International Pediatric CPVT Registry Research

Do you have a child or teen (ages 5-18 years old) with CPVT who would like to participate in research?

The International Pediatric CPVT Registry based at the BC Children's Hospital in Vancouver has two new CPVT studies on physical activity in CPVT and ICD quality of life in CPVT.

The physical activity study aims to determine whether there is a relationship between physical activity levels and abnormal heart rhythms in young people with CPVT, and the ICD quality of life study is studying how living with an ICD might affect young people with CPVT.

To participate, can register below.
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*First Name:

*Last Name:

*Phone Number:

*Phone Type:

*Email:

*City:

*State or Province:

*Zip/Postal Code:

*Country:

Please fill out for you (if affected) or the Affected Family Member

*Do you have CPVT:

Yes

If you selected "No" please enter the name of the affected below:

Relationship to affected:

*Mutation Type - choose all that apply (hold down shift key to choose more than one):

If you selected other, please specify:

*Which study do you want to participate in? (Select all that apply):

Physical Activity in CPVT

Implantable Cardioverter Defibrillators Quality of Life in CPVT

*I give permission to share this information to the CPVT Research Coordinator at BC Childern's Hospital:

Yes

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Warning Signs
- Family history of unexpected, unexplained sudden death under age 40.
- Fainting or seizure during exercise, excitement or startle.
- Consistent or unusual chest pain &/or shortness of breath during exercise.

International Pediatric CPVT Registry Research

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Warning Signs