IRX3 variant as a modifier of Brugada syndrome with frequent ventricular fibrillation Yoshitaka Kimura, MD, Takeshi Aiba, MD, PhD, Tetsuo Sasano, MD,

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IRX3 variant as a modifier of Brugada syndrome with frequent ventricular fibrillation Yoshitaka Kimura, MD, Takeshi Aiba, MD, PhD, Tetsuo Sasano, MD, PhD, Tetsushi Furukawa, MD, PhD, Kengo Kusano, MD, PhD, Wataru Shimizu, MD, PhD HeartRhythm Case Reports Volume 2, Issue 6, Pages 465-468 (November 2016) DOI: 10.1016/j.hrcr.2016.06.002 Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 1 A: Surface electrocardiogram (ECG) of the proband in the fourth and the third intercostal spaces (ICS). ECG showed coved-type ST elevation in V1 and V2 (arrows), which was more pronounced in the third ICS than the fourth ICS. B: Monitor ECG of a spontaneous occurrence of ventricular fibrillation (VF) in the proband. Premature ventricular complexes developed immediately before the occurrence of VF. C: Family pedigree of Brugada syndrome patient with the SCN5A A735V mutation. In those with available ECG recordings, V1- and V2-lead ECGs are shown. Arrows: proband. Square: male subjects; circle: female subjects. HeartRhythm Case Reports 2016 2, 465-468DOI: (10.1016/j.hrcr.2016.06.002) Copyright © 2016 Heart Rhythm Society Terms and Conditions

Figure 2 A: DNA sequence analysis results of the proband. The arrow indicates a heterozygous variant in the IRX3 gene (Q479H). B: Homology of human IRX3 and murine Irx3. Amino acids sequence conserved between human IRX3 and mouse Irx3 was highly conserved between human IRX3 and mouse Irx3. C: Effects of transfection of HL-1 cells with Irx3 in pcDNA3.1 vector on the expression of SCN5A. The expression of SCN5A was normalized to that of Irx3. Wild-type Irx3 increased the mRNA expression of SCN5A, whereas Irx3-Q485H (human Q479H) did not increase the SCN5A mRNA expression. *P < .05 vs control. HeartRhythm Case Reports 2016 2, 465-468DOI: (10.1016/j.hrcr.2016.06.002) Copyright © 2016 Heart Rhythm Society Terms and Conditions