren
- From the Clinical Pharmacology (P.B.M., S.A., J.C., A.T., S.C.H., Q.A., H.R.W.) and National Institute for Health Research Barts Cardiovascular Biomedical Research Unit (P.B.M., A.T., H.R.W.), William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, United Kingdom; Genome Centre, Queen Mary University of London, United Kingdom (I.D., C.M., A.T., M.S., B.V.); Centre for Perinatal Neuroscience, Imperial College London, United Kingdom (S.A., P.J.L., S.T.); Paediatric Cardiology, Children's Hospital Boston, MA (D.J.A.); Histopathology, Great Ormond Street Hospital, London, United Kingdom (N.J.S.); Histopathology, Sheffield Children's Hospital, United Kingdom (M.M.C.); Histopathology, Southampton General Hospital, United Kingdom (D.J.F.); Institute for Women's Health, San Antonio, TX (D.P.); and Institute for Cardiovascular Science, University College London, United Kingdom (A.M.T.)
| | - Bhumita Vadgama
- From the Clinical Pharmacology (P.B.M., S.A., J.C., A.T., S.C.H., Q.A., H.R.W.) and National Institute for Health Research Barts Cardiovascular Biomedical Research Unit (P.B.M., A.T., H.R.W.), William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, United Kingdom; Genome Centre, Queen Mary University of London, United Kingdom (I.D., C.M., A.T., M.S., B.V.); Centre for Perinatal Neuroscience, Imperial College London, United Kingdom (S.A., P.J.L., S.T.); Paediatric Cardiology, Children's Hospital Boston, MA (D.J.A.); Histopathology, Great Ormond Street Hospital, London, United Kingdom (N.J.S.); Histopathology, Sheffield Children's Hospital, United Kingdom (M.M.C.); Histopathology, Southampton General Hospital, United Kingdom (D.J.F.); Institute for Women's Health, San Antonio, TX (D.P.); and Institute for Cardiovascular Science, University College London, United Kingdom (A.M.T.)
| | - Darren J Fowler
- From the Clinical Pharmacology (P.B.M., S.A., J.C., A.T., S.C.H., Q.A., H.R.W.) and National Institute for Health Research Barts Cardiovascular Biomedical Research Unit (P.B.M., A.T., H.R.W.), William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, United Kingdom; Genome Centre, Queen Mary University of London, United Kingdom (I.D., C.M., A.T., M.S., B.V.); Centre for Perinatal Neuroscience, Imperial College London, United Kingdom (S.A., P.J.L., S.T.); Paediatric Cardiology, Children's Hospital Boston, MA (D.J.A.); Histopathology, Great Ormond Street Hospital, London, United Kingdom (N.J.S.); Histopathology, Sheffield Children's Hospital, United Kingdom (M.M.C.); Histopathology, Southampton General Hospital, United Kingdom (D.J.F.); Institute for Women's Health, San Antonio, TX (D.P.); and Institute for Cardiovascular Science, University College London, United Kingdom (A.M.T.)
| | - Donald Peebles
- From the Clinical Pharmacology (P.B.M., S.A., J.C., A.T., S.C.H., Q.A., H.R.W.) and National Institute for Health Research Barts Cardiovascular Biomedical Research Unit (P.B.M., A.T., H.R.W.), William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, United Kingdom; Genome Centre, Queen Mary University of London, United Kingdom (I.D., C.M., A.T., M.S., B.V.); Centre for Perinatal Neuroscience, Imperial College London, United Kingdom (S.A., P.J.L., S.T.); Paediatric Cardiology, Children's Hospital Boston, MA (D.J.A.); Histopathology, Great Ormond Street Hospital, London, United Kingdom (N.J.S.); Histopathology, Sheffield Children's Hospital, United Kingdom (M.M.C.); Histopathology, Southampton General Hospital, United Kingdom (D.J.F.); Institute for Women's Health, San Antonio, TX (D.P.); and Institute for Cardiovascular Science, University College London, United Kingdom (A.M.T.)
