Abstract
The congenital long QT syndrome (LQTS) is considered to be one of the hereditary cardiac arrhythmia syndromes, nowadays also known as cardiac channelopathies. The syndrome is characterized by prolongation of the heart rate corrected QT-interval (QTc) on the 12-lead electrocardiogram (ECG). In affected family members, it is associated with recurrent syncope, seizures, and sudden cardiac death due to ventricular arrhythmias (Torsade des Pointes (TdP) and ventricular fibrillation), which typically follow a precipitating event such as exertion, extreme emotion, swimming and diving, or auditory stimulation.
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References
Jervell A, Lange-Nielsen F. Congenital deaf-mutism, functional heart disease with prolongation of the Q-T interval and sudden death. Am Heart J. 1957 July;54(1):59-68.
Romano C, Gemme G, Pongiglione R. Rare cardiac arrythmias of the pediatric age. II. Syncopal attacks due to paroxysmal ventricular fibrillation (presentation of 1st case in Italian pediatric literature. Clin Pediatr (Bologna). 1963 September;45:656-683.
Ward OC. A new familial cardiac syndrome in children. J Irish Med Assoc. 1964;54:103-106. Ref Type: Generic.
Curran ME, Splawski I, Timothy KW, Vincent GM, Green ED, Keating MT. A molecular basis for cardiac arrhythmia: HERG mutations cause long QT syndrome. Cell. 1995 March 10;80(5):795-803.
Wang Q, Shen J, Splawski I, et al. SCN5A mutations associated with an inherited cardiac arrhythmia, long QT syndrome. Cell. 1995 March 10;80(5):805-811.
Moss AJ, Kass RS. Long QT syndrome: from channels to cardiac arrhythmias. J Clin Invest. 2005 August;115(8):2018-2024.
Tan HL, Hou CJ, Lauer MR, Sung RJ. Electrophysiologic mechanisms of the long QT interval syndromes and torsade de pointes. Ann Intern Med. 1995 May 1;122(9):701-714.
Grunnet M, Hansen RS, Olesen SP. hERG1 channel activators: a new anti-arrhythmic principle. Prog Biophys Mol Biol. 2008 October;98(2–3):347-362.
el-Sherif N, Caref EB, Yin H, Restivo M. The electrophysiological mechanism of ventricular arrhythmias in the long QT syndrome. Tridimensional mapping of activation and recovery patterns. Circ Res. 1996 September;79(3):474-492.
Murakawa Y, Sezaki K, Yamashita T, Kanese Y, Omata M. Three-dimensional activation sequence of cesium-induced ventricular arrhythmias. Am J Physiol. 1997 September;273(3 Pt 2):H1377-H1385.
Ackerman MJ. The long QT syndrome: ion channel diseases of the heart. Mayo Clin Proc. 1998 March;73(3):250-269.
Schwartz PJ, Stramba-Badiale M, Crotti L, et al. Prevalence of the congenital long-QT syndrome. Circulation. 2009 November 3;120(18):1761-1767.
Tester DJ, Ackerman MJ. Postmortem long QT syndrome genetic testing for sudden unexplained death in the young. J Am Coll Cardiol. 2007 January 16;49(2):240-246.
Splawski I, Shen J, Timothy KW, et al. Spectrum of mutations in long-QT syndrome genes. KVLQT1, HERG, SCN5A, KCNE1, and KCNE2. Circulation. 2000 September 5;102(10):1178-1185.
Goldenberg I, Moss AJ. Long QT syndrome. J Am Coll Cardiol. 2008 June 17;51(24):2291-2300.
Chen L, Marquardt ML, Tester DJ, Sampson KJ, Ackerman MJ, Kass RS. Mutation of an A-kinase-anchoring protein causes long-QT syndrome. Proc Natl Acad Sci USA. 2007 December 26;104(52):20990-20995.
Ueda K, Valdivia C, Medeiros-Domingo A, et al. Syntrophin mutation associated with long QT syndrome through activation of the nNOS-SCN5A macromolecular complex. Proc Natl Acad Sci USA. 2008 July 8;105(27):9355-9360.
