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Is Atrial Fibrillation a Genetic Disease?

Data from the offspring of Framingham Heart Study participants help to answer this question.

Atrial fibrillation (AF), the most common sustained arrhythmia, is associated with increased risk for stroke, death, and the development of adverse symptoms including fatigue and palpitations. Very unusual familial forms of AF have recently been reported.

Motivated by interest in the genetics of AF, researchers used data from 2243 offspring (52% women) of participants in the Framingham Heart Study to assess whether parental history of AF confers risk for AF development. Upon enrollment, the offspring were at least 30 years old and free of AF; 681 (30%) had at least one parent with documented AF. Follow-up evaluation took place every 4 years according to Framingham protocol.

During follow-up, 70 offspring (23 women) developed AF at a mean age of 62 (range, 40-81). After adjustment for multiple potentially confounding variables, having at least one parent with AF was associated with a significantly higher 4-year risk for AF development than was not having a parent with AF (odds ratio, 1.85). This risk was even greater when parent and offspring samples were restricted to people younger than age 75 without clinically overt heart disease.

Comment: Parental atrial fibrillation may be a far more potent risk factor for AF development than previously recognized. The genetic underpinnings for this association remain to be identified. Also unclear is whether patients with familial AF and those with sporadic AF respond differently to treatment. As these issues are being sorted out, clinicians should begin to pay greater attention to family history when evaluating patients with AF.

— Hugh Calkins, MD

Published in Journal Watch Cardiology August 20, 2004

Citation(s):

Fox CS et al. Parental atrial fibrillation as a risk factor for atrial fibrillation in offspring. JAMA 2004 Jun 16; 291:2851-5.

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