Published Online
on January 15, 2007

A more recent version of this article appeared on January 30, 2007

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Submitted on October 4, 2006
Accepted on November 22, 2006

Loss-of-Function Mutations in the Cardiac Calcium Channel Underlie a New Clinical Entity Characterized by ST-Segment Elevation, Short QT Intervals, and Sudden Cardiac Death

Charles Antzelevitch PhD^*, Guido D. Pollevick PhD, Jonathan M. Cordeiro PhD, Oscar Casis PhD, Michael C. Sanguinetti PhD, Yoshiyasu Aizawa MD, PhD, Alejandra Guerchicoff PhD, Ryan Pfeiffer BS, Antonio Oliva MD, PhD, Bernd Wollnik MD, Philip Gelber MD, Elias P. Bonaros Jr MD, Elena Burashnikov MS, Yuesheng Wu MD, John D. Sargent PhD, Stefan Schickel MD, Ralf Oberheiden MD, Atul Bhatia MD, Li-Fern Hsu MD, Michel Haïssaguerre MD, Rainer Schimpf MD, Martin Borggrefe MD, and Christian Wolpert MD

From the Masonic Medical Research Laboratory (C.A., G.D.P., J.M.C., H.A., A.G., R.P., A.O., E.B., Y.W.), Utica, NY; Nora Eccles Harrison Cardiovascular Research and Training Institute (O.C., M.C.S., J.D.S.), University of Utah, Salt Lake City, Utah; Center for Molecular Medicine Cologne (B.W.), Institute of Human Genetics, University of Cologne, Germany; Cardiovascular Consultants of Long Island (P.G., E.P.B.), New Hyde Park, NY; Department of Internal Medicine (S.S., R.O.), Academic Hospital Oberhausen, Oberhausen, Germany; University of Wisconsin Medical School (A.B.), Milwaukee, Wis; Hopital Cardiologique du Haut-Leveque (L.-F.H., M.H.), Bordeaux, France; and 1st Department of Medicine-Cardiology (R.S., M.B., C.W.), University Hospital Mannheim, Faculty of Clinical Medicine of the University of Heidelberg, Mannheim, Germany. Dr Oliva is currently at the Catholic University in Rome, Italy.

^* To whom correspondence should be addressed. E-mail: ca{at}mmrl.edu.

Background--Cardiac ion channelopathies are responsible for an ever-increasing number and diversity of familial cardiac arrhythmia syndromes. We describe a new clinical entity that consists of an ST-segment elevation in the right precordial ECG leads, a shorter-than-normal QT interval, and a history of sudden cardiac death.

Methods and Results--Eighty-two consecutive probands with Brugada syndrome were screened for ion channel gene mutations with direct sequencing. Site-directed mutagenesis was performed, and CHO-K1 cells were cotransfected with cDNAs encoding wild-type or mutant CACNB2b (Ca_v2b), CACNA2D1 (Ca_v21), and CACNA1C tagged with enhanced yellow fluorescent protein (Ca_v1.2). Whole-cell patch-clamp studies were performed after 48 to 72 hours. Three probands displaying ST-segment elevation and corrected QT intervals 360 ms had mutations in genes encoding the cardiac L-type calcium channel. Corrected QT ranged from 330 to 370 ms among probands and clinically affected family members. Rate adaptation of QT interval was reduced. Quinidine normalized the QT interval and prevented stimulation-induced ventricular tachycardia. Genetic and heterologous expression studies revealed loss-of-function missense mutations in CACNA1C (A39V and G490R) and CACNB2 (S481L) encoding the ₁- and _2b-subunits of the L-type calcium channel. Confocal microscopy revealed a defect in trafficking of A39V Ca_v1.2 channels but normal trafficking of channels containing G490R Ca_v1.2 or S481L Ca_v2b-subunits.

Conclusions--This is the first report of loss-of-function mutations in genes encoding the cardiac L-type calcium channel to be associated with a familial sudden cardiac death syndrome in which a Brugada syndrome phenotype is combined with shorter-than-normal QT intervals.

Key words: arrhythmia • genetics • electrophysiology • tachycardia • fibrillation

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