| | - Andrew M Taylor
- From the Clinical Pharmacology (P.B.M., S.A., J.C., A.T., S.C.H., Q.A., H.R.W.) and National Institute for Health Research Barts Cardiovascular Biomedical Research Unit (P.B.M., A.T., H.R.W.), William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, United Kingdom; Genome Centre, Queen Mary University of London, United Kingdom (I.D., C.M., A.T., M.S., B.V.); Centre for Perinatal Neuroscience, Imperial College London, United Kingdom (S.A., P.J.L., S.T.); Paediatric Cardiology, Children's Hospital Boston, MA (D.J.A.); Histopathology, Great Ormond Street Hospital, London, United Kingdom (N.J.S.); Histopathology, Sheffield Children's Hospital, United Kingdom (M.M.C.); Histopathology, Southampton General Hospital, United Kingdom (D.J.F.); Institute for Women's Health, San Antonio, TX (D.P.); and Institute for Cardiovascular Science, University College London, United Kingdom (A.M.T.)
| | - Peter J Lally
- From the Clinical Pharmacology (P.B.M., S.A., J.C., A.T., S.C.H., Q.A., H.R.W.) and National Institute for Health Research Barts Cardiovascular Biomedical Research Unit (P.B.M., A.T., H.R.W.), William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, United Kingdom; Genome Centre, Queen Mary University of London, United Kingdom (I.D., C.M., A.T., M.S., B.V.); Centre for Perinatal Neuroscience, Imperial College London, United Kingdom (S.A., P.J.L., S.T.); Paediatric Cardiology, Children's Hospital Boston, MA (D.J.A.); Histopathology, Great Ormond Street Hospital, London, United Kingdom (N.J.S.); Histopathology, Sheffield Children's Hospital, United Kingdom (M.M.C.); Histopathology, Southampton General Hospital, United Kingdom (D.J.F.); Institute for Women's Health, San Antonio, TX (D.P.); and Institute for Cardiovascular Science, University College London, United Kingdom (A.M.T.)
| | - Sudhin Thayyil
- From the Clinical Pharmacology (P.B.M., S.A., J.C., A.T., S.C.H., Q.A., H.R.W.) and National Institute for Health Research Barts Cardiovascular Biomedical Research Unit (P.B.M., A.T., H.R.W.), William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, United Kingdom; Genome Centre, Queen Mary University of London, United Kingdom (I.D., C.M., A.T., M.S., B.V.); Centre for Perinatal Neuroscience, Imperial College London, United Kingdom (S.A., P.J.L., S.T.); Paediatric Cardiology, Children's Hospital Boston, MA (D.J.A.); Histopathology, Great Ormond Street Hospital, London, United Kingdom (N.J.S.); Histopathology, Sheffield Children's Hospital, United Kingdom (M.M.C.); Histopathology, Southampton General Hospital, United Kingdom (D.J.F.); Institute for Women's Health, San Antonio, TX (D.P.); and Institute for Cardiovascular Science, University College London, United Kingdom (A.M.T.).
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Baruteau AE, Abrams DJ, Ho SY, Thambo JB, McLeod CJ, Shah MJ. Cardiac Conduction System in Congenitally Corrected Transposition of the Great Arteries and Its Clinical Relevance. J Am Heart Assoc 2017; 6:JAHA.117.007759. [PMID: 29269355 PMCID: PMC5779063 DOI: 10.1161/jaha.117.007759] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Alban-Elouen Baruteau
- Department of Congenital Cardiology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom .,M3C CHU de Nantes, Fédération des Cardiopathies Congénitales, Nantes, France
| | - Dominic J Abrams
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Siew Yen Ho
- Cardiac Morphology, Royal Brompton Hospital and Harefield NHS Foundation Trust, Imperial College London, London, United Kingdom
| | - Jean-Benoit Thambo
- Department of Paediatric Cardiology, CHU Bordeaux, Pessac, France.,IHU LIRYC, Electrophysiology and Heart Modeling Institute, Bordeaux, France
| | - Christopher J McLeod
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN
| | - Maully J Shah
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA
