Genotype Predicts Outcomes in Fetuses and Neonates With Severe Congenital Long QT Syndrome

Jeremy P. Moore, Roberto G. Gallotti, Kevin M. Shannon, J. Martijn Bos, Elham Sadeghi, Janette F. Strasburger, Ronald T. Wakai, Hitoshi Horigome, Sally Ann Clur, Allison C. Hill, Maully J. Shah, Shashank Behere, Georgia Sarquella-Brugada, Richard Czosek, Susan P. Etheridge, Peter Fischbach, Prince J. Kannankeril, Kara Motonaga, Andrew P. Landstrom, Matthew WilliamsAkash Patel, Federica Dagradi, Reina B. Tan, Elizabeth Stephenson, Mani Ram Krishna, Christina Y. Miyake, Michelle E. Lee, Shubhayan Sanatani, Seshadri Balaji, Ming Lon Young, Saad Siddiqui, Peter J. Schwartz, Kalyanam Shivkumar, Michael J. Ackerman

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
JournalJACC: Clinical Electrophysiology
DOIs
Publication statusAccepted/In press - 2020

Keywords

  • atrioventricular block
  • cardiac sympathetic denervation
  • fetal arrhythmia
  • fetus
  • genetic testing
  • implantable cardioverter-defibrillator
  • long QT syndrome
  • magnetocardiography
  • sudden cardiac death
  • torsades de pointes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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