title: Long QT syndrome due to a novel mutation in SCN5A: treatment with ICD placement at 1 month and left cardiac sympathetic denervation at 3 months of age.
abstract: We describe the case of a newborn with congenital long QT syndrome, with 2:1 AV block and frequent episodes of Torsades de Pointes (TdP) requiring placement of a dual chamber ICD at 33 days and 3.63 kg, the youngest and smallest patient, thus far reported. Long QT syndrome was diagnosed due to bradycardia in the newborn nursery, with frequent episodes of TdP. The patient was initially treated with magnesium and esmolol then given lidocaine which resulted in dramatic transient normalization of the QTc with 1:1 AV nodal conduction. An attempt to transition to oral sodium channel and beta blockade was unsuccessful. An ICD was placed and dual chamber pacing was initiated which facilitated the transition to an oral medical regimen and ultimate discharge from the hospital. Soon after placement of the ICD, genetic testing revealed a novel F1473C mutation in the SCN5A gene. Episodes of TdP continued and left stellate gangliectomy was performed at 3 months of age. At 30 months follow-up, the patient has occasional, self-limited episodes of TdP and has received rare, successful, and appropriate ICD shocks.
authors: Department of Pediatrics, NY Presbyterian Hospital-Columbia University, New York, NY, USA.
authors: Eric S
authors: ES
authors: Silver
authors: Leonardo
authors: L
authors: Liberman
authors: Wendy K
authors: WK
authors: Chung
authors: Henry M
authors: HM
authors: Spotnitz
authors: Jonathan M
authors: JM
authors: Chen
authors: Michael J
authors: MJ
authors: Ackerman
authors: Christopher
authors: C
authors: Moir
authors: Allan J
authors: AJ
authors: Hordof
authors: Robert H
authors: RH
authors: Pass
mesh_terms: D003131:Combined Modality Therapy; D017147:Defibrillators, Implantable; D006801:Humans; D007231:Infant, Newborn; D008133:Long QT Syndrome / Q000151:congenital / Q000235:genetics* / Q000628:therapy*; D008297:Male; D009124:Muscle Proteins / Q000235:genetics*; D009154:Mutation; D062554:NAV1.5 Voltage-Gated Sodium Channel; D020641:Polymorphism, Single Nucleotide / Q000235:genetics; D015222:Sodium Channels / Q000235:genetics*; D013562:Sympathectomy; D016896:Treatment Outcome
chemical_list: D009124:Muscle Proteins; D062554:NAV1.5 Voltage-Gated Sodium Channel; C568320:SCN5A protein, human; D015222:Sodium Channels