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UKGTN Testing Criteria Test name: Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) 6 Gene Panel Approved name and symbol of disorder/condition(s): See Appendix 1 OMIM number(s): Approved name and symbol of gene(s): See Appendix 1 OMIM number(s): Patient name: Date of birth: Patient postcode: NHS number: Name of referrer: Title/Position: Lab ID: Referrals will only be accepted from one of the following: Referrer Tick if this refers to you. Consultant Clinical Geneticist Consultant Cardiologist Minimum criteria required for testing to be appropriate as stated in the Gene Dossier: Criteria Tick if this patient meets criteria TWO of : 1. RV dilatation, functional impairment, or localised RV aneurysm, in the absence of similar LV dysfunction. 2. Fibrofatty replacement of myocardium seen on biopsy 3. ECG shows prolongation of QRS focally in leads V1-V3 4. Family history of definite ARVC detected at autopsy/surgery OR ONE of above, AND ONE OR MORE OF : 4. Mild RV dilatation, impairment, or focal RV hypokinesis in presence of normal LV. 5. ECG shows inverted T waves in V2, V3, in absence of RBBB, OR shows signal-averaged late potential. 6. LBBB-type VT, OR frequent Vent.ectopics (>1000/24hrs) 7. Close F.Hist. of sudden cardiac death <35yrs, suspected as ARVD OR NONE OF 1-3, but ALL of 4-7. Additional Information: For panel tests: At risk family members where familial mutation is known do not require a full panel test but should be offered analysis of the known mutation If the sample does not fulfil the clinical criteria or you are not one of the specified types of referrer and you still feel that testing should be performed please contact the laboratory to discuss testing of the sample. Approval Date: Sept 2014 Copyright UKGTN © 2014 Appendix 1: Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) 6 Gene Panel Genes in panel test and associated conditions Rows that are highlighted in yellow show where the gene is currently being fully analysed in the context of a single separate UKGTN test HGNC standard name and symbol of the gene DSC2 HGNC number OMIM number OMIM standard name of condition and symbol Mode of inheritance OMIM number Evidence of association between gene(s) and condition HGNC:3036 *125645 Arrhythmogenic right ventricular dysplasia 11 AD 610476 PubMed: Various % of horizontal coverage of gene 100% DSG2 HGNC:3049 *125671 Arrhythmogenic right ventricular dysplasia 10 Cardiomyopathy, dilated, 1BB Arrhythmogenic right ventricular dysplasia 8 AD 610193 PubMed: Various 100% AD 610193 PubMed: Various AD 607450 PubMed: Various 100% DSP HGNC:3052 *125647 JUP HGNC:6207 *173325 Arrhythmogenic right ventricular dysplasia 12 AD 611528 PubMed: 17924338 100% PKP2 HGNC:9024 *602861 Arrhythmogenic right ventricular dysplasia 9 AD 609040 [PubMed: 15489853 100% TMEM43 HGNC:28472 *612048 Arrhythmogenic right ventricular dysplasia 5 AD 604400 PubMed: Various 100% Approval Date: Sept 2014 MLPA Comments Yes – selected exons Yes – selected exons Fully analysed in a UKGTN panel test Fully analysed in a UKGTN panel test Yes – selected exons Yes – selected exons Yes – selected exons No Fully analysed in a UKGTN panel test Not available in UKGTN Fully analysed in a UKGTN panel test Not available in UKGTN Copyright UKGTN © 2014