Indian Pacing and Electrophysiology Journal

Sergio Dubner, Edgardo Schapachnik, and Andrés Ricardo Pérez Riera, Presidents of the Scientific and Steering Committees.

From: the Presidents of the Scientific and Steering Committees of the First International Symposium on Long QT Syndrome through the Internet, April 2004.
To: the "Event Recorder" Section in IPEJ

            With the First Virtual Symposium on Long QT Syndrome already finished; which was held over the month of April, 2004 as an educational activity of the International Society for Holter and Noninvasive Electrocardiology (ISHNE), and completely through the Internet; we, the Presidents of the Scientific and Steering Committees, Sergio Dubner, Edgardo Schapachnik and Andrés Ricardo Pérez Riera, are wondering gladly surprised, which may have been the main causes of such a huge success as we have reached, and the enormous interest arisen. Just to have an idea of the dimension achieved, data obtained from http://www.a9.com (an Amazon.com site) or with the traditional search engine Google, prove that the first reply when you request information about long QT Syndrome is the access site of the Symposium. We believe that the response to this question may be summarized in one word: REALIZATION. The best definition for success is realization. The huge motivation in each one of us made the difference. We worked with a cohesive group, like a team, aware of the unparalleled and great opportunity Prof. Arthur Moss had initially assigned to Sergio Dubner and Edgardo Schapachnik, an invitation that the latter extended to Andrés Ricardo Pérez Riera.
            As we see it, the huge repercussion achieved was due to multiple factors:
1) The participation and lead by distinguished Prof. Moss; one of the world pillars/icons in the study of this syndrome;
2) The participation of the most relevant Faculties and scientists on the topic;
3) The bilingual and at times trilingual aspect, which enhanced the range to the numerous world of the Hispanic/Portuguese languages;
4) The fantastic backstage work of the "anonymous" members of the Akros Group,
5) The successful previous experience of the First Virtual Symposium about Brugada Syndrome, on the occasion of the 10th anniversary of its discovery, which encouraged Prof. Moss to check the positive conclusions by Prof. Charles Antzelevitch, one of the most distinguished scientists in the world;
6) The sponsorship and economic support by St. Jude Medical, which democratized the event, enabling free of charge access;
7) And ourselves, who gave the best of each of us.
            In the opening, we had already prophesized that the clever choice of Prof. Moss, our dear Honorary President, the most important Faculties in the world, and the great figures that made and make history in the advancement of the knowledge of the syndrome, would guarantee a greatly successful Symposium. During the event, due to the magic of the Internet –a tool that democratized knowledge and consequently, power- we managed to develop in depth and didactically through presentations, radio interviews and discussions, the knowledge of the main topics in connection to the syndrome, from the concept itself to the different types, relevant historical aspects, prevalence, genetic types, presentation of a new mutation not described before, symptomatology, ECG diagnostic criteria, clinical and family history, risk factors, analysis of the longitudinal international study of families, influence of gender, race and age group, characteristics of ECG in different genotypes, determination of normal borderline values of QT and QTc, JT and JTc, the current value for the use of the Bazett's formula, Q-aTc interval or Q-T peak interval (QTpc), T end (Tpec), QT interval dispersion, microvolt T wave alternans, and RR variability.
            The different presentation forms were analyzed, according to the different genotypes in all the age groups, included those before birth, in infants, children, teenagers and adults. We discussed risk stratification in different circumstances, as in the absence of genotypic information, particularly QT interval duration and when this information exists, and the bases were set for the definition of high-risk patients.
            We studied the different aspects of influences in pregnancy, analysis of the main triggers, such as slow heart rates, short-long sequences; also characterization of T wave alternans and differential diagnosis for torsades de pointes, the role of M cells as determinants for ventricular thickness heterogeneity, the different aspects of the U wave as its controversial genesis and its interference in QT interval measurement, the possible alterations in atrial action potential as determinants of the tendency to different supraventricular arrhythmias. The links were analyzed to other allelic entities, such as Brugada syndrome, congenital short QT syndrome and other syndromes responsible for long QT interval, such as Rett's, Bartter's/Gitelman's and the last variant identified, known as Andersen's syndrome, considered to be LQT7.
            The different therapeutic approaches were discussed, both for congenital and acquired forms, in their pharmacological aspects, with beta-blockers, mexiletine, flecainide and left stellate ganglionectomy, current indications for pacemakers and use of the "pacing algorithm-rate smoothing" to prevent pause-dependent torsade de pointes. It was highlighted that the new pacemaker models with double chamber and the new ICD models have pacemaking functions included. Furthermore, topics about the future were approached, regarding a possible genetic manipulation.
            Several clinical cases were studied and presented, and the most appropriate therapeutic strategies were discussed.
            We are honored and moved to know that Prof. Moss is planning to publish the main questions and replies in the Annals of Noninvasive Electrocardiology, the official Journal of the ISHNE.

Thank you very much to all of you.

Sergio Dubner, Edgardo Schapachnik, and Andrés Ricardo Pérez Riera, Presidents of the Scientific and Steering Committees.