Catecholaminergic Polymorphic Ventricular Tachycardia

Cardiol Rev. 2020 Nov/Dec;28(6):325-331. doi: 10.1097/CRD.0000000000000302.

Abstract

Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare congenital arrhythmogenic disorder induced by physical or emotional stress. It mainly affects children and younger adults and is characterized by rapid polymorphic and bidirectional ventricular tachycardia. Symptoms can include dizziness, palpitations, and presyncope, which may progress to syncope, hypotonia, convulsive movements, and sudden cardiac death. CPVT is the result of perturbations in Ca ion handling in the sarcoplasmic reticulum of cardiac myocytes. Mutations in the cardiac ryanodine receptor gene and the calsequestrin isoform 2 gene are most commonly seen in familial CPVT patients. Under catecholaminergic stimulation, either mutation can result in an excess Ca load during diastole resulting in delayed after depolarization and subsequent arrhythmogenesis. The current first-line treatment for CPVT is β-blocker therapy. Other therapeutic interventions that can be used in conjunction with β-blockers include moderate exercise training, flecainide, left cardiac sympathetic denervation, and implantable cardioverter-defibrillators. Several potential therapeutic interventions, including verapamil, dantrolene, JTV519, and gene therapy, are also discussed.

Publication types

  • Review

MeSH terms

  • Calsequestrin / genetics*
  • Disease Management
  • Humans
  • Mutation
  • Ryanodine Receptor Calcium Release Channel / genetics*
  • Tachycardia, Ventricular* / genetics
  • Tachycardia, Ventricular* / physiopathology
  • Tachycardia, Ventricular* / therapy

Substances

  • CASQ2 protein, human
  • Calsequestrin
  • RyR2 protein, human
  • Ryanodine Receptor Calcium Release Channel

Supplementary concepts

  • Polymorphic catecholergic ventricular tachycardia