Cor Vasa 2007, 49(11):416-425 | DOI: 10.33678/cor.2007.144
The long QT syndrome
- Interní kardiologická klinika, Fakultní nemocnice Brno, Brno, Česká republika
The long QT syndrome is characterized by QT interval prolongation and increased risk of malignant arrhythmias, which can cause syncope or even sudden death. A typical feature is absence of structural cardiac disease. The article summarizes the most recent information on the syndrome "from cell to bedside": pathophysiology at molecular and cellular levels, clinical diagnosis and the current recommended therapeutic approaches. The acquired long QT syndrome and other hereditary arrhythmic syndromes are also briefly mentioned. In conclusion, the contribution of long QT syndrome research to the issue of sudden cardiac death in the general population is emphasized.
Keywords: Gene; Ion channel; Sudden cardiac death; Long QT syndrome
Published: November 1, 2007 Show citation
References
- Jervell A, Lange-Nielsen F. Congenital deaf-mutism, functional heart disease with prolongation of QT interval and sudden death. Am Heart J 1957;54:59-68.
Go to original source...
Go to PubMed...
- Romano C, Gemme G, Pongiglione R. Aritmie rare dell'eta pediatrica. Clin Pediatr (Bologna) 1963;45:656-83.
Go to PubMed...
- Ward OC. A new familial cardiac syndrome in children. J Irish Med Assoc 1964;54:103-6.
- Yanowitz F, Preston JB, Abildskov JA. Functional distribution of right and left stellate inervation to the ventricles: production of neurogenic electrocardiographic changes by unilateral alteration of sympatethic tone. Circ Res 1966;18:416-28.
Go to original source...
Go to PubMed...
- Schwartz PJ, Periti M, Malliani A. The long Q-T syndrome. Am Heart J 1975;89:378-90.
Go to original source...
Go to PubMed...
- Keating M, Atkinson D, Dunn C, et al. Linkage of cardiac arrhythmia, the long QT syndrome, and the Harvey ras-1 gene. Science 1991;252:704-6
Go to original source...
Go to PubMed...
- Priori SG, Rivolta I, Napolitano C. Genetics of long QT, Brugada, and other channelopathies. In: Zipes DP, Jalife J (eds). Cardiac electrophysiology: from cell to bedside. 4th ed. Philadelphia: Saunders, 2004:462-70.
Go to original source...
- Ackerman MJ, Clapham DE. Excitability and Conduction. In: Chien KR (ed). Molecular basis of cardiovascular disease: a companion to Braunwald's heart disease. Philadelphia: Saunders, 2004:311-35.
Go to original source...
- Roden DM, Gerorge AL. Structure and functions of cardiac sodium and potassium channels. Am J Physiol 1997;273:H511-H525.
Go to original source...
Go to PubMed...
- Wu J, Wu J, Zipes DP. Mechanisms of initiation of ventricular tachyarrhythmias. In: Zipes DP, Jalife J (eds). Cardiac electrophysiology: from cell to bedside. 4th ed. Philadelphia: Saunders, 2004:380-9.
Go to original source...
- Schwartz PJ, Moss AJ, Vincent GM, Crampton RS. Diagnostic criteria for the long QT syndrome: an update. Circulation 1993;88:782-4.
Go to original source...
Go to PubMed...
- Priori GS, Schwartz PJ, Napolitano C, et al. Risk stratification in the long QT syndrome. New Engl J Med 2003;348:1866-74.
Go to original source...
Go to PubMed...
- Šišáková M, Vlašínová J, Vojtíšková M. Kolísání klidových hodnot QT intervalu u pacientů s mutací KCNQ1 genu. Kardiol Rev 2001;3:8-10.
- Cowan JC, Yusoff K, Moore, et al. Importance of lead selection in the QT interval measurement. Am J Cardiol 1988;61:83-7.
Go to original source...
Go to PubMed...
- Camm AJ, Malik M, Yap YG. Measurement of QT interval and repolarization assessment. In: Camm AJ, Malik M, Yap YG. Acquired Long QT Syndrome. Oxford: Blackwell Futura, 2004:24-59.
Go to original source...
- Lepeschkin E, Surawicz B. The measurement of the QT interval of the electrocardiogram. Circulation 1952;6: 378-88.
Go to original source...
Go to PubMed...
