Genetic Variants Associated With Nonpulmonary Vein Triggers of Atrial Fibrillation

Figures

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  Figure 1. Classification of Patients With Atrial Fibrillation Into the Pulmonary Vein and Non–Pulmonary Vein Groups Based on the Origin of Atrial Fibrillation Triggers Of the 1,091 patients with atrial fibrillation who underwent initial catheter ablation, 54 with post-PV isolation atrial fibrillation recurrence without repeat radiofrequency catheter ablation and 27 with atrial fibrillation recurrence despite maintained PV isolation due to noninducibility were excluded, and 884 and 126 were classified into the pulmonary vein and non–pulmonary vein groups, respectively. ABL = ablation; AF = atrial fibrillation; non-PV = non–pulmonary vein; PV = pulmonary vein; PVI = PV isolation.

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  Figure 2. Distribution of Non–Pulmonary Vein Atrial Fibrillation Trigger Sites The superior vena cava was the most common source of atrial fibrillation among patients in the non–pulmonary vein group with identified trigger sites. CS = coronary sinus; CT = crista terminalis; LAAW = left atrial anterior wall; LIAS = left interatrial septum; RAAW = right atrial anterior wall; RIAS = right interatrial septum; SVC = superior vena cava.

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  Figure 3. Kaplan-Meier Analysis of Atrial Fibrillation Recurrence After the First Radiofrequency Catheter Ablation in the Pulmonary Vein and Non–Pulmonary Vein Groups Over a mean follow-up of 20 ± 13 months, 139 of 884 patients (15.7%) in the pulmonary vein group and 71 of 126 (56.4%) in the non–pulmonary vein group had atrial fibrillation recurrence. The recurrence rate was significantly higher in the non–pulmonary vein group than in the pulmonary vein group (log-rank test, P < 0.001). AF = atrial fibrillation; PV = pulmonary vein.

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  Figure 4. Genome-Wide Association Study Analysis for Atrial Fibrillation Originating From Non–Pulmonary Vein Foci A, Manhattan plot of the genome-wide association study result. A P value of 5 × 10−6 indicated by the blue line and a P value of 5 × 10−8 indicated by the red line. A genome-wide significant association was noted for the single-nucleotide variant rs117203318, located on chromosome 3 (P = 4.65 × 10-14). Its minor allele was significantly more common in patients with atrial fibrillation originating from non–pulmonary vein foci. B, Quantile-quantile plot of the genome-wide association study. Lambda GC = 1.01. C, The regional plot of rs117203318.

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  Central Illustration. Genetic and Clinical Factors Associated With Non–Pulmonary Vein Atrial Fibrillation Non–pulmonary vein foci were defined as atrial triggers excluding the pulmonary veins and left atrial posterior wall. The minor allele of rs117203318 near SERP1 was significantly associated with atrial fibrillation originating from non–pulmonary vein foci. Female sex, absence of hypertension, and reduced intra-atrial conduction velocity were also associated with increased susceptibility to non–pulmonary vein atrial fibrillation. AF = atrial fibrillation; non-PV = non–pulmonary vein; PV = pulmonary vein.