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Cirino AL, Harris S, Lakdawala NK, Michels M, Olivotto I, Day SM, Abrams DJ, Charron P, Caleshu C, Semsarian C, Ingles J, Rakowski H, Judge DP, Ho CY. Role of Genetic Testing in Inherited Cardiovascular Disease. JAMA Cardiol 2017; 2:1153-1160. [DOI: 10.1001/jamacardio.2017.2352] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Allison L. Cirino
- Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Stephanie Harris
- Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Neal K. Lakdawala
- Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Michelle Michels
- Department of Cardiology, The Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Iacopo Olivotto
- Referral Centre for Myocardial Diseases, Careggi University Hospital, Florence, Italy
| | - Sharlene M. Day
- Cardiovascular Division, Department of Internal Medicine, University of Michigan, Ann Arbor
| | - Dominic J. Abrams
- Inherited Cardiac Arrhythmia Program, Division of Cardiac Electrophysiology, Boston Children’s Hospital, Boston, Massachusetts
| | - Philippe Charron
- Referral Center for Cardiac Hereditary Diseases, Assistance Publique–Hôpitaux de Paris, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Colleen Caleshu
- Stanford Center for Inherited Cardiovascular Disease, Stanford, California
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, University of Sydney, Sydney, Australia
| | - Jodie Ingles
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, University of Sydney, Sydney, Australia
| | - Harry Rakowski
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Daniel P. Judge
- Division of Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - Carolyn Y. Ho
- Cardiovascular Division, Brigham and Women’s Hospital, Boston, Massachusetts
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Chambers KD, Beausejour Ladouceur V, Alexander ME, Hylind RJ, Bevilacqua L, Mah DY, Bezzerides V, Triedman JK, Walsh EP, Abrams DJ. Cardiac Events During Competitive, Recreational, and Daily Activities in Children and Adolescents With Long QT Syndrome. J Am Heart Assoc 2017; 6:e005445. [PMID: 28935680 PMCID: PMC5634250 DOI: 10.1161/jaha.116.005445] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 06/13/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND The 2005 Bethesda Conference Guidelines advise patients with long QT syndrome against competitive sports. We assessed cardiac event rates during competitive and recreational sports, and daily activities among treated long QT syndrome patients. METHODS AND RESULTS Long QT syndrome patients aged ≥4 years treated with anti-adrenergic therapy were included. Demographics included mechanism of presentation, corrected QT interval pretreatment, symptom history, medication compliance, and administration of QT-prolonging medications. Corrected QT interval ≥550 ms or prior cardiac arrest defined high risk. Sports were categorized by cardiovascular demand per the 2005 Bethesda Conference Guidelines. Each was classified as recreational or competitive. One hundred seventy-two patients (90; 52% female) with median age 15.2 years (interquartile range 11.4, 19.4) were included. Evaluation was performed for family history (102; 59%), incidental finding (34; 20%), and symptoms (36; 21%). Median corrected QT interval was 474 ms (interquartile range 446, 496) and 14 patients (8%) were deemed high risk. Treatment included β-blockers (171; 99%), implantable cardioverter-defibrillator (27; 16%), left cardiac sympathetic denervation (7; 4%), and pacemaker (3; 2%). Sports participation was recreational (66; 38%) or competitive (106; 62%), with 92 (53%) exercising against the Bethesda Conference Guidelines. There were no cardiac events in competitive athletes and no deaths. There were 13 cardiac events in 9 previously symptomatic patients during either recreational exercise or activities of daily life. CONCLUSIONS In this cohort of appropriately managed children with long QT syndrome, cardiac event rates were low and occurred during recreational but not competitive activities. This study further supports the need for increased assessment of arrhythmia risk during exercise in this patient population.