- Batchvarov VN, Ghuran A, Smetana P, et al. QT-RR relationship in healthy subjects exhibits substantial intersubject variability and intrasubject stability. Am J Physiol Heart Circ Physiol 2000;282:H2356-H2363.
Go to original source...
Go to PubMed...
- Zhang L, Timothy KW, Vincent M, et al. Spectrum of ST-T-wave pattterns and repolarizaiton parametres in congenital long-QT syndrome. ECG findings identify genotypes. Circulation 2000;102:2849-55.
Go to original source...
Go to PubMed...
- 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;24: 746-54.
Go to original source...
Go to PubMed...
- Lupoglazoff JM, Denjoy I, Berthet M, et al. Notched T waves on Holter recordings enhance detection of patients with LQT2 (HERG) mutations. Circulation 2001; 103:1095-101.
Go to original source...
Go to PubMed...
- Emori T, Antzelevitch C. Cellular basis for complex T waves and arrhythmic activity following combined IKr and IKs block. J Cardiovasc Electrophysiol 2001;12: 1369-78.
Go to original source...
Go to PubMed...
- Shimizu W, Antzelevitch C. Differential effects of beta-adrenergic agonists and antagonists in LQT1, LQT2 and LQT3 models of the long QT syndrome. J Am Coll Cardiol 2000;35:778-86.
Go to original source...
Go to PubMed...
- Shimizu W, Noda T, Takaki H, et al. Epinephrine unmasks latent mutation carriers with LQT1 form of a congenital long-QT syndrome. J Am Coll Cardiol 2003; 41:633-42.
Go to original source...
Go to PubMed...
- Vyas H, Hejlik J, Ackerman MJ. Epinephrine QT stress testing in the evaluation of congenital long-QT syndrome: diagnostic accuracy of the paradoxical QT response. Circulation 2006;113:1385-92.
Go to original source...
Go to PubMed...
- Takenaka K, Ai T, Shimizu W, et al. Exercise stress test amplifies genotype-phenotype correlation in the LQT1 and LQT2 forms of the long QT syndrome. Circulation 2003;107:838-44.
Go to original source...
Go to PubMed...
- Novotný T, Semrád B, Kadlecová J, a spol. Postavení ergometrického vyšetření v diagnostice latentního syndromu dlouhého QT intervalu. Vnitř Lék 2000;46: 843-7.
Go to PubMed...
- Novotný T, Šišáková M, Kadlecová J, et al. Occurence of notched T wave in healthy family members with the long QT interval syndrome. Am J Cardiol 2004;94:808-11.
Go to original source...
Go to PubMed...
- Wang Q, Curran ME, Splawski I, et al. Positional cloning of a novel potassium channel gene: KVLQT1 mutations cause cardiac arrhythmias. Nat Genet 1996;12:17-23.
Go to original source...
Go to PubMed...
- Barhanin J, Lesage F, Guillemare E, et al. KVLQT1 and IsK(minK) proteins associate to form the IKs cardiac potassium current. Nature 1996;384:78-80.
Go to original source...
Go to PubMed...
- Sanguinetti MC, Curran ME, Zou A, et al. Coassembly of K(V)LQT1 and minK (IsK) proteins to form cardiac I(Ks) potassium channel. Nature 1996;384:80-3.
Go to original source...
Go to PubMed...
- Schwartz PJ, Priori SG. Long QT syndrome: genotype-phenotype correlations. In: Zipes DP, Jalife J (eds). Cardiac electrophysiology: from cell to bedside. 4th ed. Philadelphia: Saunders, 2004:651-9.
Go to original source...
- Schwartz PJ, Priori SG, Spazollini C, et al. Genotype-phenotype correlations in the long QT syndrome: gene-specific triggers for life-threatening arrhythmias. Circulation 2001;103:89-95.
Go to original source...
Go to PubMed...
- Splawski I, Timothy KW, Vincent GM, et al. Molecular basis of the long-QT syndrome associated with deafness. New Engl J Med 1997;336:1562-7.
Go to original source...
Go to PubMed...
- Curran ME, Splawski, Timothy KW, et al. A molecular basis for cardiac arrhythmia: HERG mutations cause long QT syndrome. Cell 1995;80:795-803.
Go to original source...
Go to PubMed...
