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Genotype looms large in risk for post-op arrhythmia

Mar. 11, 2021, 9:40 AM


by Paul Govern

Postoperative atrial fibrillation (PoAF), a form of arrhythmia, complicates 20-40% of cardiac surgical procedures and 10–20% of non-cardiac thoracic operations, cropping up two to four days after surgery to pose risk of stroke, heart attack, mortality, longer hospital stays and greater cost.

In what looks to be the first study of the relationship between polygenic variation and post-cardiac surgery AF, researchers from Vanderbilt University Medical Center report that risk of this complication is greatly influenced by genotype.

In Circulation: Genomic and Precision Medicine, Miklos Kertai, MD, PhD, Lisa Bastarache, MS, and colleagues report that risk of PoAF rose 63% per every standard deviation increase in polygenic risk score.

“We also established in this initial test that polygenic risk scoring, while strikingly predictive on its own, can significantly enhance conventional clinical models of post-cardiac surgery AF risk,” said Kertai, professor of Anesthesiology.

The team scored polygenic risk for PoAF in 1,047 patients of white European ancestry based on 2,746 common genetic variants previously associated with atrial fibrillation. The patients had no history of AF, underwent either coronary artery bypass grafting or heart valve surgery at VUMC, and happened to be participants in BioVU, Vanderbilt’s bank of de-identified DNA samples. Based on analysis of their de-identified health care records, 25% of patients in the group developed AF following their procedure.

“If further studies bear out our results and with clinical genotyping seemingly more in reach every day, it bodes well for prediction and prevention of this dangerous post-op complication.,” Kertai said.

Also on the study were Jonathan Mosley, MD, PhD, Jing He, MS, Abinaya Ramakrishnan, Mark Abdelmalak, Yurim Hong, Benjamin Shoemaker, MD, and Dan Roden, MDCM.

The study was funded in part by the National Institutes of Health (LM010685, GM130791).

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