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Affiliation(s)
- Kristina D Chambers
- Inherited Cardiac Arrhythmia Program & Division of Cardiac Electrophysiology, Boston Children's Hospital & Harvard Medical School, Boston, MA
| | - Virginie Beausejour Ladouceur
- Inherited Cardiac Arrhythmia Program & Division of Cardiac Electrophysiology, Boston Children's Hospital & Harvard Medical School, Boston, MA
| | - Mark E Alexander
- Inherited Cardiac Arrhythmia Program & Division of Cardiac Electrophysiology, Boston Children's Hospital & Harvard Medical School, Boston, MA
| | - Robyn J Hylind
- Inherited Cardiac Arrhythmia Program & Division of Cardiac Electrophysiology, Boston Children's Hospital & Harvard Medical School, Boston, MA
| | - Laura Bevilacqua
- Inherited Cardiac Arrhythmia Program & Division of Cardiac Electrophysiology, Boston Children's Hospital & Harvard Medical School, Boston, MA
| | - Douglas Y Mah
- Inherited Cardiac Arrhythmia Program & Division of Cardiac Electrophysiology, Boston Children's Hospital & Harvard Medical School, Boston, MA
| | - Vassilios Bezzerides
- Inherited Cardiac Arrhythmia Program & Division of Cardiac Electrophysiology, Boston Children's Hospital & Harvard Medical School, Boston, MA
| | - John K Triedman
- Inherited Cardiac Arrhythmia Program & Division of Cardiac Electrophysiology, Boston Children's Hospital & Harvard Medical School, Boston, MA
| | - Edward P Walsh
- Inherited Cardiac Arrhythmia Program & Division of Cardiac Electrophysiology, Boston Children's Hospital & Harvard Medical School, Boston, MA
| | - Dominic J Abrams
- Inherited Cardiac Arrhythmia Program & Division of Cardiac Electrophysiology, Boston Children's Hospital & Harvard Medical School, Boston, MA
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Abstract
Ebstein anomaly is a rare form of congenital heart disease with a uniquely high prevalence of arrhythmias. The most prevalent arrhythmia mechanisms are intrinsic to the underlying embryologic defects and may manifest at any stage. Current electrophysiological and surgical strategies are well equipped to address these arrhythmia mechanisms, yet despite available technology and a robust understanding of the mechanisms, these cases remain challenging. Surgical techniques that render arrhythmia substrates unreachable mandate comprehensive presurgical electrophysiological assessment and potential ablation. As the population ages, the need to address atrial fibrillation management and risk stratification for sudden cardiac death becomes ever more pertinent.
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Affiliation(s)
- Elizabeth D Sherwin
- Division of Cardiology, Children's National Health System, 111 Michigan Avenue NW, Washington, DC 20010, USA
| | - Dominic J Abrams
- Division of Cardiac Electrophysiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA.
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Mah DY, Shakti D, Gauvreau K, Colan SD, Alexander ME, Abrams DJ, Brown DW. Relation of Left Atrial Size to Atrial Fibrillation in Patients Aged ≤22 Years. Am J Cardiol 2017; 119:52-56. [PMID: 27780555 DOI: 10.1016/j.amjcard.2016.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 09/13/2016] [Accepted: 09/13/2016] [Indexed: 11/26/2022]
Abstract
Left atrial (LA) dilation has been shown to be associated with atrial fibrillation (AF) in the adult population, with some studies indicating that larger LAs are more prone to AF recurrence. The relation of LA size to AF in the pediatric and young adult population has not been investigated. In this study, all pediatric patients (aged ≤22 years) who presented to Boston Children's Hospital from January 2002 to December 2012 with AF were reviewed. Patients with significant congenital heart disease, cardiomyopathies, proven channelopathies, previous cardiac surgery, end-stage renal disease, or severe lung disease/cystic fibrosis were excluded. LA measurements were taken using the echocardiogram performed at the initial presentation. In total, 48 patients with AF were identified. The median age at presentation was 17.1 years (range 3.7 to 22.9 years); 38 patients (79%) were men. Eleven patients (23%) had at least 1 recurrence of their AF. There was no difference in body mass index, prevalence of systemic hypertension, alcohol, stimulant, or illicit drug use between those who had an isolated episode of AF and those who had a recurrence. There was no significant difference in LA dimension Z-scores between groups, with only 2 patients (1 isolated AF, 1 recurrent AF) having Z-scores >2. In conclusion, AF in the young without underlying heart disease is not associated with LA dilation.
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46
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Beauséjour Ladouceur V, Abrams DJ. Whole-Exome Molecular Autopsy After Exertional Sudden Cardiac Death: Not a Panacea but a Step in the Right Direction. Circ Cardiovasc Genet 2016; 9:210-2. [PMID: 27329652 DOI: 10.1161/circgenetics.116.001484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Virginie Beauséjour Ladouceur
- From the Inherited Cardiac Arrhythmia Program, Division of Cardiac Electrophysiology, Boston Children's Hospital, MA
| | - Dominic J Abrams
- From the Inherited Cardiac Arrhythmia Program, Division of Cardiac Electrophysiology, Boston Children's Hospital, MA.