- Furutani M, Trudeau MC, Hagiwara N, et al. Novel mechanism associated with an iheritied arrhythmia: defective protein trafficking by the mutant HERG (G601S) potassium channel. Circulation 1999;99:2290-4.
Go to original source...
Go to PubMed...
- Wang Q, Shen J, Splawski I, et al. SCN5A mutations associated with an inherited cardiac arrhythmia, long QT syndrome. Cell 1995;80:805-11.
Go to original source...
Go to PubMed...
- Goldstein SAN, Keating MT, Sanguinetti MC. Cardiac arrhythmias: Inherited molecular mechamisms. In: Chien KR (ed). Molecular basis of cardiovascular disease: a companion to Braunwald's heart disease. Philadelphia: Saunders, 2004:311-35.
Go to original source...
- Schott JJ, Charpentier F, Peltier S, et al. Mapping of a gene for long QT syndrome to chromosome 4q25-27. Am J Hum Genet 1995;57:1114-22.
- Mohler PJ, Schott JJ, Gramolini AO, et al. Ankyrin B mutation causes type 4 long QT cardiac arrhythmia and sudden death. Nature 2003;421:634-9.
Go to original source...
Go to PubMed...
- Sherman J, Tester DJ, Ackerman MJ. Targeted mutational analysis of ankyyrin-B in 541 consecutive, unrelated patients referred for long QT syndrome genetic testing and 200 healthy subjects. Heart Rhythm 2005;2:1218-23.
Go to original source...
Go to PubMed...
- Tawil R, Ptacek LJ, Pavlakis SC, et al. Andersen's syndrome: potassium-sensitive paralysis, ventricular ectopy and dysmorphic features. Ann Neurol 1994;35: 326-30.
Go to original source...
Go to PubMed...
- Plaster NM, Tawil R, Tristani-Firouzi M, et al. Mutations in Kir2.1 cause the QT developmental and episodic electrical phenotypes of Andersen's syndrome. Cell 2001;105:511-9.
Go to original source...
Go to PubMed...
- Splawski I, Timothy KW, Decher N, et al. Severe arrhythmia disorder caused by cardiac L-type calcium channel mutation. Proc Natl Acad Sci USA 2005;102: 8089-96.
Go to original source...
Go to PubMed...
- Vatta M, Ackermann MJ, Ye B, et al. Mutant caveolin-3 induces persistent late sodium current and is associated with long-QT syndrome. Circulation 2006;114:2104-12.
Go to original source...
Go to PubMed...
- Moss AJ, Zareba W. Long QT syndrome: Therapeutic considerations. In: Zipes DP, Jalife J (eds). Cardiac electrophysiology: from cell to bedside. 4th ed. Philadelphia: Saunders, 2004:660-7.
Go to original source...
- Moss AJ, Zareba W, Hall WJ, et al. Effectiveness andlimitations of beta-blocker therapy in congenital long-QT syndrome. Circulation 2000;101:616-23.
Go to original source...
Go to PubMed...
- Zareba W, Moss AJ, Daubert JP, et al. Implantable cardioverter-defibrillator in high-risk long QT syndrome patients. J Cardiovasc Electrophysiol 2003;14:337-41.
Go to original source...
Go to PubMed...
- Dorostkar PC, Eldar A, Belhassen B, et al. Long-term follow-up of patients with long-QT syndrome treated with betablockers and continuous pacing. Circulation 1999;100:2431-6.
Go to original source...
Go to PubMed...
- Cerrone M, Spazzolini C, Priori SG, et al. Left cardiac sympathetic denervation in the manegement of the long QT syndrome. A worldwide survey. Circulation 2002; 106 (pt II):701.
- Fenichel RR, Malik M, Antzelevitch C, et al. Independent Academic Task Force. Drug-induced torsades de pointes and implications for drug development. J Cardiovasc Electrophysiol 2004;15:475-95.
Go to original source...
Go to PubMed...
- Semrád B. Proarytmie - závažná komplikace farmakoterapie. Kapitoly z kardiologie 2004;6:138-41.
- Napolitano C, Schwartz PJ, Brown AM, et al. Evidence for a cardiac ion channel mutation underlying drug-induced QT prolongation and life-threatening arrhythmias. J Cardiovasc Electrophysiol 2000;11:691-6.
Go to original source...
Go to PubMed...
