The "missing" link in atrial fibrillation heritability
JOURNAL OF ELECTROCARDIOLOGY
Authors: Parvez, Babar; Darbar, Dawood
Abstract
Atrial fibrillation (AF), the most common sustained cardiac arrhythmia, represents a major health burden to individuals and health care system within the Western world. The lifetime risk for the development of AF at age 40 years has been estimated to be approximately 1 in 4. Atrial fibrillation is associated with substantial morbidity and a 2-fold increased risk of mortality. Given its increasing prevalence with age, coupled with the aging population, the number of Americans affected with AF is expected to increase from approximately 2.3 million in the year 2000 to nearly 16 million by 2050. This AF epidemic is further complicated by the lack of highly effective therapies. One reason for the lack of effective therapies for AF stems from incomplete understanding of the complex pathophysiology of the arrhythmia. Atrial fibrillation has often been regarded as a condition that occurs in the context of atrial electrical and structural remodeling that can result from cardiac and systemic disorders. However, up to 30% of patients have no obvious cause and are said to have idiopathic or "lone" AF. Up until recently, AF was considered to be a sporadic, nongenetic disorder, but we and others have shown that lone AF has a substantial genetic basis. Mutations in genes encoding cardiac ion channels (KCNQ1, KCNE1-5, KCNJ2, KCNA5, and SCN5A), gap junctions (GJA5), and signaling molecules (atrial natriuretic peptide, nucleoporins [NUP155]) have been reported in isolated cases and small kindreds. The advent of the human genome and HapMap projects and high-throughput genotyping has fundamentally accelerated our ability to discover the genetic contribution to common variation in human disease. In 2007, a genome-wide association study identified 2 genetic variants that associated with AF. More recently, 2 additional AF loci on chromosomes 16q22 and 1q21 have been identified. It is quite likely, however, that the effects of alleles in many genes contribute to common complex diseases such as AF. The overall AF risk associated with common variants identified by the genome-wide association study approach is small (odds ratios, 1.1-2.5) and explains less than 10% of the heritability in lone AF. This raises the possibility that rare independent variants with large effects strong effects may account for a large fraction of the risk for lone AF. (C) 2011 Elsevier Inc. All rights reserved.
Very early-onset lone atrial fibrillation patients have a high prevalence of rare variants in genes previously associated with atrial fibrillation
HEART RHYTHM
Authors: Olesen, Morten S.; Andreasen, Laura; Jabbari, Javad; Refsgaard, Lena; Haunso, Stig; Olesen, Soren-Peter; Nielsen, Jonas B.; Schmitt, Nicole; Svendsen, Jesper H.
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common cardiac arrhythmia. Currently, 14 genes important for ion channel function, intercellular signaling, and homeostatic control have been associated with AF. OBJECTIVE We hypothesized that rare genetic variants in genes previously associated with AF had a higher prevalence in early onset lone AF patients than in the background population. METHODS Sequencing results of KCNQ1, KCNH2, SCN5A, KCNA5, KCND3, KCNE1, 2, 5, KCNJ2, SCN1-3B, NPPA, and GJA5 from 192 early- onset lone AF patients were compared with data from the National Heart, Lung, and Blood Institute Exome Variant Server consisting of 6503 persons from 18 different cohort studies. RESULTS Among the lone AF patients, 29 (7.6%) alleles harbored a novel or very rare variant (minor allele frequency <0.1 in the Exome Variant Server), a frequency that was significantly higher than what was found in the reference database (4.1%; with minor allele frequency <0.1; P = .0012). Previously published electrophysiological data showed that 96% (n = 23) of the rare variants that has been functionally investigated (n 24) displayed significant functional changes. CONCLUSIONS We report a much higher prevalence of rare variants in genes associated with AF in early-onset lone AF patients than in the background population. By presenting these data, we believe that we are the first to provide quantitative evidence for the role of rare variants across AF susceptibility genes as a possible pathophysiological substrate for AF.