Test code: CA1601
The Blueprint Genetics Arrhythmia Panel is a 50-gene test for genetic diagnostics of patients with clinical diagnosis or suspicion of a hereditary ventricular arrhythmia disorder.
Hereditary vantricular arrhythmia disorders are inherited mainly in an autosomal dominant manner. In rare cases the an autosomal recessive inheritance may occur. Genetic diagnosis confirms the clinical diagnosis and arrhythmia mechanisms. Genetic diagnosis can also guide risk assessment and treatment strategies. Identifying the genetc cause enables risk assessment among asymptomatic family members. The Arrhythmia Panel includes the Long QT Syndrome Panel, the CPVT Panel, the Brugada Panel, the Short QT Panel and the ARVC Panel.
All the diseases included in the Arrhythmia Panel manifest with similar symptoms such as palpitations, pre-syncope/syncope or sudden cardiac death leaving the differential diagnostic challenges entirely to cardiology investigations. Although clinical evaluation combined to rest-, stress- and Holter-ECG, and echocardiography is considered helpful in diagnostics, they rarely offer definitive diagnosis of specific arrhythmia disease. Effective and safe arrhythmia treatments have been challenging to develop as severe arrhythmias represent a heterogeneous group of diseases with diverse cellular mechanisms. The role of molecular genetic diagnostics is increasing and can dominate the diagnostics, prognostics, and treatment of hereditary arrhythmia diseases.
Results in 3-4 weeks. We do not offer a maternal cell contamination (MCC) test at the moment. We offer prenatal testing only for cases where the maternal cell contamination studies (MCC) are done by a local genetic laboratory. Read more.
|ABCB4||Gallbladder disease, Low phospholipid-associated cholelithiasis, Cholestasis||AD/AR||16||202|
|AKAP9||Long QT syndrome||AD||4||19|
|ANK2||Cardiac arrhythmia, Long QT syndrome||AD||9||46|
|CACNA1C*||Brugada syndrome, Timothy syndrome||AD||16||54|
|CACNA2D4||Retinal cone dystrophy||AR||1||9|
|CALM1*||Ventricular tachycardia, catecholaminergic polymorphic, Recurrent cardiac arrest, infantile, Long QT syndrome||AD||5||10|
|CALM2||Long QT syndrome||AD||6||8|
|CALM3||Catecholaminergic polymorphic ventricular tachycardia||AD/AR||3|
|CASQ2||Ventricular tachycardia, catecholaminergic, polymorphic||AR||17||30|
|CAV3||Creatine phosphokinase, elevated serum, Hypertrophic cardiomyopathy (HCM), Long QT syndrome||AD/Digenic||23||47|
|CTNNA3||Arrhythmogenic right ventricular dysplasia||AD||5||39|
|DBH||Dopamine beta-hydroxylase deficiency||AR||10||26|
|DES||Dilated cardiomyopathy (DCM), Myopathy, myofibrillar||AD/AR||51||95|
|DSC2||Arrhythmogenic right ventricular dysplasia with palmoplantar keratoderma and woolly hair, Arrhythmogenic right ventricular dysplasia||AD/AR||16||66|
|DSG2||Arrhythmogenic right ventricular dysplasia, Dilated cardiomyopathy (DCM)||AD||32||102|
|DSP||Cardiomyopathy, dilated, with wooly hair, keratoderma, and tooth agenesis, Arrhythmogenic right ventricular dysplasia, familial, Cardiomyopathy, dilated, with wooly hair and keratoderma||AD/AR||101||195|
|GATA6||Heart defects, congenital, and other congenital anomalies||AD||15||68|
|GJA5||Progressive familial heart block, Atrial standstill, digenic, Atrial fibrillation||AD/Digenic||7||35|
|HCN4||Sick sinus syndrome, Brugada syndrome||AD||7||24|
|JUP||Arrhythmogenic right ventricular dysplasia, Naxos disease||AD/AR||10||28|
|KCNE1||Long QT syndrome, Jervell and Lange-Nielsen syndrome||AD/AR/Digenic||6||46|
|KCNE2||Long QT syndrome, Atrial fibrillation, familial||AD||6||23|
|KCNH2||Short QT syndrome, Long QT syndrome||AD||275||897|
|KCNJ2||Short QT syndrome, Andersen syndrome, Long QT syndrome, Atrial fibrillation||AD||34||83|
|KCNJ5||Long QT syndrome, Hyperaldosteronism, familial||AD||7||12|
|KCNQ1||Short QT syndrome, Long QT syndrome, Atrial fibrillation, Jervell and Lange-Nielsen syndrome||AD/AR/Digenic||237||590|
