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Erschienen in: Herzschrittmachertherapie + Elektrophysiologie 3/2014

01.09.2014 | Schwerpunkt

Ionenkanalerkrankungen bei Kindern

verfasst von: Prof. Dr. med. Christian Wolpert, Ulli Parade, Claudia Herrera-Siklody, Christian Strotmann, Norman Rüb

Erschienen in: Herzschrittmachertherapie + Elektrophysiologie | Ausgabe 3/2014

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Zusammenfassung

Unter dem Begriff Ionenkanalerkrankung werden verschiedene Ursachen für brady- und tachykarde supraventrikuläre Arrhythmien, ventrikuläre Arrhythmien, Synkopen und den plötzlichen Herztod zusammengefasst. In der vorliegenden Arbeit soll auf die häufigsten Ursachen eingegangen werden. Hierzu gehört u. a. das Long-QT-Syndrom, Brugada-Syndrom sowie die catecholaminerge polymorphe ventrikuläre Tachykardie und das Andersen-Tawil-Syndrom. Im Prinzip werden die Erkrankungen nach ihrem EKG-Phänotyp benannt. Für die meisten dieser EKG-Phänotypen sind verschiedene Ionenkanäle bzw. genetische Mutationen, die zu einer Fehlfunktion der Ionenströme führen, identifiziert worden. Dies bedeutet z. B., dass für das Brugada-Syndrom und das Long-QT-Syndrom viele verschiedene Mutationen beschrieben wurden, die für mehrere defekte Ionenströme verantwortlich sind. Allen gemeinsam sind die Gefahren der Arrhythmieentstehung und in den meisten Fällen auch sichtbare EKG-Veränderungen, die häufig nur transient sein können. Der Zeitpunkt der Erstmanifestation ist für die verschiedenen Erkrankungen unterschiedlich und wichtig für die Initiierung der Primärdiagnostik. Ebenfalls ist die Therapie der diversen Erkrankungen nicht uniform und die Entscheidung bleibt oft individuell.
Literatur
1.
Zurück zum Zitat Ackermann MJ, Priori S, Willems S et al (2011) HRS/EHRA expert consensus statement on the state of genetic testing for the channelopathies and cardiomyopathies. Europace 13:1077–1109CrossRef Ackermann MJ, Priori S, Willems S et al (2011) HRS/EHRA expert consensus statement on the state of genetic testing for the channelopathies and cardiomyopathies. Europace 13:1077–1109CrossRef
2.
Zurück zum Zitat Antzelevitch C, Fish J (2001) Electrical heterogeneity within the ventricular wall. Basic Res Cardiol 96: 517–527PubMedCrossRef Antzelevitch C, Fish J (2001) Electrical heterogeneity within the ventricular wall. Basic Res Cardiol 96: 517–527PubMedCrossRef
3.
Zurück zum Zitat Bos JM, Bos KM, Johnson JN et al (2013) Left cardiac sympathetic denervation in long QT syndrome. Analysis of therapeutic nonresponders. Circ Arrhythm Electrophysiol 6:705–711PubMedCrossRef Bos JM, Bos KM, Johnson JN et al (2013) Left cardiac sympathetic denervation in long QT syndrome. Analysis of therapeutic nonresponders. Circ Arrhythm Electrophysiol 6:705–711PubMedCrossRef
4.
Zurück zum Zitat Brugada P, Brugada J (1992) 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 20:1391–1396PubMedCrossRef Brugada P, Brugada J (1992) 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 20:1391–1396PubMedCrossRef
5.
Zurück zum Zitat Choi G, Kopplin LJ, Tester DJ et al (2004) Spectrum and frequency of cardiac channel defects in swimming-triggered arrhythmia syndromes. Circulation 110:2119–2124PubMedCrossRef Choi G, Kopplin LJ, Tester DJ et al (2004) Spectrum and frequency of cardiac channel defects in swimming-triggered arrhythmia syndromes. Circulation 110:2119–2124PubMedCrossRef
6.
Zurück zum Zitat Chockalingam P, Clur AAB, Breur JMPJ et al. (2012) The diagnostic and therapeutic aspects of loss-of-function cardiac sodium channelopathies. Heart Rhythm 9:1986–1992PubMedCrossRef Chockalingam P, Clur AAB, Breur JMPJ et al. (2012) The diagnostic and therapeutic aspects of loss-of-function cardiac sodium channelopathies. Heart Rhythm 9:1986–1992PubMedCrossRef
7.
