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  • LQTS is classified into subtypes LQT to LQT based

    2019-04-26

    LQTS is classified into subtypes LQT1 to LQT13 based on the site of genetic mutation. Each type possesses distinct clinical characteristics and a different prognosis. Treatment choice depends partly on individual phenotype and partly on genotype. Among Asian countries, several reports have been published on the clinical characteristics and course of LQTS patients from Japan, Korea, and China, but reports from other regions are rare [3–6].
    Materials and methods
    Results
    Discussion Multiple genes encoding these cardiac ion noradrenaline have been identified as causes of congenital LQTS, which has been historically divided into two main subtypes: Romano–Ward syndrome (autosomal dominant) and Jervell and Lange–Nielsen syndrome (autosomal recessive with neurosensory deafness) [7,9]. Both subtypes are now further subclassified based on genotype. This classification system provides an important guide for selecting proper treatment and preventive method for specific patients. Unfortunately, clinical presentation, heart rate, QTc interval, and Schwartz score cannot be used with certainty to differentiate among subtypes of LQTS [10]. Instead, ECG phenotypes have been used to predict the genotypes of LQTS based on differentiate T-wave morphology and ST-T segment. However, the application of this method is not specific to all types of LQTS [11].
    Conclusion
    Conflict of interest
    Introduction It has been reported that 30–40% of patients undergoing open heart surgery experience paroxysmal atrial fibrillation (AF) during the postoperative period [1,2]. Postoperative AF may lead to the deterioration of cardiac hemodynamics, and may increase the incidence of serious complications such as ventricular tachyarrhythmia, heart failure, and ischemic stroke [1–3]. This may result in prolonged hospitalization, increased health care costs, and worsening of the clinical course after surgery [4–6]. The prompt treatment of postoperative AF will improve prognoses and decrease health care costs for patients following cardiovascular surgery. However, most previous reports on the efficacy of medical prevention for paroxysmal AF after cardiovascular surgery have focused on the use of amiodarone [6–9], beta blockers [9,10], and sotalol [7,9,11]. Moreover, the efficacy of other anti-arrhythmic drugs for the prevention of AF recurrence remains unclear.
    Material and methods
    Results
    Discussion AF reportedly develops after cardiac surgery due to certain preoperative baseline clinical characteristics such age [1,2,16,17], male sex [2,17], cardiac valvulopathy [1,16], anamnestic AF [1,17], cardiac arrest [1,17], basic pulmonary disease [1,17], and neglecting the internal use of beta blockers [1,16]. In addition, specific perioperative events (inflammation, stress, atrial ischemia, and pulmonary venous blood removal due to surgical stress) and postoperative events (volume overload, increases in afterload, reductions in blood pressure, and electrolyte abnormalities) might be important factors inducing postoperative AF [18]. Thus, the underlying mechanisms involved in postoperative AF development are multifactorial, and are currently not fully understood. However, some other causative mechanisms have been proposed, including pericardial inflammation, myocardial ischemia, excessive production of catecholamines, autonomic imbalances during the postoperative period, and neurohumoral environments. The mechanisms of AF occurrence between postoperative AF and ordinary AF may be different. According to the ACC/AHA/ESC guidelines for the prevention of paroxysmal AF after cardiac surgery, oral beta blockers are a Class I indication and oral amiodarone or preoperative oral anti-arrhythmic drugs are a Class IIa indication [19]. On the other hand, according to the Japanese Circulation Society’s guidelines (JCS 2008), bepridil, aprindine, sotalol, and amiodarone are recommended as first-line drugs for preventing paroxysmal AF in the presence of underlying cardiac disease [20]. In Japan, the use of sotalol and amiodarone for the prevention of AF after cardiac surgery is not covered by insurance. Therefore, Locus study compared the pharmacological efficacy of bepridil and aprindine for the prevention of paroxysmal AF after cardiac surgery. Our results show that bepridil is superior to aprindine for this purpose.