Faculty Collaboration Database

Genotype Predicts Outcomes in Fetuses and Neonates With Severe Congenital Long QT Syndrome. JACC Clin Electrophysiol 2020 Nov;6(12):1561-1570

Date

11/21/2020

Pubmed ID

33213816

Pubmed Central ID

PMC7679474

DOI

10.1016/j.jacep.2020.06.001

Scopus ID

2-s2.0-85090485030 (requires institutional sign-in at Scopus site)   35 Citations

Abstract

OBJECTIVES: This study sought to determine the relationship between long QT syndrome (LQTS) subtype (LTQ1, LTQ2, LTQ3) and postnatal cardiac events (CEs).

BACKGROUND: LQTS presenting with 2:1 atrioventricular block or torsades de pointes in the fetus and/or neonate has been associated with risk for major CEs, but overall outcomes and predictors remain unknown.

METHODS: A retrospective study involving 25 international centers evaluated the course of fetuses/newborns diagnosed with congenital LQTS and either 2:1 atrioventricular block or torsades de pointes. The primary outcomes were age at first CE after dismissal from the newborn hospitalization and death and/or cardiac transplantation during follow-up. CE was defined as aborted cardiac arrest, appropriate shock from implantable cardioverter-defibrillator, or sudden cardiac death.

RESULTS: A total of 84 fetuses and/or neonates were identified with LQTS (12 as LQT1, 35 as LQT2, 37 as LQT3). Median gestational age at delivery was 37 weeks (interquartile range: 35 to 39 weeks) and age at hospital discharge was 3 weeks (interquartile range: 2 to 5 weeks). Fetal demise occurred in 2 and pre-discharge death in 1. Over a median of 5.2 years, there were 1 LQT1, 3 LQT2, and 23 LQT3 CEs (13 aborted cardiac arrests, 5 sudden cardiac deaths, and 9 appropriate shocks). One patient with LQT1 and 11 patients with LQT3 died or received cardiac transplant during follow-up. The only multivariate predictor of post-discharge CEs was LQT3 status (LQT3 vs. LQT2: hazard ratio: 8.4; 95% confidence interval: 2.6 to 38.9; p < 0.001), and LQT3, relative to LQT2, genotype predicted death and/or cardiac transplant (p < 0.001).

CONCLUSIONS: In this large multicenter study, fetuses and/or neonates with LQT3 but not those with LQT1 or LQT2 presenting with severe arrhythmias were at high risk of not only frequent, but lethal CEs.

Author List

Moore JP, Gallotti RG, Shannon KM, Bos JM, Sadeghi E, Strasburger JF, Wakai RT, Horigome H, Clur SA, Hill AC, Shah MJ, Behere S, Sarquella-Brugada G, Czosek R, Etheridge SP, Fischbach P, Kannankeril PJ, Motonaga K, Landstrom AP, Williams M, Patel A, Dagradi F, Tan RB, Stephenson E, Krishna MR, Miyake CY, Lee ME, Sanatani S, Balaji S, Young ML, Siddiqui S, Schwartz PJ, Shivkumar K, Ackerman MJ

Author

Janette F. Strasburger MD Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Aftercare
Electrocardiography
Fetus
Genotype
Humans
Infant, Newborn
Long QT Syndrome
Patient Discharge
Retrospective Studies