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De Ferrari GM, Dusi V, Spazzolini C, Bos JM, Abrams DJ, Berul CI, Crotti L, Eldar M, Kharlap M, Khoury A, Krahn AD, Leenhardt A, Moir CR, Odero A, Nordkamp LO, Paul T, i Noguer FR, Shkolnikova M, Till J, Wilde AA, Ackerman MJ, Schwartz PJ. Response to Letters Regarding Article, “Clinical Management of Catecholaminergic Polymorphic Ventricular Tachycardia: The Role of Left Cardiac Sympathetic Denervation”. Circulation 2016; 133:e366-7. [DOI: 10.1161/circulationaha.115.019465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Gaetano M. De Ferrari
- Department of Cardiology and Cardiovascular Clinical Research Center, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Veronica Dusi
- Department of Cardiology and Cardiovascular Clinical Research Center, Fondazione IRCCS Policlinico San Matteo, Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Carla Spazzolini
- Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Istituto Auxologico Italiano, Milano, Italy
| | - J. Martijn Bos
- Departments of Medicine, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics, Divisions of Cardiovascular Diseases and Pediatric Cardiology Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN
| | - Dominic J. Abrams
- Cardiac Arrhythmia Service, Department of Cardiology, Children’s Hospital, Boston, MA
| | - Charles I. Berul
- Division of Cardiology, Children’s National Heart Institute, George Washington University, Washington, DC
| | - Lia Crotti
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
- San Luca Hospital, IRCCS Istituto Auxologico Italiano, Milano, Italy
| | - Michael Eldar
- Heart Institute Leviev Heart Center, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Maria Kharlap
- Department of Clinical Cardiology and Molecular Genetics, National Center for Preventive Medicine, Ministry of Healthcare, Russian Federation, Moscow, Russia
| | - Asaad Khoury
- The Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Andrew D. Krahn
- Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Antoine Leenhardt
- AP-HP, Hôpital Bichat, Service de Cardiologie et Centre de Référence des Maladies, Cardiaques Héréditaires, Paris
- Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Christopher R. Moir
- Departments of Medicine, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics, Divisions of Cardiovascular Diseases and Pediatric Cardiology Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN
| | - Attilio Odero
- Division of Vascular Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Louise Olde Nordkamp
- Heart Centre AMC, Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands
| | - Thomas Paul
- Department of Pediatric Cardiology and Intensive Care Medicine, University Hospital, Georg-August-University, Göttingen, Germany
| | | | - Maria Shkolnikova
- Research Clinical Institute for Pediatrics of the Pirogov National, Research Medical University, Moscow, Russia
| | - Jan Till
- Royal Brompton Hospital, London, UK
| | - Arthur A.M. Wilde
- Heart Centre AMC, Department of Cardiology, Academic Medical Centre, Amsterdam, The Netherlands
- Princess Al Jawhara Albrahim Centre of Excellence in Research of Hereditary Disorders, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Michael J. Ackerman
- Departments of Medicine, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics, Divisions of Cardiovascular Diseases and Pediatric Cardiology Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, MN
| | - Peter J. Schwartz
- Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Istituto Auxologico Italiano, Milano, Italy
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48
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Russell M, Roberts AE, Abrams DJ, Murphy AM, Towbin JA, Chung WK. How to effectively utilize genetic testing in the care of children with cardiomyopathies. Progress in Pediatric Cardiology 2015. [DOI: 10.1016/j.ppedcard.2015.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Abrams DJ, Kirkby C, Page SP, Earley MJ, Nitiou D, Kelsell DP, Schilling RJ. Evolution of Electrocardiographic and Structural Features Over 3 Decades in Arrhythmogenic Cardiomyopathy. Circulation 2015; 131:2233-5. [DOI: 10.1161/circulationaha.115.014371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Dominic J. Abrams
- From Cardiovascular Biomedical Research Unit, St. Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (D.J.A., C.K., S.P.P., M.J.E., R.J.S.); and Centre for Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom (D.N., D.P.K.)
