Possible bradycardic mode of death and successful pacemaker treatment in a large family with features of long QT syndrome type 3 and Brugada syndrome.
BACKGROUND
We recently identified a novel mutation of SCN5A (1795insD) in a large family with features of both long QT syndrome type 3 and the Brugada syndrome. The purpose of this study was to detail the clinical features and efficacy of pacemaker therapy in preventing sudden death in this family.


RESULTS
The study group consisted of 116 adult family members: 60 carriers (29 males) and 56 noncarriers (28 males) of the mutant gene. Investigations included 24-hour Holter monitoring, ergometry, and electrophysiologic studies. Mean, lowest, and highest heart rate were lower in the carriers, but heart rate variability was comparable. In carriers, disproportional QT prolongation was present during bradycardia. No complex ventricular ectopy was recorded, and there were fewer isolated premature beats (both ventricular and atrial) in carriers. All patients were asymptomatic, except for two individuals who experienced syncope; in one of these patients, asystolic episodes (up to 9 sec) were repeatedly recorded. Prolonged HV intervals were present in 5 of 6 patients. Thirty carriers received a prophylactic backup pacemaker. During median follow-up of 4.5 years (range 0.0 to 22.6), their survival rate was 100%. There were five sudden deaths among the remaining 30 carriers without a pacemaker (P = 0.019).


CONCLUSIONS
This family with a high incidence of nocturnal sudden death is characterized by bradycardia-dependent QT prolongation, intrinsic sinus node dysfunction, and generalized conduction abnormalities. There is a striking absence of complex ventricular ectopy, and pacemaker implantation was effective in preventing sudden death. These findings raise the possibility of a bradycardic rather than tachycardic mode of death.
van den Berg
M P
MP
Department of Cardiology, University Hospital Groningen, The Netherlands. m.p.van.den.berg@thorax.azg.nl
Wilde
A A
AA
Viersma TJW
Brouwer
J
J
Haaksma
J
J
van der Hout
A H
AH
Stolte-Dijkstra
I
I
Bezzina TCR
Van Langen
I M
IM
Beaufort-Krol
G C
GC
Cornel
J H
JH
Crijns
H J
HJ
D000328:Adult; D001919:Bradycardia / Q000235:genetics / Q000503:physiopathology* / Q000628:therapy*; D002037:Bundle-Branch Block / Q000235:genetics / Q000503:physiopathology* / Q000628:therapy*; D002423:Cause of Death; D003645:Death, Sudden / Q000209:etiology; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory; D004594:Electrophysiology; D005080:Exercise Test; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008133:Long QT Syndrome / Q000235:genetics / Q000503:physiopathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial