Brugada syndrome pathophysiology: Difference between revisions
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==Pathophysiology== | ==Pathophysiology== | ||
===Genetics=== | ===Genetics=== | ||
Approximately 20% of the cases of Brugada syndrome have been shown to be associated with mutation(s) in the [[gene]] that encodes for the [[sodium]] [[ion channel]] in the [[cell (biology)|cell]] [[cell membrane|membrane]]s of the muscle cells of the heart (the [[myocyte]]s). The gene, named [[SCN5A]], is located on the short arm of the third [[chromosome]] (3p21). Loss-of-function mutations in this gene lead to a loss of the action potential dome of some epicardial areas of the right ventricle. This results in transmural and epicardial dispersion of repolarization. The transmural dispersion underlies ST-segment elevation and the development of a vulnerable window across the ventricular wall, whereas the epicardial dispersion of repolarization facilitates the development of phase 2 reentry, which generates a phase 2 reentrant extrasystole that captures the vulnerable window to precipitate ventricular tachycardia and/or fibrillation that often results in sudden cardiac death. At present time however, all the reported patients died because of the disease and submitted to detailed necropsy study, have shown a structural right ventricular pathology underlying the syndrome. | |||
{| class="wikitable" | |||
| '''Type''' || '''OMIM''' || '''Mutation''' || '''Notes''' | |||
|- | |||
| B1 || {{OMIM2|601144}} || alpha subunit of the [[sodium channel]] ([[SCN5A]]) || Current through this channel is commonly referred to as I<sub>Na</sub>. Gain of this channel leads to an unopposed Ito current ([[KCND2]]) | |||
|- | |||
| B2 || {{OMIM2|611778}} || [[GPD1L]], Glycerol-3-phosphate dehydrogenase like peptide|| | |||
|- | |||
| B3 || {{OMIM2|114205}} || [[CACNA1C]] || Alpha subunit of cardiac L-type calcium channel.<ref name="pmid 17224476">{{cite journal |author= Antzelevitch C, Pollevick GD, Cordeiro JM, et al |title= Loss-of-function mutations in the cardiac calcium channel underlie a new clinical entity characterized by ST-segment elevation, short QT intervals, and sudden cardiac death |journal=Circulation |volume=115 |issue=4 |pages=442–229 |year=2007 |pmid= 17224476 |doi=10.1161/CIRCULATIONAHA.106.668392}}</ref> | |||
|- | |||
| B4 || {{OMIM2|600003}} || [[CACNB2]] || Beta-2 subunit of the voltage dependent L-type calcium channel.<ref name="pmid 17224476">{{cite journal |author= Antzelevitch C, Pollevick GD, Cordeiro JM, et al |title= Loss-of-function mutations in the cardiac calcium channel underlie a new clinical entity characterized by ST-segment elevation, short QT intervals, and sudden cardiac death |journal=Circulation |volume=115 |issue=4 |pages=442–229 |year=2007 |pmid= 17224476 |doi=10.1161/CIRCULATIONAHA.106.668392}}</ref> | |||
|- | |||
| B5 || {{OMIM2|604433}} || [[KCNE3]] which coassembles with [[KCND3]] || Beta subunit to [[KCND3]]. Modulates the Ito potassium outward current<ref>{{cite journal|doi=10.1161/CIRCEP.107.748103|title=Functional Effects of KCNE3 Mutation and Its Role in the Development of Brugada Syndrome|year=2008|author=Delpon E, Cordeiro JM, Núñez L, et al|journal=Circulation Arrhythmia and Electrophysiology |volume=1 |pages=209-18 |issue=3 |year=2008 |pmid=19122847 }}</ref> | |||
|- | |||
| B6 || {{OMIM2|600235}} || [[SCN1B]] || Beta-1 subunit of the sodium channel [[SCN5A]]<ref>{{cite journal|author=Watanabe H, Koopmann TT, Le Scouarnec S, ''et al'' |title=Sodium channel beta1 subunit mutations associated with Brugada syndrome and cardiac conduction disease in humans |journal=J. Clin. Invest. |volume=118 |issue=6 |pages=2260–8 |year=2008 |month=June |pmid=18464934 |pmc=2373423 |doi=10.1172/JCI33891 |url=}}</ref> | |||
|- | |||
|} | |||