Sanguinetti MC, Curran ME, Spector PS, Keating MT. Spectrum of HERG K + -channel dysfunction in an inherited cardiac arrhythmia. Proc Natl Acad Sci USA. 1996 March 5;93(5):2208-2212.
Mohler PJ, Schott JJ, Gramolini AO, et al. Ankyrin-B mutation causes type 4 long-QT cardiac arrhythmia and sudden cardiac death. Nature. 2003 February 6;421(6923):634-639.
Vatta M, Ackerman MJ, Ye B, et al. Mutant caveolin-3 induces persistent late sodium current and is associated with long-QT syndrome. Circulation. 2006 November 14;114(20):2104-2112.
Andersen ED, Krasilnikoff PA, Overvad H. Intermittent muscular weakness, extrasystoles, and multiple developmental anomalies. A new syndrome? Acta Paediatr Scand. 1971 September;60(5):559-564.
Tawil R, Ptacek LJ, Pavlakis SG, et al. Andersen’s syndrome: potassium-sensitive periodic paralysis, ventricular ectopy, and dysmorphic features. Ann Neurol. 1994 March;35(3):326-330.
Reichenbach H, Meister EM, Theile H. The heart-hand syndrome. A new variant of disorders of heart conduction and syndactylia including osseous changes in hands and feet. Kinderarztl Prax. 1992 April;60(2):54-56.
Schulze-Bahr E, Wang Q, Wedekind H, et al. KCNE1 mutations cause jervell and Lange-Nielsen syndrome. Nat Genet. 1997 November;17(3):267-268.
Tan HL, Bardai A, Shimizu W, et al. Genotype-specific onset of arrhythmias in congenital long-QT syndrome: possible therapy implications. Circulation. 2006 November 14;114(20):2096-2103.
Viswanathan PC, Rudy Y. Pause induced early afterdepolarizations in the long QT syndrome: a simulation study. Cardiovasc Res. 1999 May;42(2):530-542.
Marban E, Robinson SW, Wier WG. Mechanisms of arrhythmogenic delayed and early afterdepolarizations in ferret ventricular muscle. J Clin Invest. 1986 November;78(5):1185-1192.
Burashnikov A, Antzelevitch C. Acceleration-induced action potential prolongation and early afterdepolarizations. J Cardiovasc Electrophysiol. 1998 September;9(9):934-948.
Antzelevitch C, Pollevick GD, Cordeiro JM, et al. Loss-of-function mutations in the cardiac calcium channel underlie a new clinical entity characterized by ST-segment elevation, short QT intervals, and sudden cardiac death. Circulation. 2007 January 30;115(4):442-449.
Conrath CE, Opthof T. Ventricular repolarization: an overview of (patho)physiology, sympathetic effects and genetic aspects. Prog Biophys Mol Biol. 2006 November;92(3):269-307.
Tsien RW, Giles W, Greengard P. Cyclic AMP mediates the effects of adrenaline on cardiac purkinje fibres. Nat New Biol. 1972 December 6;240(101):181-183.
Priori SG, Corr PB. Mechanisms underlying early and delayed afterdepolarizations induced by catecholamines. Am J Physiol. 1990 June;258(6 Pt 2):H1796-H1805.
Yang T, Kanki H, Roden DM. Phosphorylation of the IKs channel complex inhibits drug block: novel mechanism underlying variable antiarrhythmic drug actions. Circulation. 2003 July 15;108(2):132-134.
Thomas D, Kiehn J, Katus HA, Karle CA. Adrenergic regulation of the rapid component of the cardiac delayed rectifier potassium current, I(Kr), and the underlying hERG ion channel. Basic Res Cardiol. 2004 July;99(4):279-287.
Veldkamp MW, Verkerk AO, van Ginneken AC, et al. Norepinephrine induces action potential prolongation and early afterdepolarizations in ventricular myocytes isolated from human end-stage failing hearts. Eur Heart J. 2001 June;22(11):955-963.
