Abstract
The current risk stratification for long QT syndrome (LQTS) includes clinical parameters such as age, gender and QT interval, but mutation-specific information is rarely used. We investigated whether changes in ion channel characteristics (channel current, current activation rate, current deactivation rate, voltage dependence of activation and maximal conductance) caused by missense mutations linked to LQTS type 1 (LQT1) correlate with increased risk of cardiac events for carriers of the mutations. 387 LQT1 patients carrying 17 different mutations from 4 international LQTS registries were included in this study. The electrophysiological parameters were obtained from expression of mutant ion channels in Xenopus laevis oocytes. Linear regression was used to test for correlation between ion channel characteristics and clinical phenotype, and Cox proportional hazard regression was used to identify independent risk factors for cardiac events.
We found that channels with decreased rate of current activation are associated with increased risk of cardiac events (HR = 2.02) independently of clinical risk factors. In patients with moderate QT prolongation (QTc < 500 ms), slower activation remained as an independent predictor for cardiac events (HR = 2.10), whereas QTc did not. A cardiomyocyte action potential model showed the prolongation of action potential duration for channels with slower activation rates. A pseudo-transmural ECG model predicted T-wave alternans due to early after depolarizations for mutants with slower activation rates.
Our results suggest that slow channel activation impairs cardiac repolarization contributing to arrhythmogenesis. Our results highlight the importance of genotype analysis in the risk stratification of LQT1 patients and its potential use in risk stratification of genetic diseases.
