A multicentre study of patients with Timothy syndrome

Mark A Walsh, Christian Turner, Katherine W Timothy, Neil Seller, Dominic L Hares, Andrew F James, Jules C Hancox, Orhan Uzun, Dean Boyce, Alan G Stuart, Paul Brennan, Caroline Sarton, Karen McGuire, Ruth A Newbury-Ecob, Karen Mcleod

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Abstract

Aims: Timothy syndrome (TS) is an extremely rare multisystem disorder characterized by marked QT prolongation, syndactyly, seizures, behavioural abnormalities, immunodeficiency, and hypoglycaemia. The aim of this study was to categorize the phenotypes and examine the outcomes of patients with TS.

Methods and results: All patients diagnosed with TS in the United Kingdom over a 24-year period were reviewed. Fifteen centres in the British Congenital Arrhythmia Group network were contacted to partake in the study. Six patients with TS were identified over a 24-year period (4 boys and 2 girls). Five out of the six patients were confirmed to have a CACNA1C mutation (p.Gly406Arg) and the other patient was diagnosed clinically. Early presentation with heart block, due to QT prolongation was frequently seen. Four are still alive, two of these have a pacemaker and two have undergone defibrillator implantation. Five out of six patients have had a documented cardiac arrest with three occurring under general anaesthesia. Two patients suffered a cardiac arrest while in hospital and resuscitation was unsuccessful, despite immediate access to a defibrillator. Surviving patients seem to have mild developmental delay and learning difficulties.

Conclusion: Timothy syndrome is a rare disorder with a high attrition rate if undiagnosed. Perioperative cardiac arrests are common and not always amenable to resuscitation. Longer-term survival is possible, however, patients invariably require pacemaker or defibrillator implantation.

Original languageEnglish
Article numbereuw433
Pages (from-to)377-385
Number of pages9
JournalEP-Europace
Volume20
Issue number2
Early online date24 Mar 2017
DOIs
Publication statusPublished - 1 Feb 2018

Keywords

  • Timothy syndrome
  • Long QT
  • Paediatrics
  • Cardiac arrest
  • Defibrillator

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    Walsh, M. A., Turner, C., Timothy, K. W., Seller, N., Hares, D. L., James, A. F., Hancox, J. C., Uzun, O., Boyce, D., Stuart, A. G., Brennan, P., Sarton, C., McGuire, K., Newbury-Ecob, R. A., & Mcleod, K. (2018). A multicentre study of patients with Timothy syndrome. EP-Europace, 20(2), 377-385. [euw433]. https://doi.org/10.1093/europace/euw433