|LDB3||Dilated cardiomyopathy (DCM), Myopathy, myofibrillar||AD||10||11|
|LMNA||Heart-hand syndrome, Slovenian, Limb-girdle muscular dystrophy, Muscular dystrophy, congenital, LMNA-related, Lipodystrophy (Dunnigan), Emery-Dreiffus muscular dystrophy, Malouf syndrome, Dilated cardiomyopathy (DCM), Mandibuloacral dysplasia type A, Progeria Hutchinson-Gilford type||AD/AR||183||458|
|MYH6||Hypertrophic cardiomyopathy (HCM), Dilated cardiomyopathy (DCM)||AD||9||61|
|NKX2-5||Conotruncal heart malformations, Hypothyroidism, congenital nongoitrous,, Atrial septal defect||AD||41||101|
|PKP2*||Arrhythmogenic right ventricular dysplasia||AD||94||229|
|PLN||Hypertrophic cardiomyopathy (HCM), Dilated cardiomyopathy (DCM)||AD/AR||8||21|
|RYR2||Ventricular tachycardia, catecholaminergic polymorphic, Arrhythmogenic right ventricular dysplasia||AD||114||287|
|SCN1B||Atrial fibrillation, Brugada syndrome, Generalized epilepsy with febrile seizures plus||AD||11||18|
|SCN3B||Atrial fibrillation, familial, Brugada syndrome||AD||4||7|
|SCN5A||Heart block, nonprogressive, Heart block, progressive, Long QT syndrome, Ventricular fibrillation, Atrial fibrillation, Sick sinus syndrome, Brugada syndrome, Dilated cardiomyopathy (DCM)||AD/AR/Digenic||193||795|
|SCN10A||Paroxysmal extreme pain disorder, Channelopathy-associated congenital insensitivity to pain, Primary erythermalgia, Sodium channelopathy-related small fiber neuropathy, Brugada syndrome||AD/AR||2||48|
|TGFB3||Loeys-Dietz syndrome (Reinhoff syndrome), Arrhythmogenic right ventricular dysplasia||AD||8||18|
|TMEM43||Arrhythmogenic right ventricular dysplasia, Emery-Dreifuss muscular dystrophy||AD||5||15|
|TNNI3||Hypertrophic cardiomyopathy (HCM), Cardiomyopathy, restrictive, Dilated cardiomyopathy (DCM)||AD/AR||55||92|
|TNNT2||Left ventricular noncompaction, Hypertrophic cardiomyopathy (HCM), Cardiomyopathy, restrictive, Dilated cardiomyopathy (DCM)||AD||56||114|
|TRDN||Ventricular tachycardia, catecholaminergic polymorphic||AR||3||6|
|TRPM4||Progressive familial heart block||AD||4||21|
|TTN*||Hypertrophic cardiomyopathy (HCM), Dilated cardiomyopathy (DCM)||AD||437||226|
- * Some regions of the gene are duplicated in the genome leading to limited sensitivity within the regions. Thus, low-quality variants are filtered out from the duplicated regions and only high-quality variants confirmed by other methods are reported out. Read more.
Gene, refers to HGNC approved gene symbol; Inheritance to inheritance patterns such as autosomal dominant (AD), autosomal recessive (AR) and X-linked (XL); ClinVar, refers to a number of variants in the gene classified as pathogenic or likely pathogenic in ClinVar (http://www.ncbi.nlm.nih.gov/clinvar/); HGMD, refers to a number of variants with possible disease association in the gene listed in Human Gene Mutation Database (HGMD, http://www.hgmd.cf.ac.uk/ac/). The list of associated (gene specific) phenotypes are generated from CDG (http://research.nhgri.nih.gov/CGD/) or Orphanet (http://www.orpha.net/) databases.
|Gene||Genomic location HG19||HGVS||RefSeq||RS-number||Comment||Reference|
Blueprint Genetics offers a comprehensive Arrhythmia Panel that covers classical genes associated with abnormal ECG, arrhythmogenic right ventricular cardiomyopathy (ARVC), Brugada syndrome, cardiac arrest cause unspecified, cardiac arrest underlying cardiac condition, catecholaminergic polymorphic ventricular tachycardia (CPVT), long QT syndrome, short QT syndrome and syncope and collapse. The genes are carefully selected based on the existing scientific evidence, our experience and most current mutation databases. Candidate genes are excluded from this first-line diagnostic test. The test does not recognise balanced translocations or complex inversions, and it may not detect low-level mosaicism. The test should not be used for analysis of sequence repeats or for diagnosis of disorders caused by mutations in the mitochondrial DNA.
