scholarly journals Familial dilated cardiomyopathy caused by a novel variant in the Lamin A/C gene: a case report

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Jing Huang ◽  
Qing Wan ◽  
Yu Zou ◽  
Lijie Wang ◽  
Yesheng Pan

Abstract Background Familial dilated cardiomyopathy (FDCM) is most commonly inherited as an autosomal dominant trait. The Lamin A/C (LMNA) gene variants have been identified to be associated with DCM, conductive system disorders, type 2 Emery-Dreifuss muscular dystrophy and several other disorders. Here, we reported a novel variant in the LMNA gene that might be related to FDCM. Case presentation A 30-year-old young man was hospitalized for chest tightness, extreme fatigue, palpitation and impaired activity tolerance. He had clinical characteristics including cardiac dilatation, atrial tachyarrhythmia, severe conductive system disorders, and dyskinesia of both upper limbs and the neck. Genetic sequence analysis indicated that the patient carried a novel c.1325 T>C heterozygous LMNA gene variant. Catheter ablation and cardiac resynchronization therapy with pacing function (CRT-P) were performed to treat the arrhythmia. Conclusion The variant c.1325 T>C is a novel variant in the LMNA gene that has not been previously reported. Young patients with DCM, conductive system disorders and skeletal myopathy should be alert to the possibility of LMNA gene variant. Cardiac resynchronization therapy (CRT) may be a reasonable choice for patient carrying a LMNA gene variant with third-degree atrioventricular block even if the left ventricular ejection fraction is preserved in order to prevent the deterioration of cardiac function caused by right ventricular pacing dependency.

2021 ◽  
Vol 5 (8) ◽  
Author(s):  
Dmytro Volkov ◽  
Dmytro Lopin ◽  
Stanislav Rybchynskyi ◽  
Dmytro Skoryi

Abstract Background  Cardiac resynchronization therapy (CRT) is an option for treatment for chronic heart failure (HF) associated with left bundle branch block (LBBB). Patients with HF and right bundle branch block (RBBB) have potentially worse outcomes in comparison to LBBB. Traditional CRT in RBBB can increase mortality and HF deterioration rates over native disease progression. His bundle pacing may improve the results of CRT in those patients. Furthermore, atrioventricular node ablation (AVNA) for rate control in atrial fibrillation (AF) can be challenging in patients with previously implanted leads in His region. Case summary  We report the case of 74-year-old gentleman with a 5-year history of HF, permanent AF with a rapid ventricular response, and RBBB. He was admitted to the hospital with complaints of severe weakness and shortness of breath. Left ventricular ejection fraction (LVEF) was decreased (41%), right ventricle (RV) was dilated (41 mm), and QRS was prolonged (200 ms) with RBBB morphology. The patient underwent His-optimized CRT with further left-sided AVNA. As a result, LVEF increased to 51%, RV dimensions decreased to 35 mm with an improvement of the clinical status during a 6-month follow-up. Discussion  Patients with AF, RBBB, and HF represent the least evaluated clinical subgroup of individuals with less beneficial clinical outcomes according to CRT studies. Achieving the most effective resynchronization could require pacing fusion from sites beyond traditional with the intention to recruit intrinsic conduction pathways. This approach can be favourable for reducing RV dilatation, improving LVEF, and maximizing electrical resynchronization.


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