Abstract 12110: The Multi-Racial Clinical and Familial Characteristics of Early and Late Onset Atrial Flutter

Abstract

Introduction: Studies in Whites of European descent have shown that atrial fibrillation (AF) have a strong genetic component especially in probands with early-onset (EO) AF. However, the role of family history in the pathogenesis of EO atrial flutter (EOAFL) across race-ethnicity remains unclear. Here, we sought to determine if African American, European American, and Hispanic/Latino probands with EOAFL have a higher rate of arrhythmia recurrence in first-degree family members than ethnically-matched patients with late-onset AFL (LOAFL). Methods: In this cohort study, 917 adults with AFL were identified between 2015 and 2021 across 3 sites in the Chicagoland area. EOAFL was defined as AFL occurring before 60 years of age. Primary analysis of reported family history in first-degree relatives with sensitivity analysis restricted to those in whom a family history was confirmed by medical record review and electrocardiogram was done. Results: Those with EOAFL were more overweight, Black or White, and had more comorbidities ( Table 1 ). Multivariate analysis showed that BMI ≥ 40 kg/m 2 (odds ratio [OR]: 5.4; 95% confidence interval [CI]: 3.2-9.4, p <0.001) and a family history (OR: 3.7; 95% CI: 2.1-6.9, P <0.001) carried the highest adjusted odds of EOAFL followed by alcohol use (OR: 2.1; 95% CI: 1.5-3.0, P <0.001), Black race (OR: 1.6; 95% CI: 1.1-2.3, P =0.021), and heart failure (OR: 1.4; 95% CI: 1-1.9, P =0.03). Adjusting for effect modification on the association of family history and race, among Whites, the odds of EOAFL in patients with family history was 6.1 (95% CI: 2.1-22.3, P =0.002) comparative to those with no family history, and among Blacks, it was 4.9 (95% CI: 1.6-6.1, P =0.021). Conclusion: Obesity and family history were strongly associated with EOAFL. Whites with EOAFL were more likely to have a first-degree relative with AF/AFL when compared to Blacks or Hispanics/Latinos. These findings support genetic predisposition to EOAFL across all 3 races.