Arrhythmias & electrophysiology

Embryological Classification of Arrhythmogenic Triggers Initiating Atrial Fibrillation

J Am Coll CardiolPublished Cohort study

Authors' conclusion

SV-derived AF triggers may have hereditary factors with a favorable postablation prognosis, whereas PA-derived triggers are linked to AF persistence and poor ablation response.

Study context

Population
Patients with atrial fibrillation (AF) undergoing pulmonary vein (PV) isolation815 with genetic analysis
Participants
3,067 patients
Exposure
AF triggers by embryological origin: common PV vs sinus venosus vs primitive atrium
  • Sinus venosus (SV)n = 622
  • Primitive atrium (PA)n = 365
Outcome
Arrhythmia recurrence after repeated procedures
Methodological detailsgenetic analysis subcohort
  • Genetic analysis subcohort

Main finding

As reported in the abstract

Hazard ratio (95% CI)P value
PAvs Common PV
1.75(1.34–2.29)
P < 0.001
PAvs SV
1.31(1.19–1.45)
P < 0.001

Observational data: associations, not effects.

Further findings

OutcomeSVPA
Prevalence of extra-PV AF trigger origin (cohort 1)20.3%11.9%

Predictors of trigger origin (multivariate, cohort 2)

SV-AF associated with female sex, lower BMI, absence of hypertension, rs2634073 near PITX2 and rs6584555 in NEURL1
PA-AF predicted by nonparoxysmal AF and rs2634073 near PITX2

Safety

Adverse events

Incidence did not differ significantly among the 3 groups

Original publication

Embryological Classification of Arrhythmogenic Triggers Initiating Atrial Fibrillation. J Am Coll Cardiol. Published 23 October 2024. doi:10.1016/j.jacc.2024.08.060

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