Division of Cardiology, Department of Medicine University of Illinois Chicago Chicago IL.
Jesse Brown Veterans Administration Medical Center Chicago IL.
J Am Heart Assoc. 2024 May 21;13(10):e032320. doi: 10.1161/JAHA.123.032320. Epub 2024 May 10.
Genetic and familial contributions to early-onset atrial fibrillation are described primarily in individuals of European ancestry. However, the role of racial and familial contributions in the pathogenesis of early-onset atrial flutter (EOAFL) is unclear.
In this cross-sectional study, participants were enrolled prospectively from 2015 to 2021 in multiple academic centers with a diagnosis of atrial flutter (AFL) confirmed by ECG. EOAFL was defined as a diagnosis of AFL before age 66 years with no concomitant or previous diagnosis of atrial tachyarrhythmias. Family history was adjudicated through baseline questionnaires and direct family interviews about the diagnosis of atrial tachyarrhythmias, stroke, and cardiomyopathy. The primary exposure was a positive family history in first-degree relatives, and the primary outcome was the odds of EOAFL versus late-onset AFL. A total of 909 patients were enrolled. Participants with a positive family history of atrial tachyarrhythmias were younger, less likely to be of Black race, and more likely to have EOAFL. The adjusted odds ratio (OR) for EOAFL in those with a positive family history was 1.8 (95% CI, 1.1-3.0). There was an increased odds of EOAFL in those of Black race (OR, 2.1 [95% CI, 1.4-3.2]), alcohol use (OR, 1.6 [95% CI, 1.0-2.6]), and obstructive sleep apnea (OR, 1.9 [95% CI, 1.0-3.4]). Use of cardioselective β blockers or calcium channel blockers before the diagnosis of AFL were associated with a lower odds of EOAFL (OR, 0.5 [95% CI, 0.2-0.9]).
These findings suggest a potentially hereditary predisposition to EOAFL across race and ethnicity, warranting further study of the genetic contributions to AFL.
早发性心房颤动的遗传和家族因素主要在欧洲血统个体中描述。然而，种族和家族因素在早发性心房扑动（EOAFL）发病机制中的作用尚不清楚。
在这项横断面研究中，参与者于 2015 年至 2021 年期间在多个学术中心前瞻性入组，通过心电图确诊为心房扑动（AFL）。EOAFL 的定义为 66 岁之前诊断为 AFL，且无合并或先前诊断的房性心动过速。家族史通过基线问卷和直接对家族成员关于房性心动过速、中风和心肌病的诊断进行家庭访谈进行裁定。主要暴露是一级亲属中有阳性家族史，主要结局是 EOAFL 与晚发性 AFL 的比值比（OR）。共纳入 909 例患者。有阳性房性心动过速家族史的患者年龄较小，黑人种族的可能性较低，且更有可能患有 EOAFL。阳性家族史患者 EOAFL 的调整 OR 为 1.8（95%CI，1.1-3.0）。黑人种族（OR，2.1[95%CI，1.4-3.2]）、饮酒（OR，1.6[95%CI，1.0-2.6]）和阻塞性睡眠呼吸暂停（OR，1.9[95%CI，1.0-3.4]）的 EOAFL 可能性增加。在 AFL 诊断前使用心脏选择性β受体阻滞剂或钙通道阻滞剂与 EOAFL 的可能性降低相关（OR，0.5[95%CI，0.2-0.9]）。
这些发现表明 EOAFL 存在跨种族和民族的潜在遗传易感性，需要进一步研究 AFL 的遗传贡献。
