Management of Inherited Arrhythmia Syndromes: A HiRO Consensus Handbook on Process of Care
Mikyla Janzen, Brianna Davies, Zachary Laksman, Jason D. Roberts, Shubhayan Sanatani, Christian Steinberg, Rafik Tadros, Julia Cadrin‐Tourigny, Ciorsti MacIntyre, Joseph Atallah, Anne Fournier, Martin S. Green, Robert M. Hamilton, Habib Khan, Shane Kimber, Steven M. White, Jacqueline Joza, Bhavanesh Makanjee, Erkan İlhan, David Lee, Simon Hansom, Alexios Hadjis, Laura Arbour, Richard Leather, Colette Seifer, Paul Angaran, Christopher S. Simpson, Jeff S. Healey, Martin J. Gardner, Mario Talajic, Andrew D. Krahn
Abstract
Inherited arrhythmia syndromes are rare genetic conditions that predispose seemingly healthy individuals to sudden cardiac arrest and death. The Hearts in Rhythm Organization is a multidisciplinary Canadian network of clinicians, researchers, patients, and families that aims to improve care for patients and families with inherited cardiac conditions, focused on those that confer predisposition to arrhythmia and sudden cardiac arrest and/or death. The field is rapidly evolving as research discoveries increase. A streamlined, practical guide for providers to diagnose and follow pediatric and adult patients with inherited cardiac conditions represents a useful tool to improve health system utilization, clinical management, and research related to these conditions. This review provides consensus care pathways for 7 conditions, including the 4 most common inherited cardiac conditions that confer predisposition to arrhythmia, with scenarios to guide investigation, diagnosis, risk stratification, and management. These conditions include Brugada syndrome, long QT syndrome, arrhythmogenic right ventricular cardiomyopathy and related arrhythmogenic cardiomyopathies, and catecholaminergic polymorphic ventricular tachycardia. In addition, an approach to investigating and managing sudden cardiac arrest, sudden unexpected death, and first-degree family members of affected individuals is provided. Referral to specialized cardiogenetic clinics should be considered in most cases. The intention of this review is to offer a framework for the process of care that is useful for both experts and nonexperts, and related allied disciplines such as hospital management, diagnostic services, coroners, and pathologists, in order to provide high-quality, multidisciplinary, standardized care.