Analytical validation is a continuous process at Blueprint Genetics. Our mission is to improve the quality of the sequencing process and each modification is followed by our standardized validation process. Average sensitivity and specificity in Blueprint NGS Panels is 99.3% and 99.9% for detecting SNPs. Sensitivity to for indels vary depending on the size of the alteration: 1-10bps (96.0%), 11-20 bps (88.4%) and 21-30 bps (66.7%). The longest detected indel was 46 bps by sequence analysis. Detection limit for Del/Dup (CNV) analysis varies through the genome depending on exon size, sequencing coverage and sequence content. The sensitivity is 71.5% for single exon deletions and duplications and 99% for three exons’ deletions and duplications. We have validated the assays for different starting materials including EDTA-blood, isolated DNA (no FFPE) and saliva that all provide high-quality results. The diagnostic yield varies substantially depending on the used assay, referring healthcare professional, hospital and country. Blueprint Genetics’ Plus Analysis (Seq+Del/Dup) maximizes the chance to find molecular genetic diagnosis for your patient although Sequence Analysis or Del/Dup Analysis may be cost-effective first line test if your patient’s phenotype is suggestive for a specific mutation profile.
The sequencing data generated in our laboratory is analyzed with our proprietary data analysis and annotation pipeline, integrating state-of-the art algorithms and industry-standard software solutions. Incorporation of rigorous quality control steps throughout the workflow of the pipeline ensures the consistency, validity and accuracy of results. The highest relevance in the reported variants is achieved through elimination of false positive findings based on variability data for thousands of publicly available human reference sequences and validation against our in-house curated mutation database as well as the most current and relevant human mutation databases. Reference databases currently used are the 1000 Genomes Project (http://www.1000genomes.org), the NHLBI GO Exome Sequencing Project (ESP; http://evs.gs.washington.edu/EVS), the Exome Aggregation Consortium (ExAC; http://exac.broadinstitute.org), ClinVar database of genotype-phenotype associations (http://www.ncbi.nlm.nih.gov/clinvar) and the Human Gene Mutation Database (http://www.hgmd.cf.ac.uk). The consequence of variants in coding and splice regions are estimated using the following in silico variant prediction tools: SIFT (http://sift.jcvi.org), Polyphen (http://genetics.bwh.harvard.edu/pph2/), and Mutation Taster (http://www.mutationtaster.org).
Through our online ordering and statement reporting system, Nucleus, the customer can access specific details of the analysis of the patient. This includes coverage and quality specifications and other relevant information on the analysis. This represents our mission to build fully transparent diagnostics where the customer gains easy access to crucial details of the analysis process.
In addition to our cutting-edge patented sequencing technology and proprietary bioinformatics pipeline, we also provide the customers with the best-informed clinical report on the market. Clinical interpretation requires fundamental clinical and genetic understanding. At Blueprint Genetics our geneticists and clinicians, who together evaluate the results from the sequence analysis pipeline in the context of phenotype information provided in the requisition form, prepare the clinical statement. Our goal is to provide clinically meaningful statements that are understandable for all medical professionals, even without training in genetics.
Variants reported in the statement are always classified using the Blueprint Genetics Variant Classification Scheme modified from the ACMG guidelines (Richards et al. 2015), which has been developed by evaluating existing literature, databases and with thousands of clinical cases analyzed in our laboratory. Variant classification forms the corner stone of clinical interpretation and following patient management decisions. Our statement also includes allele frequencies in reference populations and in silico predictions. We also provide PubMed IDs to the articles or submission numbers to public databases that have been used in the interpretation of the detected variants. In our conclusion, we summarize all the existing information and provide our rationale for the classification of the variant.
A final component of the analysis is the Sanger confirmation of the variants classified as likely pathogenic or pathogenic. This does not only bring confidence to the results obtained by our NGS solution but establishes the mutation specific test for family members. Sanger sequencing is also used occasionally with other variants reported in the statement. In the case of variant of uncertain significance (VUS) we do not recommend risk stratification based on the genetic finding. Furthermore, in the case VUS we do not recommend use of genetic information in patient management or genetic counseling. For some cases Blueprint Genetics offers a special free of charge service to investigate the role of identified VUS.
We constantly follow genetic literature adapting new relevant information and findings to our diagnostics. Relevant novel discoveries can be rapidly translated and adopted into our diagnostics without delay. These processes ensure that our diagnostic panels and clinical statements remain the most up-to-date on the market.
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ICD & CPT codes
Commonly used ICD-10 codes when ordering the Arrhythmia Panel
|I49.9||Catecholaminergic polymorphic ventricular tachycardia (CPVT)|
|I46.2||Cardiac arrest underlying cardiac condition|
|I46.9||Cardiac arrest cause unspecified|
|I45.81||Long QT syndrome|
|I42.8||Arrhythmogenic right ventricular cardiomyopathy (ARVC)|
|I49.9||Short QT syndrome|
Accepted sample types
- EDTA blood, min. 1 ml
- Purified DNA, min. 5μg
- Saliva (Oragene DNA OG-500 kit)
Label the sample tube with your patient’s name, date of birth and the date of sample collection.
Note that we do not accept DNA samples isolated from formalin-fixed paraffin-embedded (FFPE) tissue.