Roden DM, Lazzara R, Rosen M, Schwartz PJ, Towbin J, Vincent GM. Multiple mechanisms in the long-QT syndrome. Current knowledge, gaps, and future directions. The SADS Foundation Task Force on LQTS. Circulation. 1996 October 15;94(8):1996-2012.
Schwartz PJ, Priori SG, Locati EH, et al. Long QT syndrome patients with mutations of the SCN5A and HERG genes have differential responses to Na + channel blockade and to increases in heart rate. Implications for gene-specific therapy. Circulation. 1995 December 15;92(12):3381-3386.
Moss AJ, Schwartz PJ, Crampton RS, et al. The long QT syndrome. Prospective longitudinal study of 328 families. Circulation. 1991 September;84(3):1136-1144.
Zareba W, Moss AJ, Schwartz PJ, et al. Influence of genotype on the clinical course of the long-QT syndrome. International Long-QT Syndrome Registry Research Group. N Engl J Med. 1998 October 1;339(14):960-965.
Schwartz PJ, Priori SG, Spazzolini C, et al. Genotype-phenotype correlation in the long-QT syndrome: gene-specific triggers for life-threatening arrhythmias. Circulation. 2001 January 2;103(1):89-95.
Moss AJ, Robinson JL, Gessman L, et al. Comparison of clinical and genetic variables of cardiac events associated with loud noise versus swimming among subjects with the long QT syndrome. Am J Cardiol. 1999 October 15;84(8):876-879.
Ackerman MJ, Tester DJ, Porter CJ. Swimming, a gene-specific arrhythmogenic trigger for inherited long QT syndrome. Mayo Clin Proc. 1999 November;74(11):1088-1094.
Wilde AA, Jongbloed RJ, Doevendans PA, et al. Auditory stimuli as a trigger for arrhythmic events differentiate HERG-related (LQTS2) patients from KVLQT1-related patients (LQTS1). J Am Coll Cardiol. 1999 February;33(2):327-332.
Schwartz PJ. Idiopathic long QT syndrome: progress and questions. Am Heart J. 1985 February;109(2):399-411.
Crotti L, Celano G, Dagradi F, Schwartz PJ. Congenital long QT syndrome. Orphanet J Rare Dis. 2008;3:18.
Lepeschkin E, Surawicz B. The measurement of the Q-T interval of the electrocardiogram. Circulation. 1952 September;6(3):378-388.
Bazett HC. An analysis of the time-relations of electrocardiograms. Heart. 1920;7:353-370.
Allan WC, Timothy K, Vincent GM, Palomaki GE, Neveux LM, Haddow JE. Long QT syndrome in children: the value of the rate corrected QT interval in children who present with fainting. J Med Screen. 2001;8(4):178-182.
Viskin S, Rosovski U, Sands AJ, et al. Inaccurate electrocardiographic interpretation of long QT: the majority of physicians cannot recognize a long QT when they see one. Heart Rhythm. 2005 June;2(6):569-574.
Postema PG, De Jong JS, van der Bilt IA, Wilde AA. Accurate electrocardiographic assessment of the QT interval: teach the tangent. Heart Rhythm. 2008 July;5(7):1015-1018.
Moss AJ, Schwartz PJ, Crampton RS, Locati E, Carleen E. The long QT syndrome: a prospective international study. Circulation. 1985 January;71(1):17-21.
Merri M, Benhorin J, Alberti M, Locati E, Moss AJ. Electrocardiographic quantitation of ventricular repolarization. Circulation. 1989 November;80(5):1301-1308.
Vincent GM, Timothy KW, Leppert M, Keating M. The spectrum of symptoms and QT intervals in carriers of the gene for the long-QT syndrome. N Engl J Med. 1992 September 17;327(12):846-852.
Moss AJ. Long QT syndromes. Curr Treat Options Cardiovasc Med. 2000 August;2(4):317-322.
Schwartz PJ. Clinical applicability of molecular biology: the case of the long QT syndrome. Curr Control Trials Cardiovasc Med. 2000;1(2):88-91.
Goldenberg I, Moss AJ, Zareba W. QT interval: how to measure it and what is “normal”. J Cardiovasc Electrophysiol. 2006 March;17(3):333-336.
