Evaluation of age at symptom onset, proband status, and sex as predictors of disease severity in pediatric catecholaminergic polymorphic ventricular tachycardia

Dania Kallas, Thomas M. Roston, Sonia Franciosi, Laura Brett, Krystien V.V. Lieve, Sit Yee Kwok, Prince J. Kannankeril, Andrew D. Krahn, Martin J. LaPage, Susan Etheridge, Allison Hill, Christopher Johnsrude, James Perry, Linda Knight, Peter Fischbach, Seshadri Balaji, Svjetlana Tisma-Dupanovic, Ian Law, Joseph Atallah, David BackhoffAnna Kamp, Peter Kubus, Adam Kean, Peter F. Aziz, Joshua Kovach, Yung Lau, Jordana Kron, Sally Ann Clur, Georgia Sarquella-Brugada, Arthur A.M. Wilde, Shubhayan Sanatani

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: Children with catecholaminergic polymorphic ventricular tachycardia (CPVT) are at risk for sudden death, and a risk stratification tool does not exist. Objective: The purpose of this study was to determine whether proband status, age at symptom onset, and/or sex are independent predictors of cardiac events. Methods: A multicenter, ambispective, cohort of pediatric CPVT patients was categorized by sex, proband status, and age at symptom onset (D1: first decade of life [symptom onset <10 years] or D2: second decade of life [symptom onset 10–18 years, inclusive]). Demographics, therapy, genetics, and outcomes were compared between groups. Results: A total of 133 patients were included and stratified into 58 D1 and 75 D2 patients (68 female and 65 male; 106 probands and 27 relatives). Localization of RYR2 variants to hotspots differed based on proband status and age at symptom onset. The cardiac event rate was 33% (n = 44/133), inclusive of a 3% (n = 4/133) mortality rate, over a median of 6 years (interquartile range 3–11) after time of symptom onset. Proband status, rather than age at of symptom onset or sex, was an independent predictor of time to first cardiac event (P =.008; hazard ratio = 4.4). The 5-, 10- and 15-year event-free survival rates for probands were 77%, 56%, and 46%, respectively, and for relatives were 96%, 91%, and 86%, respectively. Event risk after diagnosis was 48% (32/67) in patients on β-blocker or flecainide alone vs 10% (5/48) in patients on β-blocker plus flecainide and/or left cardiac sympathetic denervation (P <.001). Conclusion: Proband status, but not age at symptom onset or male sex, independently predicted an earlier onset of cardiac events. A larger sample size would enable a comprehensive investigation of other risk factors.

Original languageEnglish (US)
Pages (from-to)1825-1832
Number of pages8
JournalHeart Rhythm
Volume18
Issue number11
DOIs
StatePublished - Nov 2021

Keywords

  • Catecholaminergic polymorphic ventricular tachycardia
  • Inherited arrhythmia
  • Pediatrics
  • Risk predictors
  • Ryanodine receptor

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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