Association of ZFHX3 Genetic Polymorphisms and Extra-Pulmonary Vein Triggers in Patients With Atrial Fibrillation Who Underwent Catheter Ablation

The gene (16q22) is the second most highly associated gene with atrial fibrillation (AF) and is related to inflammation and fibrosis. We hypothesized that is associated with extra-pulmonary vein (PV) triggers, left atrial (LA) structural remodeling, and poor rhythm outcomes of AF catheter ablation (AFCA). We included 1,782 patients who underwent a AFCA (73.5% male, 59.4 ± 10.8 years old, 65.9% paroxysmal AF) and genome-wide association study and divided them into discovery ( = 891) and replication cohorts ( = 891). All included patients underwent isoproterenol provocation tests and LA voltage mapping. We analyzed the , extra-PV trigger-related factors, and rhythm outcomes. Among 14 single-nucleotide polymorphisms (SNPs) of , rs13336412, rs61208973, rs2106259, rs12927436, and rs1858801 were associated with extra-PV triggers. In the overall patient group, extra-PV triggers were independently associated with the polygenic risk score (PRS) (OR 1.65 [1.22-2.22], = 0.001, model 1) and a low LA voltage (OR 0.74 [0.56-0.97], = 0.029, model 2). During 49.9 ± 40.3 months of follow-up, clinical recurrence of AF was significantly higher in patients with extra-PV triggers (Log-rank < 0.001, HR 1.89 [1.49-2.39], < 0.001, model 1), large LA dimensions (Log-rank < 0.001, HR 1.03 [1.01-1.05], = 0.002, model 2), and low LA voltages (Log-rank < 0.001, HR 0.73 [0.61-0.86], < 0.001, model 2) but not the PRS (Log-rank = 0.819). The extra-PV triggers had significant associations with both genetic polymorphisms and acquired LA remodeling. Although extra-PV triggers were an independent predictor of AF recurrence after AFCA, the studied AF risk SNPs intronic in were not associated with AF recurrence.