Over 160 mutations in the SCN5A gene have been discovered to date, each having varying mechanisms and effects on function, thereby explaining the varying degrees of penetration and expression of this disorder. <ref name="pmid16972995">{{cite journal |author=Napolitano C, Priori SG |title=Brugada syndrome |journal=Orphanet journal of rare diseases |volume=1 |issue= |pages=35 |year=2006 |pmid=16972995 |doi=10.1186/1750-1172-1-35}}</ref> | |||
An example of one of the mechanisms in which a loss of function of the sodium channel occurs is a mutation in the gene that disrupts the sodium channel's ability to bind properly to [[ankyrin]]-G, an important protein mediating interaction between ion channels and cytoskeletal elements. Very recently a mutation in a second gene, [[Glycerol-3-phosphate dehydrogenase]] 1-like gene ({{Gene|GPD1L}}) has been shown to result in Brugada Syndrome in a large multigenerational family (London, 2006). This gene acts as an ion channel modulator in the heart, although the exact mechanism is not yet understood. | |||
Recently Antzelevitch has identified mutations in the [[Voltage-dependent calcium channel|L-type calcium channel]] subunits ({{Gene|CACNA1C}} (A39V and G490R) and {{Gene|CACNB2}} (S481L)) leading to ST elevation and a relatively short QT interval (below 360 msec).<ref name="pmid17556198">{{cite journal |author=Antzelevitch C |title=Genetic basis of Brugada syndrome |journal=Heart rhythm : the official journal of the Heart Rhythm Society |volume=4 |issue=6 |pages=756–7 |year=2007 |pmid=17556198 |doi=10.1016/j.hrthm.2007.03.015}}</ref> | |||
This condition is inherited in an [[autosomal dominant]] pattern and is more common in males. In addition it has a higher prevalence in most Asian populations.<ref>Brugada Syndrome. Charles Antzelevitch, PH.D. PACE 2006; 29:1130–1159</ref> <ref>Brugada P, Brugada J. Right bundle branch block, persistent ST segment elevation and sudden cardiac death: A distinct clinical and electrocardiographic syndrome: A multicenter report. J Am Coll Cardiol 1992; 20:1391–1396.</ref> <ref>Antzelevitch C, Brugada P, Brugada J, Brugada R, Shimizu W, Gussak I, Perez Riera AR. Brugada syndrome. A decade of progress. Circ Res 2002; 91:1114–1119.</ref> <ref>Wilde AA, Antzelevitch C, Borggrefe M, et al. Proposed diagnostic criteria for the Brugada syndrome: Consensus report. Eur Heart J 2002; 23:1648–1654.</ref> <ref>Wilde AA, Antzelevitch C, Borggrefe M, et al. Proposed diagnostic criteria for the Brugada syndrome: Consensus report. Circulation 2002; 106:2514–2519.</ref> <ref>Antzelevitch C, Brugada P, Borggrefe M, et al. Brugada syndrome. Report of the second consensus conference. Endorsed by the Heart Rhythm Society and the European Heart Rhythm Association. Circulation 2005; 111:659–670.</ref> <ref>Antzelevitch C, Brugada P, Borggrefe M, et al. Brugada syndrome:Report of the second consensus conference. Heart Rhythm 2005; 2:429–440.</ref> | |||
==References== | ==References== | ||
Revision as of 01:09, 31 August 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Pathophysiology
Genetics
Approximately 20% of the cases of Brugada syndrome have been shown to be associated with mutation(s) in the gene that encodes for the sodium ion channel in the cell membranes of the muscle cells of the heart (the myocytes). The gene, named SCN5A, is located on the short arm of the third chromosome (3p21). Loss-of-function mutations in this gene lead to a loss of the action potential dome of some epicardial areas of the right ventricle. This results in transmural and epicardial dispersion of repolarization. The transmural dispersion underlies ST-segment elevation and the development of a vulnerable window across the ventricular wall, whereas the epicardial dispersion of repolarization facilitates the development of phase 2 reentry, which generates a phase 2 reentrant extrasystole that captures the vulnerable window to precipitate ventricular tachycardia and/or fibrillation that often results in sudden cardiac death. At present time however, all the reported patients died because of the disease and submitted to detailed necropsy study, have shown a structural right ventricular pathology underlying the syndrome.