Zurück zum Zitat Conte G, Dewals W, Sieira J et al (2014) Drug-induced Brugada syndrome in children: clinical features, device-based management and long-term follow-up. J Am Coll Cardiol 63:2272–2279PubMedCrossRef Conte G, Dewals W, Sieira J et al (2014) Drug-induced Brugada syndrome in children: clinical features, device-based management and long-term follow-up. J Am Coll Cardiol 63:2272–2279PubMedCrossRef
8.
Zurück zum Zitat Delannoy E, Sacher F, Maury P et al (2013) Cardiac characteristics and long-term outcome in Andersen-Tawil syndrome patients related to KCNJ2 mutation. Europace 15:1805–1811PubMedCrossRef Delannoy E, Sacher F, Maury P et al (2013) Cardiac characteristics and long-term outcome in Andersen-Tawil syndrome patients related to KCNJ2 mutation. Europace 15:1805–1811PubMedCrossRef
9.
Zurück zum Zitat Di Diego JM, Cordeiro JM, Goodrow RJ et al (2002) Ionic and cellular basis for the predominance of the Brugada syndrome phenotype in males. Circulation 106:2004–2011PubMedCrossRef Di Diego JM, Cordeiro JM, Goodrow RJ et al (2002) Ionic and cellular basis for the predominance of the Brugada syndrome phenotype in males. Circulation 106:2004–2011PubMedCrossRef
10.
Zurück zum Zitat Fish JM, Antzelevitch C (2003) Cellular and ionic basis for the sex-related difference in the manifestation of the Brugada syndrome and progressive conduction disease phenotypes. J Electrocardiol 36(Suppl):173–179PubMedCrossRef Fish JM, Antzelevitch C (2003) Cellular and ionic basis for the sex-related difference in the manifestation of the Brugada syndrome and progressive conduction disease phenotypes. J Electrocardiol 36(Suppl):173–179PubMedCrossRef
11.
Zurück zum Zitat Giustetto C, Di Monte F, Wolpert C et al (2006). Short QT syndrome: clinical findings and diagnostic-therapeutic implications. Eur Heart J 27:2440–2447PubMedCrossRef Giustetto C, Di Monte F, Wolpert C et al (2006). Short QT syndrome: clinical findings and diagnostic-therapeutic implications. Eur Heart J 27:2440–2447PubMedCrossRef
12.
Zurück zum Zitat Goldenberg I, Bradley J, Moss A et al (2010) ß-Blocker efficacy in high-risk patients with the congenital Long-QT syndrome types 1 and 2: implications for patient management. J Cardiovasc Electrophysiol 21:893–901PubMedCentralPubMed Goldenberg I, Bradley J, Moss A et al (2010) ß-Blocker efficacy in high-risk patients with the congenital Long-QT syndrome types 1 and 2: implications for patient management. J Cardiovasc Electrophysiol 21:893–901PubMedCentralPubMed
13.
Zurück zum Zitat Hermida JS, Lemoine JL, Aoun FB et al (2000) Prevalence of the brugada syndrome in an apparently healthy population. Am J Cardiol 86:91–94.PubMedCrossRef Hermida JS, Lemoine JL, Aoun FB et al (2000) Prevalence of the brugada syndrome in an apparently healthy population. Am J Cardiol 86:91–94.PubMedCrossRef
14.
Zurück zum Zitat Hayashi M, Denjoy I, Extramiana F et al (2009) Incidence and risk factors of arrhythmic events in catecholaminergic polymorphic ventricular tachycardia. Circulation 119:2426–2434PubMedCrossRef Hayashi M, Denjoy I, Extramiana F et al (2009) Incidence and risk factors of arrhythmic events in catecholaminergic polymorphic ventricular tachycardia. Circulation 119:2426–2434PubMedCrossRef
15.
Zurück zum Zitat Hobbs JB, Peterson DR, Moss AJ et al (2006) Risk of aborted cardiac arrest or sudden cardiac death during adolescence in the long-QT syndrome. JAMA 296:1249–1254PubMedCrossRef Hobbs JB, Peterson DR, Moss AJ et al (2006) Risk of aborted cardiac arrest or sudden cardiac death during adolescence in the long-QT syndrome. JAMA 296:1249–1254PubMedCrossRef
16.
