Author + information
- Received April 17, 2018
- Revision received July 5, 2018
- Accepted July 6, 2018
- Published online November 19, 2018.
- Navraj Malhi, MDa,∗,
- Petsy P. So, MDa,∗,
- Christopher C. Cheung, MDa,
- Zachary W.M. Laksman, MDa,
- Jeffrey S. Healey, MDb,
- Vijay S. Chauhan, MDc,
- Martin S. Green, MDd,
- Jean Champagne, MDe,
- Christian Steinberg, MDe,
- Shubhayan Sanatani, MDf,
- Paul Angaran, MDg,
- Henry Duff, MDh,
- Jason D. Roberts, MD, MASi,
- Laura Arbour, MDj,
- Richard Leather, MDj,
- Christopher S. Simpson, MDk,
- Rafik Tadros, MD, PhDl,
- Mario Talajic, MDl,
- Martin Gardner, MDm,
- Colette Siefer, MDn and
- Andrew D. Krahn, MDa,∗ ()
- aUniversity of British Columbia, Vancouver, British Columbia, Canada
- bPopulation Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- cUniversity Health Network, Toronto, Ontario, Canada
- dUniversity of Ottawa Heart Institute, Ottawa, Ontario, Canada
- eInstitut Universitaire de Cardiologie et Pneumologie de Québec, Quebec City, Quebec, Canada
- fBritish Columbia Children’s Hospital, Vancouver, British Columbia, Canada
- gSt. Michael’s Hospital, Toronto, Ontario, Canada
- hLibin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
- iWestern University, London, Ontario, Canada
- jRoyal Jubilee Hospital, Victoria, British Columbia, Canada
- kQueen's University, Kingston, Ontario, Canada
- lDepartment of Medicine, University of Montreal, Research Center, Montreal Heart Institute, Montreal, Quebec, Canada
- mQueen Elizabeth II Health Sciences Center, Halifax, Nova Scotia, Canada
- nSt. Boniface Hospital, Winnipeg, Manitoba, Canada
- ↵∗Address for correspondence:
Dr. Andrew Krahn, Heart Rhythm Vancouver, 211-1033 Davie Street, Vancouver, British Columbia V6E 1M7, Canada.
Objectives This study explored early repolarization (ER) pattern inheritance between survivors of unexplained cardiac arrest (UCA) and their first-degree relatives.
Background ER is considered a factor that confers an increased risk of sudden death. A monogenic explanation for ER is seldom evident after cascade screening.
Methods UCA survivors and their first-degree relatives enrolled in the CASPER (Cardiac Arrest Survivors With Preserved Ejection Fraction Registry) were included in the study. ER was defined and characterized according to accepted criteria. Logistic regression was performed to explore the association between ER status in the UCA survivor and first-degree relative groups based on the presence of an ER pattern in their related family members after adjusting for age, sex, and ethnicity.
Results A total of 289 patients from 14 Canadian sites were studied (age: 43.0 ± 15.9 years; 148 women), and 945 electrocardiograms were analyzed. Seventy-five patients had the ER pattern. There was a significantly higher prevalence of the ER pattern in UCA survivors who had first-degree relatives with the ER pattern (adjusted odds ratio: 5.79; 95% confidence intervals [CIs]: 1.79 to 18.7). There was also a nonsignificant higher prevalence of the ER pattern in first-degree relatives of UCA survivors with the ER pattern (OR: 2.43; 95% CI: 0.70 to 8.43). The highest prevalence of the ER pattern was seen in first-degree relatives of UCA survivors with ER syndrome (29%).
Conclusions The ER pattern appeared to be more common among UCA survivors and first-degree relatives whose related family members had similar changes on electrocardiography, which suggested that genetically complex factors contribute to electrocardiographic patterns that predispose to cardiac arrest.
↵∗ Drs. Malhi and So contributed equally to this work and are joint first authors.
The study was supported by the Heart and Stroke Foundation of Canada (G-13-0002775 and G-14-0005732), the Canadian Institute of Health Research (MOP-142218 and SRG-15-P09-001). The CIHR grant number is MOP-142218, Impact of Early Repolarization on Long QT Syndrome: Canadian Genetic Heart Rhythm Network. The CANet grant number is SRG-15- P09-001, the Canadian Arrhythmia Network Cascade Screening and Risk Assessment Initiative (CANet CSI).
Dr. Krahn has received support from the Heart and Stroke Foundation of Canada, the Sauder Family, and Heart and Stroke Foundation Chair in Cardiology and the Paul Brunes Chair in Heart Rhythm Disorders. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received April 17, 2018.
- Revision received July 5, 2018.
- Accepted July 6, 2018.