Document Detail


Trigger-specific ion-channel mechanisms, risk factors, and response to therapy in type 1 long QT syndrome.
MedLine Citation:
PMID:  21871251     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Arrhythmic events in long-QT syndrome type 1 (LQT1) may be associated with exercise, acute arousal, or rest/sleep.
OBJECTIVES: We aimed to identify trigger-specific risk factors for cardiac events in patients with LQT1.
METHODS: The study population comprised 721 genetically confirmed patients with LQT1 from the US portion of the International LQTS Registry. Multivariate analysis was used to assess the independent contribution of prespecified clinical and mutation-specific factors to the development of a first reported triggered event, associated with exercise, arousal, or sleep/rest.
RESULTS: Cardiac events occurred in 221 study patients, of whom 121 (55%) were associated with exercise, 30 (14%) with arousal, 47 (21%) with sleep/rest, and 23 (10%) with other triggers. Multivariate analysis showed that males <13 years had a 2.8-fold (P < .001) increase in the risk for exercise-triggered events whereas females ≥13 years showed a 3.5-fold (P = .002) increase in the risk for sleep/rest nonarousal events. Cytoplasmic-loop mutations within the transmembrane region, involved in adrenergic channel regulation, were associated with the increased risk for both exercise- and arousal-triggered events (hazard ratio = 6.19 [P < .001] and 4.99 [P < .001], respectively) but were not associated with events during sleep/rest (hazard ratio = 0.72; P = .46). Beta-blocker therapy was associated with a pronounced 78% (P < .001) reduction in the risk for exercise-triggered events but did not have a significant effect on events associated with arousal or sleep/rest.
CONCLUSIONS: In patients with LQT1, cardiac events triggered by exercise, arousal, or rest/sleep are associated with distinctive risk factors and response to medical therapy. These findings can be used for improved recommendations for lifestyle modifications and therapeutic management in this population.
Authors:
Ilan Goldenberg; Princy Thottathil; Coeli M Lopes; Arthur J Moss; Scott McNitt; Jin O-Uchi; Jennifer L Robinson; Wojciech Zareba; Michael J Ackerman; Elizabeth S Kaufman; Jeffrey A Towbin; Michael Vincent; Alon Barsheshet
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2011-08-24
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  9     ISSN:  1556-3871     ISO Abbreviation:  Heart Rhythm     Publication Date:  2012 Jan 
Date Detail:
Created Date:  2011-12-26     Completed Date:  2012-10-29     Revised Date:  2013-05-03    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  United States    
Other Details:
Languages:  eng     Pagination:  49-56     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.
Affiliation:
Cardiology Division, University of Rochester Medical Center, Rochester, New York 14642, USA. Ilan.Goldenberg@heart.rochester.edu
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MeSH Terms
Descriptor/Qualifier:
Adrenergic beta-Antagonists / therapeutic use*
Death, Sudden, Cardiac / etiology*
Electrocardiography
Exercise / physiology
Female
Humans
Ion Channels / genetics*
Long QT Syndrome / complications,  drug therapy*,  physiopathology
Male
Multivariate Analysis
Mutation
Precipitating Factors
Risk Factors
Sleep / physiology
Grant Support
ID/Acronym/Agency:
HL-33843/HL/NHLBI NIH HHS; HL-51618/HL/NHLBI NIH HHS; R01 HL033843/HL/NHLBI NIH HHS; R01 HL051618/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Ion Channels

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