Moss AJ, Zareba W, Benhorin J, et al. ECG T-wave patterns in genetically distinct forms of the hereditary long QT syndrome. Circulation. 1995 November 15;92(10):2929-2934.
Lehmann MH, Suzuki F, Fromm BS, et al. T wave “humps” as a potential electrocardiographic marker of the long QT syndrome. J Am Coll Cardiol. 1994 September;24(3):746-754.
Lupoglazoff JM, Denjoy I, Berthet M, et al. Notched T waves on Holter recordings enhance detection of patients with LQt2 (HERG) mutations. Circulation. 2001 February 27;103(8):1095-1101.
Khositseth A, Hejlik J, Shen WK, Ackerman MJ. Epinephrine-induced T-wave notching in congenital long QT syndrome. Heart Rhythm. 2005 February;2(2):141-146.
Zareba W, Moss AJ, le CS, Hall WJ. T wave alternans in idiopathic long QT syndrome. J Am Coll Cardiol. 1994 June;23(7):1541-1546.
Napolitano C, Priori SG, Schwartz PJ. Significance of QT dispersion in the long QT syndrome. Prog Cardiovasc Dis. 2000 March;42(5):345-350.
Veldkamp MW, Wilders R, Baartscheer A, Zegers JG, Bezzina CR, Wilde AA. Contribution of sodium channel mutations to bradycardia and sinus node dysfunction in LQT3 families. Circ Res. 2003 May 16;92(9):976-983.
Vincent GM, Jaiswal D, Timothy KW. Effects of exercise on heart rate, QT, QTc and QT/QS2 in the Romano-Ward inherited long QT syndrome. Am J Cardiol. 1991 August 15;68(5):498-503.
Swan H, Viitasalo M, Piippo K, Laitinen P, Kontula K, Toivonen L. Sinus node function and ventricular repolarization during exercise stress test in long QT syndrome patients with KvLQT1 and HERG potassium channel defects. J Am Coll Cardiol. 1999 September;34(3):823-829.
Horner JM, Ackerman MJ. Ventricular ectopy during treadmill exercise stress testing in the evaluation of long QT syndrome. Heart Rhythm. 2008 December;5(12):1690-1694.
Ackerman MJ, Khositseth A, Tester DJ, Hejlik JB, Shen WK, Porter CB. Epinephrine-induced QT interval prolongation: a gene-specific paradoxical response in congenital long QT syndrome. Mayo Clin Proc. 2002 May;77(5):413-421.
Shimizu W, Noda T, Takaki H, et al. Epinephrine unmasks latent mutation carriers with LQT1 form of congenital long-QT syndrome. J Am Coll Cardiol. 2003 February 19;41(4):633-642.
Magnano AR, Talathoti N, Hallur R, Bloomfield DM, Garan H. Sympathomimetic infusion and cardiac repolarization: the normative effects of epinephrine and isoproterenol in healthy subjects. J Cardiovasc Electrophysiol. 2006 September;17(9):983-989.
Paulussen AD, Gilissen RA, Armstrong M, et al. Genetic variations of KCNQ1, KCNH2, SCN5A, KCNE1, and KCNE2 in drug-induced long QT syndrome patients. J Mol Med. 2004 March;82(3):182-188.
Yang P, Kanki H, Drolet B, et al. Allelic variants in long-QT disease genes in patients with drug-associated torsades de pointes. Circulation. 2002 April 23;105(16):1943-1948.
Roden DM. Clinical practice. Long-QT syndrome. N Engl J Med. 2008 January 10;358(2):169-176.
Van LI, Birnie E, Alders M, Jongbloed RJ, Le MH, Wilde AA. The use of genotype-phenotype correlations in mutation analysis for the long QT syndrome. J Med Genet. 2003 February;40(2):141-145.
Donger C, Denjoy I, Berthet M, et al. KVLQT1 C-terminal missense mutation causes a forme fruste long-QT syndrome. Circulation. 1997 November 4;96(9):2778-2781.
