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CLINICAL STUDIES

Sinus node function and ventricular repolarization during exercise stress test in long QT syndrome patients with KvLQT1 and HERG potassium channel defects

^a Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland

Manuscript received September 11, 1998; revised manuscript received March 25, 1999, accepted May 10, 1999.

Reprint requests and correspondence: Dr. Heikki Swan, Division of Cardiology, Department of Medicine, Helsinki University Hospital, Haartmaninkatu 4, FIN-00290 Helsinki, Finland
heikki.swan{at}helsinki.fi

OBJECTIVES

This study was performed to evaluate the QT interval and heart rate responses to exercise and recovery in gene and mutation type-specific subgroups of long QT syndrome (LQTS) patients.

BACKGROUND

Reduced heart rate and repolarization abnormalities are encountered among long QT syndrome (LQTS) patients. The most common types of LQTS are LQT1 and LQT2.

METHODS

An exercise stress test was performed in 23 patients with a pore region mutation and in 22 patients with a C-terminal end mutation of the cardiac potassium channel gene causing LQT1 type of long QT syndrome (KVLQT1 gene), as well as in 20 patients with mutations of the cardiac potassium channel gene causing LQT2 type of long QT syndrome (HERG gene) and in 33 healthy relatives. The QT intervals were measured on electrocardiograms at rest and during and after exercise. QT intervals were compared at similar heart rates, and rate adaptation of QT was studied as QT/heart rate slopes.

RESULTS

In contrast to the LQT2 patients, achieved maximum heart rate was decreased in both LQT1 patient groups, being only 76 ± 5% of predicted in patients with pore region mutation of KvLQT1. The QT/heart rate slopes were significantly steeper in LQT2 patients than in controls during exercise. During recovery, the QT/heart rate slopes were steeper in all LQTS groups than in controls, signifying that QT intervals lengthened excessively when heart rate decreased. At heart rates of 110 or 100 beats/min during recovery, all LQT1 patients and 89% of LQT2 patients had QT intervals longer than any of the controls.

CONCLUSIONS

LQT1 is associated with diminished chronotropic response and exaggerated prolongation of QT interval after exercise. LQT2 patients differ from LQT1 patients by having marked QT interval shortening and normal heart rate response to exercise. Observing QT duration during recovery enhances the clinical diagnosis of these LQTS types.

Abbreviations and Acronyms   ECG = electrocardiogram, electrocardiographic   HERG = cardiac potassium channel gene causing LQT2 type of long QT syndrome   KvLQT1 = cardiac potassium channel gene causing LQT1 type of long QT syndrome   LQTS = long QT syndrome   LQT1 = LQT1 type of long QT syndrome   LQT2 = LQT2 type of long QT syndrome   QTc = QT interval corrected with the square root formula (ms) (QT/RR1/2)

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