Zurück zum Zitat Hofmann N, Wilde AA, Tan HL (2007) Diagnostic criteria for congenital long QT syndrome in the era of molecular genetics: do we need a scoring system? Eur Heart J 28:1399CrossRef Hofmann N, Wilde AA, Tan HL (2007) Diagnostic criteria for congenital long QT syndrome in the era of molecular genetics: do we need a scoring system? Eur Heart J 28:1399CrossRef
17.
Zurück zum Zitat Kaufmann ES, McNitt S, Moss AJ et al (2008) Risk of death in the long QT syndrome when a sibling has died. Heart Rhythm 5:831–836CrossRef Kaufmann ES, McNitt S, Moss AJ et al (2008) Risk of death in the long QT syndrome when a sibling has died. Heart Rhythm 5:831–836CrossRef
18.
Zurück zum Zitat Kimura H, Zhou J, Kawamura M et al (2012) Phenotype variability in patients carrying KCNJ2 mutations. Circ Cardiovasc Genet 5:344–353PubMedCrossRef Kimura H, Zhou J, Kawamura M et al (2012) Phenotype variability in patients carrying KCNJ2 mutations. Circ Cardiovasc Genet 5:344–353PubMedCrossRef
19.
Zurück zum Zitat Leenhardt A, Lucet V, Denjoy I et al (1995) Catecholaminergic polymorphic ventricular tachycardia in children: a 7-year follow-up of 21 patients. Circulation 91:1512–1519PubMedCrossRef Leenhardt A, Lucet V, Denjoy I et al (1995) Catecholaminergic polymorphic ventricular tachycardia in children: a 7-year follow-up of 21 patients. Circulation 91:1512–1519PubMedCrossRef
20.
Zurück zum Zitat Leenhardt A, Denjoy I, Guicheney P (2012) Catecholaminergic polymorphic ventricular tachycardia. Circ Arrhythm Electrophysiol 5:1044–1052PubMedCrossRef Leenhardt A, Denjoy I, Guicheney P (2012) Catecholaminergic polymorphic ventricular tachycardia. Circ Arrhythm Electrophysiol 5:1044–1052PubMedCrossRef
21.
Zurück zum Zitat Liu JF, Jons C, Moss AJ et al (2011) Risk factors for recurrent syncope and subsequent fatal or near-fatal events in children and adolescents with Long QT syndrome. JACC 57:941–950PubMedCentralPubMedCrossRef Liu JF, Jons C, Moss AJ et al (2011) Risk factors for recurrent syncope and subsequent fatal or near-fatal events in children and adolescents with Long QT syndrome. JACC 57:941–950PubMedCentralPubMedCrossRef
22.
Zurück zum Zitat Nordkamp O, Wilde AMM, Tijssen JGP et al (2013) The ICD for primary prevention in patients with inherited cardiac diseases: Indications, use and outcome: A comparison with secondary prevention. Circ Arrhythm Electrophysiol 6:91–100CrossRef Nordkamp O, Wilde AMM, Tijssen JGP et al (2013) The ICD for primary prevention in patients with inherited cardiac diseases: Indications, use and outcome: A comparison with secondary prevention. Circ Arrhythm Electrophysiol 6:91–100CrossRef
23.
Zurück zum Zitat Postema PG, van Dessel PF, Kors JA et al (2010) Local depolarization abnormalities are the dominant pathophysiologic mechanism for type 1 electrocardiogram in brugada syndrome a study of electrocardiograms, vectorcardiograms, and body surface potential maps during ajmaline provocation. J Am Coll Cardiol 55:789–797PubMedCrossRef Postema PG, van Dessel PF, Kors JA et al (2010) Local depolarization abnormalities are the dominant pathophysiologic mechanism for type 1 electrocardiogram in brugada syndrome a study of electrocardiograms, vectorcardiograms, and body surface potential maps during ajmaline provocation. J Am Coll Cardiol 55:789–797PubMedCrossRef
24.
