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Invitae Arrhythmogenic Cardiomyopathy Panel

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  2. Invitae Arrhythmogenic Cardiomyopathy Panel
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  • Test code: 02263
  • Turnaround time:
    10–21 calendar days (14 days on average)
  • Preferred specimen:
    3mL whole blood in a purple-top tube
  • Alternate specimens:
    DNA or saliva/assisted saliva
  • Sample requirements
  • Request a sample kit
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Overview

Test description

The Invitae Arrhythmogenic Cardiomyopathy Panel provides a comprehensive analysis of the genes associated with inherited cardiomyopathy conditions that have a prominent arrhythmia phenotype or that may present with arrhythmia prior to the development of cardiomyopathy. Given the clinical overlap between different arrhythmogenic cardiomyopathy conditions, comprehensive testing enables a more efficient evaluation of multiple conditions based on a single indication for testing.

Individuals with clinical symptoms of arrhythmogenic cardiomyopathy may benefit from diagnostic genetic testing to establish or confirm diagnosis, clarify risks, or inform management. Asymptomatic individuals within a family with a known pathogenic variant may also benefit by avoiding activities and medications that can trigger symptoms.

Genes tested

Primary panel

ACTN2 DES DSC2 DSG2 DSP EMD FLNC JUP LMNA PKP2 PLN PRKAG2 RBM20 RYR2 SCN5A TMEM43 TNNI3 TNNT2 TTN

Add-on Preliminary-evidence Genes for Arrhythmogenic Cardiomyopathy

ANKRD1 CTNNA3 LDB3 PDLIM3 TGFB3

Preliminary-evidence genes currently have early evidence of a clinical association with the specific disease covered by this test. Some clinicians may wish to include genes which do not currently have a definitive clinical association, but which may prove to be clinically significant in the future. These genes can be added at no additional charge. Visit our Preliminary-evidence genes page to learn more.

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Primary panel (19 genes)

ACTN2 DES DSC2 DSG2 DSP EMD FLNC JUP LMNA PKP2 PLN PRKAG2 RBM20 RYR2 SCN5A TMEM43 TNNI3 TNNT2 TTN

Panel details and technical assay limitations
Add-on Preliminary-evidence Genes for Arrhythmogenic Cardiomyopathy (5 genes)

Preliminary-evidence genes currently have early evidence of a clinical association with the specific disease covered by this test. Some clinicians may wish to include genes which do not currently have a definitive clinical association, but which may prove to be clinically significant in the future. These genes can be added at no additional charge. Visit our Preliminary-evidence genes page to learn more.

ANKRD1 CTNNA3 LDB3 PDLIM3 TGFB3

Panel details and technical assay limitations

Alternative tests to consider

ARVC can also be ordered as part of broader panels to test for cardiomyopathy and arrhythmia disorders. Depending on the individual’s clinical and family history, one of these broader panels may be appropriate. Any of these broader panels can be ordered at no additional charge.

Clinical information

  • arrhythmogenic right ventricular cardiomyopathy (ARVC)
  • a subset of the genes associated with dilated cardiomyopathy (DCM)
  • a subset of the genes associated with hypertrophic cardiomyopathy (HCM)
  • genes on this panel are also associated with other disorders

Arrhythmogenic right ventricular cardiomyopathy (ARVC)
Arrhythmogenic right ventricular cardiomyopathy is characterized by progressive fibrofatty replacement of the myocardium. This fibrofatty replacement typically affects the right ventricle and may progressively affect the left ventricle. However, it can also present primarily in the left ventricle and resemble dilated cardiomyopathy. Ventricular tachycardia and risk of sudden cardiac arrest or death may occur with minimal or absence of cardiomyopathy.

Arrhythmia and cardiomyopathy
Arrhythmia may present with or without cardiomyopathy, a disease of the heart muscle. Some individuals who have a genetic predisposition for a primary arrhythmia condition will only develop arrhythmia. Other individuals who have a genetic predisposition for a primary arrhythmia condition develop chronic arrhythmia which can lead to cardiomyopathy. Finally, some individuals who have a genetic predisposition for a primary cardiomyopathy condition present with arrhythmia before cardiomyopathy is apparent.