Priori SG, Napolitano C, Schwartz PJ. Low penetrance in the long-QT syndrome: clinical impact. Circulation. 1999 February 2;99(4):529-533.
Taggart NW, Haglund CM, Tester DJ, Ackerman MJ. Diagnostic miscues in congenital long-QT syndrome. Circulation. 2007 May 22;115(20):2613-2620.
Tester DJ, Kopplin LJ, Will ML, Ackerman MJ. Spectrum and prevalence of cardiac ryanodine receptor (RyR2) mutations in a cohort of unrelated patients referred explicitly for long QT syndrome genetic testing. Heart Rhythm. 2005 October;2(10):1099-1105.
Goldenberg I, Moss A, Zabera W. Time-dependent gender differences in the clinical course of patients with the congenital long-QT syndrome. In: Wang P, Hsia H, Al-Ahmad A, Zei P, eds. Ventricular Arrhythmias and Sudden Cardiac Death Mechanism. Malden, MA: Blackwell Publishing; 2008:28-36.
Locati EH, Zareba W, Moss AJ, et al. Age- and sex-related differences in clinical manifestations in patients with congenital long-QT syndrome: findings from the International LQTS Registry. Circulation. 1998 June 9;97(22):2237-2244.
Zareba W, Moss AJ, Locati EH, et al. Modulating effects of age and gender on the clinical course of long QT syndrome by genotype. J Am Coll Cardiol. 2003 July 2;42(1):103-109.
Hobbs JB, Peterson DR, Moss AJ, et al. Risk of aborted cardiac arrest or sudden cardiac death during adolescence in the long-QT syndrome. JAMA. 2006 September 13;296(10):1249-1254.
Sauer AJ, Moss AJ, McNitt S, et al. Long QT syndrome in adults. J Am Coll Cardiol. 2007 January 23;49(3):329-337.
Goldenberg I, Moss AJ, Peterson DR, et al. Risk factors for aborted cardiac arrest and sudden cardiac death in children with the congenital long-QT syndrome. Circulation. 2008 April 29;117(17):2184-2191.
Goldenberg I, Moss AJ, Bradley J, et al. Long-QT syndrome after age 40. Circulation. 2008 April 29;117(17):2192-2201.
Goldenberg I, Mathew J, Moss AJ, et al. Corrected QT variability in serial electrocardiograms in long QT syndrome: the importance of the maximum corrected QT for risk stratification. J Am Coll Cardiol. 2006 September 5;48(5):1047-1052.
Moss AJ, Zareba W, Hall WJ, et al. Effectiveness and limitations of beta-blocker therapy in congenital long-QT syndrome. Circulation. 2000 February 15;101(6):616-623.
Moss AJ, Zareba W, Kaufman ES, et al. Increased risk of arrhythmic events in long-QT syndrome with mutations in the pore region of the human ether-a-go-go-related gene potassium channel. Circulation. 2002 February 19;105(7):794-799.
Moss AJ, Shimizu W, Wilde AA, et al. Clinical aspects of type-1 long-QT syndrome by location, coding type, and biophysical function of mutations involving the KCNQ1 gene. Circulation. 2007 May 15;115(19):2481-2489.
Crotti L, Spazzolini C, Schwartz PJ, et al. The common long-QT syndrome mutation KCNQ1/A341V causes unusually severe clinical manifestations in patients with different ethnic backgrounds: toward a mutation-specific risk stratification. Circulation. 2007 November 20;116(21):2366-2375.
Brink PA, Crotti L, Corfield V, et al. Phenotypic variability and unusual clinical severity of congenital long-QT syndrome in a founder population. Circulation. 2005 October 25;112(17):2602-2610.
Liu JF, Goldenberg I, Moss AJ, et al. Phenotypic variability in Caucasian and Japanese patients with matched LQT1 mutations. Ann Noninvasive Electrocardiol. 2008 July;13(3):234-241.
Crotti L, Lundquist AL, Insolia R, et al. KCNH2-K897T is a genetic modifier of latent congenital long-QT syndrome. Circulation. 2005 August 30;112(9):1251-1258.