Zurück zum Zitat Postema PG, Wolpert C, Amin AS et al (2009) Drugs and Brugada syndrome patients: review of the literature, recommendations and an up-to-date website (www.brugadadrugs.org). Heart Rhythm 6:1335–1341PubMedCentralPubMedCrossRef Postema PG, Wolpert C, Amin AS et al (2009) Drugs and Brugada syndrome patients: review of the literature, recommendations and an up-to-date website (www.brugadadrugs.org). Heart Rhythm 6:1335–1341PubMedCentralPubMedCrossRef
25.
Zurück zum Zitat Priori SG, Napolitano C, Giordano U et al (2000) Brugada syndrome and sudden cardiac death in children. Lancet 355:808–9PubMedCrossRef Priori SG, Napolitano C, Giordano U et al (2000) Brugada syndrome and sudden cardiac death in children. Lancet 355:808–9PubMedCrossRef
26.
Zurück zum Zitat Priori SG, Wilde AA, Horie M et al (2013) Executive summary: HRS/EHRA/APHRS expert consensus statement on the diagnosis and management of patients with inherited primary arrhythmia syndrome. Europace 15:1389–1406PubMedCrossRef Priori SG, Wilde AA, Horie M et al (2013) Executive summary: HRS/EHRA/APHRS expert consensus statement on the diagnosis and management of patients with inherited primary arrhythmia syndrome. Europace 15:1389–1406PubMedCrossRef
27.
Zurück zum Zitat Priori SG, Schwartz PJ, Napolitano C et al (2003) Risk stratification in the long-QT syndrome. N Engl J Med 348:1866–1874PubMedCrossRef Priori SG, Schwartz PJ, Napolitano C et al (2003) Risk stratification in the long-QT syndrome. N Engl J Med 348:1866–1874PubMedCrossRef
28.
Zurück zum Zitat Probst V, Denjoy I, Meregalli PG et al (2014) Clinical aspects and prgnosis of Brugada syndrome in children. Circulation 115:2042–2048CrossRef Probst V, Denjoy I, Meregalli PG et al (2014) Clinical aspects and prgnosis of Brugada syndrome in children. Circulation 115:2042–2048CrossRef
29.
Zurück zum Zitat Sy RW, Gollob MH, Klein GJ et al (2011) Arrhythmia characterization and long-term outcomes in catecholaminergic polymorphic ventricular tachycardia. Heart Rhythm 8:864–871PubMedCrossRef Sy RW, Gollob MH, Klein GJ et al (2011) Arrhythmia characterization and long-term outcomes in catecholaminergic polymorphic ventricular tachycardia. Heart Rhythm 8:864–871PubMedCrossRef
30.
Zurück zum Zitat Schwartz PJ, Priori SG, Cerrone M et al (2004) Left cardiac sympathetic denervation in the management of high-risk patients affected by the long-QT syndrome. Circulation 109:1826–1833PubMedCrossRef Schwartz PJ, Priori SG, Cerrone M et al (2004) Left cardiac sympathetic denervation in the management of high-risk patients affected by the long-QT syndrome. Circulation 109:1826–1833PubMedCrossRef
31.
Zurück zum Zitat Tan HL, Hofman N, van Langen IM et al (2005) Sudden unexplained death: Heritability and diagnostic yield of cardiological and genetic examination in surviving relatives. Circulation 112:207–213PubMedCrossRef Tan HL, Hofman N, van Langen IM et al (2005) Sudden unexplained death: Heritability and diagnostic yield of cardiological and genetic examination in surviving relatives. Circulation 112:207–213PubMedCrossRef
32.
Zurück zum Zitat Tester DJ, Arya P, Will M et al (2006) Genotypic heterogeneity and phenotypic mimicry among unrelated patients referred for catecholaminergic polymorphic ventricular tachycardia genetic testing. Heart Rhythm 3:800–805PubMedCrossRef Tester DJ, Arya P, Will M et al (2006) Genotypic heterogeneity and phenotypic mimicry among unrelated patients referred for catecholaminergic polymorphic ventricular tachycardia genetic testing. Heart Rhythm 3:800–805PubMedCrossRef
33.
Zurück zum Zitat Veltmann C, Kuschyk J, Schimpf R et al (2010) Prevention of inappropriate ICD shocks in patients with Brugada syndrome. Clin Res Cardiol 99:37–44PubMedCrossRef Veltmann C, Kuschyk J, Schimpf R et al (2010) Prevention of inappropriate ICD shocks in patients with Brugada syndrome. Clin Res Cardiol 99:37–44PubMedCrossRef
34.