| | - Claire Kirkby
- From Cardiovascular Biomedical Research Unit, St. Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (D.J.A., C.K., S.P.P., M.J.E., R.J.S.); and Centre for Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom (D.N., D.P.K.)
| | - Stephen P. Page
- From Cardiovascular Biomedical Research Unit, St. Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (D.J.A., C.K., S.P.P., M.J.E., R.J.S.); and Centre for Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom (D.N., D.P.K.)
| | - Mark J. Earley
- From Cardiovascular Biomedical Research Unit, St. Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (D.J.A., C.K., S.P.P., M.J.E., R.J.S.); and Centre for Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom (D.N., D.P.K.)
| | - Daniela Nitiou
- From Cardiovascular Biomedical Research Unit, St. Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (D.J.A., C.K., S.P.P., M.J.E., R.J.S.); and Centre for Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom (D.N., D.P.K.)
| | - David P Kelsell
- From Cardiovascular Biomedical Research Unit, St. Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (D.J.A., C.K., S.P.P., M.J.E., R.J.S.); and Centre for Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom (D.N., D.P.K.)
| | - Richard J. Schilling
- From Cardiovascular Biomedical Research Unit, St. Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom (D.J.A., C.K., S.P.P., M.J.E., R.J.S.); and Centre for Cutaneous Research, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom (D.N., D.P.K.)
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50
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De Ferrari GM, Dusi V, Spazzolini C, Bos JM, Abrams DJ, Berul CI, Crotti L, Davis AM, Eldar M, Kharlap M, Khoury A, Krahn AD, Leenhardt A, Moir CR, Odero A, Olde Nordkamp L, Paul T, Rosés i Noguer F, Shkolnikova M, Till J, Wilde AA, Ackerman MJ, Schwartz PJ. Clinical Management of Catecholaminergic Polymorphic Ventricular Tachycardia. Circulation 2015; 131:2185-93. [DOI: 10.1161/circulationaha.115.015731] [Citation(s) in RCA: 204] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 04/21/2015] [Indexed: 11/16/2022]
Abstract
Background—
Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a genetic disorder causing life-threatening arrhythmias whenever sympathetic activity increases. β-Βlockers are the mainstay of therapy; when they fail, implantable cardioverter-defibrillators (ICDs) are used but often cause multiple shocks. Preliminary results with flecainide appear encouraging. We proposed left cardiac sympathetic denervation (LCSD) as useful additional therapy, but evidence remains anecdotal.
Methods and Results—
We report 63 patients with CPVT who underwent LCSD as secondary (n=54) or primary (n=9) prevention. The median post-LCSD follow-up was 37 months. The 9 asymptomatic patients remained free of major cardiac events. Of the 54 patients with prior major cardiac events either on (n=38) or off (n=16) optimal medical therapy, 13 (24%) had at least 1 recurrence: 0 patients had an aborted cardiac arrest, 2 patients had syncope only, 10 patients had ≥1 appropriate ICD discharges, and 1 patient died suddenly. The 1- and 2-year cumulative event-free survival rates were 87% and 81%. The percentage of patients with major cardiac events despite optimal medical therapy (n=38) was reduced from 100% to 32% (
P
<0.001) after LCSD, and among 29 patients with a presurgical ICD, the rate of shocks dropped by 93% from 3.6 to 0.6 shocks per person per year (
P
<0.001). Patients with an incomplete LCSD (n=7) were more likely to experience major cardiac events after LCSD (71% versus 17%;
P
<0.01) than those with a complete LCSD.
Conclusions—
LCSD is an effective antifibrillatory intervention for patients with CPVT. Whenever syncope occurs despite optimal medical therapy, LCSD could be considered the next step rather than an ICD and could complement ICDs in patients with recurrent shocks.
