Polygenic case of long QT syndrome confirmed through functional characterization informs the interpretation of genetic screening results Malcolm Hoshi,

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Polygenic case of long QT syndrome confirmed through functional characterization informs the interpretation of genetic screening results Malcolm Hoshi, BA, Haiyan Liu, MD, Elizabeth S. Kaufman, MD, FHRS, Isabelle Deschênes, PhD HeartRhythm Case Reports Volume 1, Issue 4, Pages 201-205 (July 2015) DOI: 10.1016/j.hrcr.2015.02.011 Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 1 Biophysical properties of SCN5A-F1596I. A: Current–voltage relationship of wild type (WT; n = 7) and F1596I (n = 11). B: Steady-state activation and inactivation C: Recovery from inactivation for F1596I. D: Representative overlaid traces of a persistent current protocol for WT and SCN5A-F1596I channels. The persistent current at 500 ms is shown in the inset. E: Summary data of persistent current experiments. HeartRhythm Case Reports 2015 1, 201-205DOI: (10.1016/j.hrcr.2015.02.011) Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 2 Characterization of hERG-A913V and hERG-S654G. A–D: Representative current traces E: Plot of tail current from A913V (n = 12) vs wild type (WT; n = 12). P <.05 for voltages >20 mV. F: Plot of tail current from S654G (n = 9) vs WT (n = 11). P <.05 for voltages >20 mV. G: Plot of tail current from hERG-S654G+hERG-A913V (n = 11) vs WT (n = 12). P <.05 for voltages >0 mV. HeartRhythm Case Reports 2015 1, 201-205DOI: (10.1016/j.hrcr.2015.02.011) Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 3 In silico effect of mutations on action potential duration (APD). A: Family tree of affected long QT (LQT) lineage. QTc at screening is indicated in seconds. Shading denotes the long QT syndrome (LQTS)–diagnosed proband carrying all 3 mutations. B: Predicted effect of family mutation status on APD. C: Isolating the effect of hERG-S654G and both hERG mutations from the proband’s simulated action potential shows all but approximately 15 ms of the prolongation is attributable to hERG-S654G and hERG-A913V together. HeartRhythm Case Reports 2015 1, 201-205DOI: (10.1016/j.hrcr.2015.02.011) Copyright © 2015 Heart Rhythm Society Terms and Conditions