• Antonio Oliva, Dan Hu, Sami Viskin, Tabitha Carrier, Jonathan M Cordeiro, Hector Barajas-Martinez, Yusheng Wu, Elena Burashnikov, Ramon Brugada, Rafael Rosso, Alexandra Guerchicoff, Guido Pollevick, Vincenzo L Pascali, and Charlie Antzelevitch.
• Institute of Forensic Medicine, Catholic University, School of Medicine, Largo Francesco Vito 1, Rome, Italy. antonio.oliva@rm.unicatt.it
• Leg Med (Tokyo). 2009 Apr 1; 11 Suppl 1: S206-9.

AbstractVentricular tachycardia and fibrillation (VT/VF) complicating Brugada syndrome, a genetic disorder linked to SCN5A mutations, and VF complicating acute myocardial infarction (AMI) have both been linked to phase 2 reentry. Because of these mechanistic similarities in arrhythmogenesis, we examined the contribution of SCN5A mutations to VT/VF complicating AMI. Nineteen consecutive patients developing VF during AMI were enrolled. Wild-type (WT) and mutant SCN5A genes were co-expressed with SCN1B in TSA201 cells and studied using whole-cell patch-clamp techniques. One missense mutation (G400A) in SCN5A was detected in a conserved region among the cohort of 19 patients. A H558R polymorphism was detected on the same allele. Unlike the other 18 patients who each developed 1-2 VF episodes during acute MI, the mutation carrier developed six episodes of VT/VF within the first 12 hours. All VT/VF episodes were associated with ST segment changes and were initiated by short-coupled extrasystoles. We describe the first sodium channel mutation to be associated with the development of an arrhythmic storm during acute ischemia. These findings suggest that a loss of function in SCN5A may predispose to ischemia induced arrhythmic storm. These results could be very useful for forensic implications regarding genetic screening in relatives.

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