Rashba EJ, Zareba W, Moss AJ, et al. Influence of pregnancy on the risk for cardiac events in patients with hereditary long QT syndrome. LQTS Investigators. Circulation. 1998 February 10;97(5):451-456.
Seth R, Moss AJ, McNitt S, et al. Long QT syndrome and pregnancy. J Am Coll Cardiol. 2007 March 13;49(10):1092-1098.
Khositseth A, Tester DJ, Will ML, Bell CM, Ackerman MJ. Identification of a common genetic substrate underlying postpartum cardiac events in congenital long QT syndrome. Heart Rhythm. 2004 May;1(1):60-64.
Heradien MJ, Goosen A, Crotti L, et al. Does pregnancy increase cardiac risk for LQT1 patients with the KCNQ1-A341V mutation? J Am Coll Cardiol. 2006 October 3;48(7):1410-1415.
Meregalli PG, Westendorp IC, Tan HL, Elsman P, Kok WE, Wilde AA. Pregnancy and the risk of torsades de pointes in congenital long-QT syndrome. Neth Heart J. 2008 December;16(12):422-425.
Kimbrough J, Moss AJ, Zareba W, et al. Clinical implications for affected parents and siblings of probands with long-QT syndrome. Circulation. 2001 July 31;104(5):557-562.
Chiang CE. Congenital and acquired long QT syndrome. Current concepts and management. Cardiol Rev. 2004 July;12(4):222-234.
Priori SG, Napolitano C, Schwartz PJ, et al. Association of long QT syndrome loci and cardiac events among patients treated with beta-blockers. JAMA. 2004 September 15;292(11):1341-1344.
Vincent GM, Schwartz PJ, Denjoy I, et al. High efficacy of beta-blockers in long-QT syndrome type 1: contribution of noncompliance and QT-prolonging drugs to the occurrence of beta-blocker treatment “failures”. Circulation. 2009 January 20;119(2):215-221.
Schwartz PJ, Spazzolini C, Crotti L. All LQT3 patients need an ICD: true or false? Heart Rhythm. 2009 January;6(1):113-120.
Schwartz PJ, Priori SG, Cerrone M, et al. Left cardiac sympathetic denervation in the management of high-risk patients affected by the long-QT syndrome. Circulation. 2004 April 20;109(15):1826-1833.
Viskin S. Cardiac pacing in the long QT syndrome: review of available data and practical recommendations. J Cardiovasc Electrophysiol. 2000 May;11(5):593-600.
Zipes DP, Camm AJ, Borggrefe M, et al. ACC/AHA/ESC 2006 guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association Task Force and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Develop guidelines for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death) developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Europace. 2006 September;8(9):746-837.
Zareba W, Moss AJ, Daubert JP, Hall WJ, Robinson JL, Andrews M. Implantable cardioverter defibrillator in high-risk long QT syndrome patients. J Cardiovasc Electrophysiol. 2003 April;14(4):337-341.
Udo EO, Baars HF, Winter JB, Wilde AA. Not just any ICD device in patients with long-QT syndrome. Neth Heart J. 2007 December;15(12):418-421.
Moss AJ, Zareba W, Schwarz KQ, Rosero S, McNitt S, Robinson JL. Ranolazine shortens repolarization in patients with sustained inward sodium current due to type-3 long-QT syndrome. J Cardiovasc Electrophysiol. 2008 December;19(12):1289-1293.
Hofman N, Wilde AA, Tan HL. Diagnostic criteria for congenital long QT syndrome in the era of molecular genetics: do we need a scoring system? Eur Heart J. 2007 June;28(11):1399.
Hendriks KS, Grosfeld FJ, van Tintelen JP, et al. Can parents adjust to the idea that their child is at risk for a sudden death?: psychological impact of risk for long QT syndrome. Am J Med Genet A. 2005 October 1;138A(2):107-112.
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Baars, H.F., van der Heijden, J.F. (2011). Congenital Long QT-Syndrome. In: Baars, H., Doevendans, P., van der Smagt, J. (eds) Clinical Cardiogenetics. Springer, London. https://doi.org/10.1007/978-1-84996-471-5_9
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