Left common trunkus pulmonary veins have genetic background and poorer rhythm outcome after paroxysmal atrial fibrillation catheter ablation

Abstract

Background: The genetic traits of pulmonary vein (PV) variants and rhythm outcomes after atrial fibrillation (AF) catheter ablation (AFCA) remain unclear. We explored the genetic and clinical characteristics and long-term rhythm outcomes of patients with AF and left common trunkus (LCT)-PVs or accessory PVs. Methods: We included 2,829 patients with AF (74.0% men, age 59.1±10.7 years, 66.3% paroxysmal AF) and available genome-wide association study, cardiac computed tomography, and protocol-based regular rhythm follow-up results from the Yonsei AF ablation cohort database. We examined 1,223 single nucleotide polymorphisms in 12 genetic loci associated with AF and long-term rhythm outcomes after AFCA. Results: We found LCT-PVs in 91(3.2%) and accessory PVs in 189(6.7%) patients. Rs9871453 (SCN10A) and rs1979409 (NEO1) were significantly associated with LCT-PV occurrence, and polygenic risk score (PRS) differed significantly between patients with LCT-PVs (p=1.64e-05) and normal PVs, but not those with accessory PVs (p=0.939). Patients with LCT-PVs had a higher proportion of the female sex(p=0.046) and CHA2DS2VASc score (p=0.026). After follow-up for 39.7±4.7 months, patients with LCT-PVs exhibited significantly greater LCT anterior wall thicknesses (p<0.001) and higher recurrence rate than those with normal PVs, particularly patients with paroxysmal AF (log-rank, p=0.042). LCT-PVs were independently associated with AF recurrence after AFCA (hazard ratio[HR], 2.26 [1.01 – 4.42]; p=0.046). Patients with LCT-PVs and higher PRSs had a higher risk of recurrent AF (adjusted HR 1.78, 95% CI 1.10?2.88, p=0.019). Conclusions: Patients with LCT-PVs have a significant genetic background. Post-AFCA recurrence rate was significantly higher in patients with LCT-PVs and higher PRSs, particularly in those with paroxysmal AF.