We describe a large Austrian family in which a novel mutation R377C (Arg377Cys) in exon 6 caused the condition. We studied 36 members of the family of whom 21 were affected. All 15 affected family members with DNA available carried the mutation. These data make this the largest CMD1A kinship so far examined at the molecular level.In addition to the cardiac phenotype 4 of 15 neurologicaly examined mutation carriers (26 %) showed recurrent myalgia and 2 (13 %) suffered from obstucive sleep apnoea syndrome. Remarkably, among the 7 patients who had undergone a pacemaker (PM) implantation, 4 experienced a stroke afterwards. No thrombembolic events were noted in patients without a PM. The high risk of stroke after PM implantation had so far not been described in CMD1A. In two patients with early onset conduction disease who had received an intrathoracal cardioverter/defibrillator (ICD), episodes of severe ventricular tachycardia (VT) were recorded and terminated within the first two years after implantation. These data suggest that for patients with lamin-cardiomyopathy who require PM implantation due to conduction disease, an ICD should be considered, even if no major episodes of VT/VF have yet been documented. For all patients with PM or ICD implants, a stringent regimen for prevention of thromboembolic events should be implemented.
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