- Sesti F, Abbot GW, Wei J, et al. A common polymorphism associated with antibiotic-induced cardiac arrhythmia. Proc Natl Acad Sci USA 2000;97:10613-8.
Go to original source...
Go to PubMed...
- Yang P, Kanki H, Drolet B, et al. Allelic variants in long-QT disease genes in patients with drug-associated torsade des pointes. Circulation 2002;105:1943-8.
Go to original source...
Go to PubMed...
- Novotný T, Kadlecová J, Papoušek I, a spol. Mutační analýza LQT genů u jedinců s polékovým prodloužením QT intervalu. Vnitř Lék 2006;52:57-9.
Go to PubMed...
- Evans WE, McLeod HL. Pharmacogenomics - drug disposition, drug targets and side effects. New Engl J Med 2003;348:538-49.
Go to original source...
Go to PubMed...
- Gussak I, Brugada P, Brugada J, et al. Idiopathic short QT interval: a new clinical syndrome? Cardiology 2000; 94:99-104.
Go to original source...
Go to PubMed...
- Brugada R, Hong K, Dumaine R, et al. Sudden death associated with short-QT syndrome linked to mutations in HERG. Circulation 2004;109:30-5.
Go to original source...
Go to PubMed...
- Bellocq C, van Ginneken AC, Bezzina CR, et al. Mutation in the KCNQ1 gene leading to the short QT-interval syndrome. Circulation 2004;109:2394-7.
Go to original source...
Go to PubMed...
- Priori SG, Pandit SV, Rivolta I, et al. A novel form of short QT syndrome (SQT3) is caused by a mutation in the KCNJ2 gene. Circ Res 2005;96:800-7.
Go to original source...
Go to PubMed...
- Brugada P, Brugada J. Right bundle branch block, persistent ST segment elevation and sudden cardiac death: A distinct clinical and electrocardiographic syndrome. J Am Coll Cardiol 1992;20:1391-6.
Go to original source...
Go to PubMed...
- Brugada P, Brugada R, Antzelevitch C, et al. The Brugada syndrome. In: Zipes DP, Jalife J (eds). Cardiac electrophysiology: from cell to bedside. 4th ed. Philadelphia: Saunders, 2004:625-32.
Go to original source...
- Leenhardt A, Lucet V, Denjoy I, et al. Catecholaminergic polymorphic ventricular tachycardia in children: a 7-year follow-up of 21 patients. Circulation 1995;91:1512-9.
Go to original source...
Go to PubMed...
- Priori SG, Napolitano C, Memmi M, et al. Clinical and molecular characterization of patients with catecholaminergic polymorphic ventricular tachycardia. Circulation 2002;106:69-74.
Go to original source...
Go to PubMed...
- Postma AV, Denjoy I, Hoorntje TM, et al. Absence of calsequestrin 2 causes severe forms of catecholaminergic polymorphic ventricular tachycardia. Circ Res 2002;91: e21-e26.
Go to original source...
Go to PubMed...
- Schwartz PJ, Priori SG, Napolitano C. How really rare are rare diseases? The intriguing case of independent compound mutations in the long QT syndrome. J Cardiovasc Electrophysiol 2003;14:1120-1.
Go to original source...
Go to PubMed...
- Friedlander Y, Siscovick DS, Weinmann S, et al. Family history as a risk factor for primary cardiac arrest. Circulation 1998;97:155-60.
Go to original source...
Go to PubMed...
- Jouvan X, Desnos M, Guerot C, et al. Predicting sudden death in the population: the Paris Prospective Study I. Circulation 1999;99:1978-83.
Go to original source...
Go to PubMed...
- Spooner PM, Albert C, Benjamin EJ, et al. Sudden cardiac death, genes and arrhythmogenesis. Consideration of new population and mechanistic approaches from a National Heart, Lung, and Blood Institute workshop, Part II. Circulation 2001;103:2447-52.
Go to original source...
Go to PubMed...
- Roden DM. Taking the "idio" out of "idiosyncratic". Predicting torsades des pointes. Pacing Clin Electrophysiol 1998;21:1029-34.
Go to original source...
Go to PubMed...
- Stephens JW, Humphries SE. The molecular genetics of cardiovascular disease: clinical implications. J Intern Med 2003;253:120-7.
Go to original source...
Go to PubMed...