Background-Understanding variation in the normal electric activity of the heart, assessed by the ECG, may provide a starting point for studies of susceptibility to serious arrhythmias such as sudden cardiac death during myocardial infarction or drug therapy. Recent genetic association studies of one ECG trait, the QT interval, have identified common variation in European-descent populations, but little is known about the genetic determinants of ECG traits in populations of African descent. Methods and Results-To identify genetic risk factors, we have undertaken a candidate gene study of ECG traits in collaboration with the Jackson Heart Study, a longitudinal study of 5301 blacks ascertained from the Jackson, Mississippi, area. Nine quantitative ECG traits were evaluated: P, PR, QRS, QT, and QTc durations, heart rate, and P, QRS, and T axes. We genotyped 72 variations in the predominant sodium channel gene expressed in heart, SCN5A, encoding the Na v 1.5 voltage-gated sodium channel in 4558 subjects. Both rare and common variants in this gene have previously been associated with inherited arrhythmia syndromes and variable conduction. Adjusting for age, sex, and European ancestry, we performed tests of association in 3054 unrelated participants and identified 14 significant associations (PϽ1.0ϫ10 Ϫ4 ), of which 13 are independent, based on linkage disequilibrium. These variants explain up to 2% of the variation in ECG traits in the Jackson Heart Study. Conclusions-These results suggest that SCN5A variation contributes to ECG trait distributions in blacks, and these same variations may be risk or protective factors associated with susceptibility to arrhythmias. (Circ Cardiovasc Genet. 2011; 4:139-144.)Key Words: electrocardiography Ⅲ arrhythmia Ⅲ genetics Ⅲ ion channels Ⅲ cardiovascular diseases M any factors are known to influence ECG measurements, including underlying heart disease such as coronary heart disease or hypertension, drug therapy, body mass index, and age. These factors, however, do not explain the majority of the trait variance observed in ECG traits, and a large portion of the variance remains unknown. 1,2 Studies in twins and populations have reported that Ͼ35% of the variance observed for specific ECG traits is heritable. [3][4][5][6][7][8] Given the heritability of ECG traits, it is possible that common genetic variation in genes that modulate the electric activity of the heart can explain a proportion of the unknown trait variance observed in the general population. Insights into such normal variability may in turn provide the starting point for predicting serious cardiovascular events such as druginduced arrhythmias or sudden cardiac death (SCD). 4 -7 SCD accounts for 10% to 20% of all deaths in adults, and risk factors include underlying heart disease and a family history of SCD. [5][6][7] Clinical Perspective on p 144The opening of sodium channels is responsible for initiating and propagating action potentials in cardiac and other excitable cells. 8 -17 Sodium channels are encoded by 9 poref...