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J Am Coll Cardiol. 2013 Jul 16;62(3):169-180. doi: 10.1016/j.jacc.2013.04.044. Epub 2013 May 15.

Impact of genetics on the clinical management of channelopathies.

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Department of Molecular Medicine, University of Pavia, Pavia, Italy; Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Cardiovascular Genetics Laboratory, Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa; Department of Medicine, University of Stellenbosch, Stellenbosch, South Africa; Chair of Sudden Death, Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia. Electronic address:
Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota; Department of Pediatrics, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota; Department of Molecular Pharmacology & Experimental Therapeutics, Windland Smith Rice Sudden Death Genomics Laboratory, Mayo Clinic, Rochester, Minnesota.
Division of Genetic Medicine, Department of Medicine, Vanderbilt University, Nashville, Tennessee; Institute for Integrative Genomics, Vanderbilt University, Nashville, Tennessee.
Department of Cardiology, Heart Failure Research Centre, Academic Medical Centre, Amsterdam, the Netherlands; Princess Al Jawhara Albrahim Centre of Excellence in Research of Hereditary Disorders, King Abdulaziz University, Jeddah, Saudi Arabia.


There are few areas in cardiology in which the impact of genetics and genetic testing on clinical management has been as great as in cardiac channelopathies, arrhythmic disorders of genetic origin related to the ionic control of the cardiac action potential. Among the growing number of diseases identified as channelopathies, 3 are sufficiently prevalent to represent significant clinical and societal problems and to warrant adequate understanding by practicing cardiologists: long QT syndrome, catecholaminergic polymorphic ventricular tachycardia, and Brugada syndrome. This review will focus selectively on the impact of genetic discoveries on clinical management of these 3 diseases. For each disorder, we will discuss to what extent genetic knowledge and clinical genetic test results modify the way cardiologists should approach and manage affected patients. We will also address the optimal use of genetic testing, including its potential limitations and the potential medico-legal implications when such testing is not performed. We will highlight how important it is to understand the ways that genotype can affect clinical manifestations, risk stratification, and responses to the therapy. We will also illustrate the close bridge between molecular biology and clinical medicine, and will emphasize that consideration of the genetic basis for these heritable arrhythmia syndromes and the proper use and interpretation of clinical genetic testing should remain the standard of care.

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