| Type | OMIM | Mutation | Notes |
| B1 | 601144 | alpha subunit of the sodium channel (SCN5A) | Current through this channel is commonly referred to as INa. Gain of this channel leads to an unopposed Ito current (KCND2) |
| B2 | 611778 | GPD1L, Glycerol-3-phosphate dehydrogenase like peptide | |
| B3 | 114205 | CACNA1C | Alpha subunit of cardiac L-type calcium channel.[1] |
| B4 | 600003 | CACNB2 | Beta-2 subunit of the voltage dependent L-type calcium channel.[1] |
| B5 | 604433 | KCNE3 which coassembles with KCND3 | Beta subunit to KCND3. Modulates the Ito potassium outward current[2] |
| B6 | 600235 | SCN1B | Beta-1 subunit of the sodium channel SCN5A[3] |
Over 160 mutations in the SCN5A gene have been discovered to date, each having varying mechanisms and effects on function, thereby explaining the varying degrees of penetration and expression of this disorder. [4]
An example of one of the mechanisms in which a loss of function of the sodium channel occurs is a mutation in the gene that disrupts the sodium channel's ability to bind properly to ankyrin-G, an important protein mediating interaction between ion channels and cytoskeletal elements. Very recently a mutation in a second gene, Glycerol-3-phosphate dehydrogenase 1-like gene (GPD1L) has been shown to result in Brugada Syndrome in a large multigenerational family (London, 2006). This gene acts as an ion channel modulator in the heart, although the exact mechanism is not yet understood.
Recently Antzelevitch has identified mutations in the L-type calcium channel subunits (CACNA1C (A39V and G490R) and CACNB2 (S481L)) leading to ST elevation and a relatively short QT interval (below 360 msec).[5]
This condition is inherited in an autosomal dominant pattern and is more common in males. In addition it has a higher prevalence in most Asian populations.[6] [7] [8] [9] [10] [11] [12]
References
- ↑ 1.0 1.1 Antzelevitch C, Pollevick GD, Cordeiro JM; et al. (2007). "Loss-of-function mutations in the cardiac calcium channel underlie a new clinical entity characterized by ST-segment elevation, short QT intervals, and sudden cardiac death". Circulation. 115 (4): 442–229. doi:10.1161/CIRCULATIONAHA.106.668392. PMID 17224476.
- ↑ Delpon E, Cordeiro JM, Núñez L; et al. (2008). "Functional Effects of KCNE3 Mutation and Its Role in the Development of Brugada Syndrome". Circulation Arrhythmia and Electrophysiology. 1 (3): 209–18. doi:10.1161/CIRCEP.107.748103. PMID 19122847.
- ↑ Watanabe H, Koopmann TT, Le Scouarnec S; et al. (2008). "Sodium channel beta1 subunit mutations associated with Brugada syndrome and cardiac conduction disease in humans". J. Clin. Invest. 118 (6): 2260–8. doi:10.1172/JCI33891. PMC 2373423. PMID 18464934. Unknown parameter
|month=ignored (help) - ↑ Napolitano C, Priori SG (2006). "Brugada syndrome". Orphanet journal of rare diseases. 1: 35. doi:10.1186/1750-1172-1-35. PMID 16972995.
- ↑ Antzelevitch C (2007). "Genetic basis of Brugada syndrome". Heart rhythm : the official journal of the Heart Rhythm Society. 4 (6): 756–7. doi:10.1016/j.hrthm.2007.03.015. PMID 17556198.
- ↑ Brugada Syndrome. Charles Antzelevitch, PH.D. PACE 2006; 29:1130–1159
- ↑ Brugada P, Brugada J. Right bundle branch block, persistent ST segment elevation and sudden cardiac death: A distinct clinical and electrocardiographic syndrome: A multicenter report. J Am Coll Cardiol 1992; 20:1391–1396.
- ↑ Antzelevitch C, Brugada P, Brugada J, Brugada R, Shimizu W, Gussak I, Perez Riera AR. Brugada syndrome. A decade of progress. Circ Res 2002; 91:1114–1119.
- ↑ Wilde AA, Antzelevitch C, Borggrefe M, et al. Proposed diagnostic criteria for the Brugada syndrome: Consensus report. Eur Heart J 2002; 23:1648–1654.
- ↑ Wilde AA, Antzelevitch C, Borggrefe M, et al. Proposed diagnostic criteria for the Brugada syndrome: Consensus report. Circulation 2002; 106:2514–2519.
- ↑ Antzelevitch C, Brugada P, Borggrefe M, et al. Brugada syndrome. Report of the second consensus conference. Endorsed by the Heart Rhythm Society and the European Heart Rhythm Association. Circulation 2005; 111:659–670.
- ↑ Antzelevitch C, Brugada P, Borggrefe M, et al. Brugada syndrome:Report of the second consensus conference. Heart Rhythm 2005; 2:429–440.