Abstract

Structural and electrical remodeling play critical roles in the maintenance of atrial arrhythmias. Rommel et al (Circ Res 2018;123:550–563, PMID 29930145) sought to identify transcription factors and downstream target genes involved in atrial structural remodeling in atrial tissues from patients with permanent atrial fibrillation (AF). They identified the transcription factor ETV1 (E twenty-six variant 1) to be significantly upregulated in AF. Moreover, Etv1 expression was 5-fold higher in atria compared to ventricular tissues. Cardiac myocyte-specific overexpression of Etv1 in a mouse model resulted in severe atrial remodeling and atrial arrhythmias. Conversely, ablation of Etv1 protected against atrial remodeling after angiotensin II stimulation. The authors identified genes involved in Ca2+ handling and gap junction formation (Ryr2, Atp2a2, Jph2, Gja5), potassium channels (Kcnh2, Kcnk3), as well as genes implicated in AF (Tbx5) as part of the ETV1-driven gene regulatory network. The authors conclude that ETV1 is a critical transcription factor in atrial remodeling and arrhythmias.

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