Analysis of the genes on this panel is expected to identify a pathogenic variant in approximately 50% of ARVC cases, with four desmosomal genes (PKP2, DSC2, DSG2, DSP) causing the majority of these cases.

ARVC is most commonly inherited as an autosomal dominant disorder. Several studies have found compound heterozygosity or digenic inheritance in a significant proportion of individuals with ARVC.

ARVC due to Naxos disease or Carvajal syndrome is autosomal recessive. Emery-Dreifuss muscular dystrophy is an X-linked disorder.

ARVC exhibits reduced penetrance, meaning not everyone who inherits a predisposition to develop ARVC will go on to manifest symptoms. The age of onset is variable, with symptoms commonly presenting in late childhood through early adulthood. Strenuous exercise has been associated with disease progression. Naxos disease and Carvajal syndrome have higher penetrance, with most individuals developing signs and symptoms during their lifetime and often at young ages.

The prevalence of ARVC affects an estimated 1 in 2,000 to 1 in 5,000 individuals. The prevalence is increased in Italy and Greece, where it can be as high as 1 in 125 to 1 in 250.

This panel may be considered for individuals with:

  • A clinical diagnosis of ARVC meeting Task Force criteria3
  • Arrhythmia with nonspecific cardiomyopathy

  1. Ackerman MJ, et al. HRS/EHRA expert consensus statement on the state of genetic testing for the channelopathies and cardiomyopathies this document was developed as a partnership between the Heart Rhythm Society (HRS) and the European Heart Rhythm Association (EHRA). 2011 Heart Rhythm Aug; 8(8):1308-1339. PMID: 21787999
  2. Hershberger RE, et al. Genetic evaluation of cardiomyopathy--a Heart Failure Society of America practice guideline. 2009 J Card Fail. Mar; 15(2):83-97. PMID: 19254666
  3. Marcus FI, et al. Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia: proposed modification of the Task Force Criteria. 2010 Eur Heart J Apr 31(7):806-814. PMID: 20172912
  4. McNally, E, et al. Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy. 2005 Apr 18. In: Pagon, RA, et al, editors. GeneReviews (Internet). University of Washington, Seattle; Available from: http://www.ncbi.nlm.nih.gov/books/NBK1131/ PMID: 20301310
  5. NCBI GeneReviews. Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy.
  6. Pinamonti B, et al. Arrhythmogenic right ventricular cardiomyopathy: From genetics to diagnostic and therapeutic challenges. 2014 World J Cardiol. Dec 26:6(12):1234-44. PMID: 25548613
  7. Priori, SG, et al. Executive summary: HRS/EHRA/APHRS expert consensus statement on the diagnosis and management of individuals with inherited primary arrhythmia syndromes. 2013. Heart Rhythm, Dec;10(12):e85-108. PMID: 23916535
  8. Saberniak J, et al. Vigorous physical activity impairs myocardial function in patients with arrhythmogenic right ventricular cardiomyopathy and in mutation positive family members. Eur J Heart Fail. 2014 Dec; 16(12):1337-1344. PMID: 25319773
  9. Saguner AM, et al. Arrhythmogenic ventricular cardiomyopathy: A paradigm shift from right to biventricular disease. 2014 World J Cardiol. Apr 26;6(4):154-174. PMID: 24772256

For links to published management guidelines for cardiology conditions, please refer to our Management guidelines page.

Assay and technical information

Invitae is a College of American Pathologists (CAP)-accredited and Clinical Laboratory Improvement Amendments (CLIA)-certified clinical diagnostic laboratory performing full-gene sequencing and deletion/duplication analysis using next-generation sequencing technology (NGS).