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Affiliation(s)
- Gaetano M. De Ferrari
- From Department of Cardiology and Cardiovascular Clinical Research Center (G.M.D.F., V.D.) and Division of Vascular Surgery (A.O.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Italy (G.M.D.T., V.D., C.S., L.C.); Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Istituto Auxologico Italiano, Milano, Italy (C.S., L.C., P.J.S.); Departments of Medicine, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics,
| | - Veronica Dusi
- From Department of Cardiology and Cardiovascular Clinical Research Center (G.M.D.F., V.D.) and Division of Vascular Surgery (A.O.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Italy (G.M.D.T., V.D., C.S., L.C.); Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Istituto Auxologico Italiano, Milano, Italy (C.S., L.C., P.J.S.); Departments of Medicine, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics,
| | - Carla Spazzolini
- From Department of Cardiology and Cardiovascular Clinical Research Center (G.M.D.F., V.D.) and Division of Vascular Surgery (A.O.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Italy (G.M.D.T., V.D., C.S., L.C.); Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Istituto Auxologico Italiano, Milano, Italy (C.S., L.C., P.J.S.); Departments of Medicine, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics,
| | - J. Martijn Bos
- From Department of Cardiology and Cardiovascular Clinical Research Center (G.M.D.F., V.D.) and Division of Vascular Surgery (A.O.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Italy (G.M.D.T., V.D., C.S., L.C.); Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Istituto Auxologico Italiano, Milano, Italy (C.S., L.C., P.J.S.); Departments of Medicine, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics,
| | - Dominic J. Abrams
- From Department of Cardiology and Cardiovascular Clinical Research Center (G.M.D.F., V.D.) and Division of Vascular Surgery (A.O.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Italy (G.M.D.T., V.D., C.S., L.C.); Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Istituto Auxologico Italiano, Milano, Italy (C.S., L.C., P.J.S.); Departments of Medicine, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics,
| | - Charles I. Berul
- From Department of Cardiology and Cardiovascular Clinical Research Center (G.M.D.F., V.D.) and Division of Vascular Surgery (A.O.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Italy (G.M.D.T., V.D., C.S., L.C.); Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Istituto Auxologico Italiano, Milano, Italy (C.S., L.C., P.J.S.); Departments of Medicine, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics,
| | - Lia Crotti
- From Department of Cardiology and Cardiovascular Clinical Research Center (G.M.D.F., V.D.) and Division of Vascular Surgery (A.O.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Italy (G.M.D.T., V.D., C.S., L.C.); Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Istituto Auxologico Italiano, Milano, Italy (C.S., L.C., P.J.S.); Departments of Medicine, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics,
| | - Andrew M. Davis
- From Department of Cardiology and Cardiovascular Clinical Research Center (G.M.D.F., V.D.) and Division of Vascular Surgery (A.O.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Italy (G.M.D.T., V.D., C.S., L.C.); Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Istituto Auxologico Italiano, Milano, Italy (C.S., L.C., P.J.S.); Departments of Medicine, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics,
| | - Michael Eldar
- From Department of Cardiology and Cardiovascular Clinical Research Center (G.M.D.F., V.D.) and Division of Vascular Surgery (A.O.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Italy (G.M.D.T., V.D., C.S., L.C.); Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Istituto Auxologico Italiano, Milano, Italy (C.S., L.C., P.J.S.); Departments of Medicine, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics,
| | - Maria Kharlap
- From Department of Cardiology and Cardiovascular Clinical Research Center (G.M.D.F., V.D.) and Division of Vascular Surgery (A.O.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Italy (G.M.D.T., V.D., C.S., L.C.); Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Istituto Auxologico Italiano, Milano, Italy (C.S., L.C., P.J.S.); Departments of Medicine, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics,
| | - Asaad Khoury
- From Department of Cardiology and Cardiovascular Clinical Research Center (G.M.D.F., V.D.) and Division of Vascular Surgery (A.O.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Italy (G.M.D.T., V.D., C.S., L.C.); Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Istituto Auxologico Italiano, Milano, Italy (C.S., L.C., P.J.S.); Departments of Medicine, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics,
| | - Andrew D. Krahn
- From Department of Cardiology and Cardiovascular Clinical Research Center (G.M.D.F., V.D.) and Division of Vascular Surgery (A.O.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Italy (G.M.D.T., V.D., C.S., L.C.); Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Istituto Auxologico Italiano, Milano, Italy (C.S., L.C., P.J.S.); Departments of Medicine, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics,
