• David R Barrón-Díaz, Armando Totomoch-Serra, Rosa E Escobar-Cedillo, Alan García-Gutierrez, Álvaro E Reyes-Quintero, Sergio E Villegas Davirán, Concepción B Ibarra-Miramón, and Manlio F Márquez.
• Department of Electrocardiology, Instituto Nacional de Cardiología "Ignacio Chávez", Mexico City, Mexico; Social Service Program, Faculty of Medicine, Universidad Autónoma de Coahuila, Unidad Torreón, Coah., Mexico.
• Rev Invest Clin. 2020 May 7; 73 (5).

BackgroundAndersen-Tawil syndrome (ATS) is a cardiac channelopathy that is inherited in an autosomal dominant way, and it is characterized by a triad of periodic paralysis, ventricular arrhythmias, and includes some dysmorphic features with incom- plete penetrance and variable expression that result in a challenging diagnosis.ObjectiveThe objective of the study was to describe the cardiac and extra-cardiac phenotype in a cohort of patients with ATS at risk of sudden cardiac death (SCD) to improve its early clinical identification.MethodsIn an observational, transversal study, with a deviant case sampling, four female patients with ATS at high risk of SCD were included in the study. They carried the heterozygous pathogenic variants c.407C>T [p.Ser136Phe], c.652C>T [p.Arg218Trp] (n=2), and c.431G>C [p.Gly144Ala] in the KCNJ2 gene. Patients were evaluated by a cardiologist, a clinical geneticist, and a physiatrist.ResultsOne patient had the classical facial phenotype and the other three had subtle manifestations. The group of patients presented a diverse set of clinical data such as: triangular face, broad forehead, broadening of medial eyebrows, auricular pits, low-set ears, eyelid ptosis, thin lips, mandibular hypoplasia, and diverse types of dental alterations, single transverse palmar crease, camptodactyly, and syndactyly. Long-exercise test showed a decrement in the percentage amplitude up to 44%, classifying patients in IV or V types according to Fournier's scale.ConclusionsExtra- cardiac manifestations were a common finding in this series of ATS type1 at high risk of SCD. Its recognition could help the clinician in the early identification of patients with ATS, especially for the cardiologist since they are commonly referred only for evaluation of ventricular arrhythmias.

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