Zurück zum Zitat Viskin S, Wilde AA, Guevara-Valdivia ME et al (2013) Quinidine, a life-saving medication for Brugada syndrome, is inaccessibile in many countries. J Am Coll Cardiol 61:2383–2387PubMedCrossRef Viskin S, Wilde AA, Guevara-Valdivia ME et al (2013) Quinidine, a life-saving medication for Brugada syndrome, is inaccessibile in many countries. J Am Coll Cardiol 61:2383–2387PubMedCrossRef
35.
Zurück zum Zitat Watanabe H, Chopra N, Laver D et al (2009) Flecainide prevents catecholaminergic polymorphic ventricular tachycardia in mice and humans. Nature Medicine 15:380–383PubMedCentralPubMedCrossRef Watanabe H, Chopra N, Laver D et al (2009) Flecainide prevents catecholaminergic polymorphic ventricular tachycardia in mice and humans. Nature Medicine 15:380–383PubMedCentralPubMedCrossRef
36.
Zurück zum Zitat Van der Werf C, Kannankeril PJ, Sacher F et al (2011) Flecainide therapy reduces exercise-induced ventricular arrhythmias in patients with catecholaminergic polymorphic ventricular tachycardia. J Am Coll Cardiol 57:2244–2254PubMedCentralPubMedCrossRef Van der Werf C, Kannankeril PJ, Sacher F et al (2011) Flecainide therapy reduces exercise-induced ventricular arrhythmias in patients with catecholaminergic polymorphic ventricular tachycardia. J Am Coll Cardiol 57:2244–2254PubMedCentralPubMedCrossRef
37.
Zurück zum Zitat Wilde AA, Bhuiyan ZA, Crotti L et al (2008)Left cardiac sympathetic denervation for catecholaminergic polymorphic ventricular tachycardia. N Engl J Med 8:2024–2029CrossRef Wilde AA, Bhuiyan ZA, Crotti L et al (2008)Left cardiac sympathetic denervation for catecholaminergic polymorphic ventricular tachycardia. N Engl J Med 8:2024–2029CrossRef
38.
Zurück zum Zitat Wolpert C, Echternach C, Veltmann C et al (2005) Intravenous drug challenge using flecainide and ajmaline in patients with Brugada syndrome. Heart Rhythm 2:254–260PubMedCentralPubMedCrossRef Wolpert C, Echternach C, Veltmann C et al (2005) Intravenous drug challenge using flecainide and ajmaline in patients with Brugada syndrome. Heart Rhythm 2:254–260PubMedCentralPubMedCrossRef
39.
Zurück zum Zitat Wolpert C, Schimpf R, Giustetto C et al (2005) Further insights into the effect of quinidine in short QT syndrome caused by a mutation in HERG. J Cardiovasc Electrophysiol 16(1):54–58PubMedCentralPubMedCrossRef Wolpert C, Schimpf R, Giustetto C et al (2005) Further insights into the effect of quinidine in short QT syndrome caused by a mutation in HERG. J Cardiovasc Electrophysiol 16(1):54–58PubMedCentralPubMedCrossRef
40.
Zurück zum Zitat Zhang L, Timothy KW, Vincent GM et al (2000) Spectrum of ST-T-wave patterns and repolarization parameters in congenital long-QT syndrome: ECG findings identify genotypes. Circulation 102:2849–2855PubMedCrossRef Zhang L, Timothy KW, Vincent GM et al (2000) Spectrum of ST-T-wave patterns and repolarization parameters in congenital long-QT syndrome: ECG findings identify genotypes. Circulation 102:2849–2855PubMedCrossRef
Metadaten
Titel
Ionenkanalerkrankungen bei Kindern
verfasst von
Prof. Dr. med. Christian Wolpert
Ulli Parade
Claudia Herrera-Siklody
Christian Strotmann
Norman Rüb
Publikationsdatum
01.09.2014
Verlag
Springer Berlin Heidelberg
Erschienen in
Herzschrittmachertherapie + Elektrophysiologie / Ausgabe 3/2014
Print ISSN: 0938-7412
Elektronische ISSN: 1435-1544
DOI
https://doi.org/10.1007/s00399-014-0325-7

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