| | - Antoine Leenhardt
- From Department of Cardiology and Cardiovascular Clinical Research Center (G.M.D.F., V.D.) and Division of Vascular Surgery (A.O.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Italy (G.M.D.T., V.D., C.S., L.C.); Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Istituto Auxologico Italiano, Milano, Italy (C.S., L.C., P.J.S.); Departments of Medicine, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics,
| | - Christopher R. Moir
- From Department of Cardiology and Cardiovascular Clinical Research Center (G.M.D.F., V.D.) and Division of Vascular Surgery (A.O.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Italy (G.M.D.T., V.D., C.S., L.C.); Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Istituto Auxologico Italiano, Milano, Italy (C.S., L.C., P.J.S.); Departments of Medicine, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics,
| | - Attilio Odero
- From Department of Cardiology and Cardiovascular Clinical Research Center (G.M.D.F., V.D.) and Division of Vascular Surgery (A.O.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Italy (G.M.D.T., V.D., C.S., L.C.); Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Istituto Auxologico Italiano, Milano, Italy (C.S., L.C., P.J.S.); Departments of Medicine, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics,
| | - Louise Olde Nordkamp
- From Department of Cardiology and Cardiovascular Clinical Research Center (G.M.D.F., V.D.) and Division of Vascular Surgery (A.O.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Italy (G.M.D.T., V.D., C.S., L.C.); Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Istituto Auxologico Italiano, Milano, Italy (C.S., L.C., P.J.S.); Departments of Medicine, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics,
| | - Thomas Paul
- From Department of Cardiology and Cardiovascular Clinical Research Center (G.M.D.F., V.D.) and Division of Vascular Surgery (A.O.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Italy (G.M.D.T., V.D., C.S., L.C.); Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Istituto Auxologico Italiano, Milano, Italy (C.S., L.C., P.J.S.); Departments of Medicine, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics,
| | - Ferran Rosés i Noguer
- From Department of Cardiology and Cardiovascular Clinical Research Center (G.M.D.F., V.D.) and Division of Vascular Surgery (A.O.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Italy (G.M.D.T., V.D., C.S., L.C.); Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Istituto Auxologico Italiano, Milano, Italy (C.S., L.C., P.J.S.); Departments of Medicine, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics,
| | - Maria Shkolnikova
- From Department of Cardiology and Cardiovascular Clinical Research Center (G.M.D.F., V.D.) and Division of Vascular Surgery (A.O.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Italy (G.M.D.T., V.D., C.S., L.C.); Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Istituto Auxologico Italiano, Milano, Italy (C.S., L.C., P.J.S.); Departments of Medicine, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics,
| | - Jan Till
- From Department of Cardiology and Cardiovascular Clinical Research Center (G.M.D.F., V.D.) and Division of Vascular Surgery (A.O.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Italy (G.M.D.T., V.D., C.S., L.C.); Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Istituto Auxologico Italiano, Milano, Italy (C.S., L.C., P.J.S.); Departments of Medicine, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics,
| | - Arthur A.M. Wilde
- From Department of Cardiology and Cardiovascular Clinical Research Center (G.M.D.F., V.D.) and Division of Vascular Surgery (A.O.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Italy (G.M.D.T., V.D., C.S., L.C.); Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Istituto Auxologico Italiano, Milano, Italy (C.S., L.C., P.J.S.); Departments of Medicine, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics,
| | - Michael J. Ackerman
- From Department of Cardiology and Cardiovascular Clinical Research Center (G.M.D.F., V.D.) and Division of Vascular Surgery (A.O.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Italy (G.M.D.T., V.D., C.S., L.C.); Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Istituto Auxologico Italiano, Milano, Italy (C.S., L.C., P.J.S.); Departments of Medicine, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics,
| | - Peter J. Schwartz
- From Department of Cardiology and Cardiovascular Clinical Research Center (G.M.D.F., V.D.) and Division of Vascular Surgery (A.O.), Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Molecular Medicine, University of Pavia, Italy (G.M.D.T., V.D., C.S., L.C.); Center for Cardiac Arrhythmias of Genetic Origin, IRCCS Istituto Auxologico Italiano, Milano, Italy (C.S., L.C., P.J.S.); Departments of Medicine, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics,
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