Our sequence analysis covers clinically important regions of each gene, including coding exons, +/- 10 base pairs of adjacent intronic sequence, and select noncoding variants. Our assay provides a Q30 quality-adjusted mean coverage depth of 350x (50x minimum, or supplemented with additional analysis). Variants classified as pathogenic or likely pathogenic are confirmed with orthogonal methods, except individual variants that have high quality scores and previously validated in at least ten unrelated samples.

Our analysis detects most intragenic deletions and duplications at single exon resolution. However, in rare situations, single-exon copy number events may not be analyzed due to inherent sequence properties or isolated reduction in data quality. If you are requesting the detection of a specific single-exon copy number variation, please contact Client Services before placing your order.

Gene Transcript reference Sequencing analysis Deletion/Duplication analysis
ACTN2 NM_001103.3
ANKRD1* NM_014391.2
CTNNA3 NM_013266.3
DES NM_001927.3
DSC2 NM_024422.4
DSG2 NM_001943.3
DSP NM_004415.2
EMD NM_000117.2
FLNC NM_001458.4
JUP NM_002230.2
LDB3 NM_001080116.1; NM_001171610.1; NM_007078.2
LMNA NM_170707.3; NM_005572.3
PDLIM3 NM_014476.5
PKP2 NM_004572.3
PLN NM_002667.3
PRKAG2 NM_016203.3
RBM20 NM_001134363.2
RYR2 NM_001035.2
SCN5A NM_198056.2
TGFB3 NM_003239.3
TMEM43 NM_024334.2
TNNI3 NM_000363.4
TNNT2 NM_001001430.2; NM_000364.3
TTN* NM_001267550.2

ANKRD1: Deletion/duplication analysis is not offered for exons 3 or 4.
TTN: Deletion/duplication and sequencing analysis is not offered for exons 153-155 (NM_133378.4). Variants are named relative to the NM_001267550.2 (meta) transcript, but only variants in the coding sequence and intronic boundaries of the clinically relevant NM_133378.4 (N2A) isoform are reported (PMID: 25589632).

References

  1. Ackerman MJ, et al. HRS/EHRA expert consensus statement on the state of genetic testing for the channelopathies and cardiomyopathies this document was developed as a partnership between the Heart Rhythm Society (HRS) and the European Heart Rhythm Association (EHRA). 2011 Heart Rhythm Aug; 8(8):1308-1339. PMID: 21787999
  2. Hershberger RE, et al. Genetic evaluation of cardiomyopathy--a Heart Failure Society of America practice guideline. 2009 J Card Fail. Mar; 15(2):83-97. PMID: 19254666
  3. Marcus FI, et al. Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia: proposed modification of the Task Force Criteria. 2010 Eur Heart J Apr 31(7):806-814. PMID: 20172912
  4. McNally, E, et al. Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy. 2005 Apr 18. In: Pagon, RA, et al, editors. GeneReviews (Internet). University of Washington, Seattle; Available from: http://www.ncbi.nlm.nih.gov/books/NBK1131/ PMID: 20301310
  5. NCBI GeneReviews. Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy.
  6. Pinamonti B, et al. Arrhythmogenic right ventricular cardiomyopathy: From genetics to diagnostic and therapeutic challenges. 2014 World J Cardiol. Dec 26:6(12):1234-44. PMID: 25548613
  7. Priori, SG, et al. Executive summary: HRS/EHRA/APHRS expert consensus statement on the diagnosis and management of individuals with inherited primary arrhythmia syndromes. 2013. Heart Rhythm, Dec;10(12):e85-108. PMID: 23916535
  8. Saberniak J, et al. Vigorous physical activity impairs myocardial function in patients with arrhythmogenic right ventricular cardiomyopathy and in mutation positive family members. Eur J Heart Fail. 2014 Dec; 16(12):1337-1344. PMID: 25319773
  9. Saguner AM, et al. Arrhythmogenic ventricular cardiomyopathy: A paradigm shift from right to biventricular disease. 2014 World J Cardiol. Apr 26;6(4):154-174. PMID: 24772256

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