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European Heart Journal Advance Access published online on January 22, 2007
European Heart Journal, doi:10.1093/eurheartj/ehl474
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Familial clustering of lone atrial fibrillation in patients with saddleback-type ST-segment elevation in right precordial leads

M. Juhani Junttila1,*, M.J. Pekka Raatikainen1, Juha S. Perkiömäki1, Kui Hong2, Ramon Brugada3 and Heikki V. Huikuri1

1 Department of Internal Medicine, Division of Cardiology, University of Oulu, PO Box 5000, Oulu 90014, Finland
2 Baylor College of Medicine, Houston, TX, USA
3 Montreal Heart Institute, Montreal, Canada

Received 7 September 2006; revised 28 November 2006; accepted 21 December 2006.

* Corresponding author. Tel: +358 8 3154447; fax: +358 8 3155599. E-mail address: mattiju{at}mail.student.oulu.fi

Aims We recently identified a large family with a high prevalence of lone atrial fibrillation (AF) and saddleback-type ST-segment elevation in leads V1–3, without a history of ventricular arrhythmias or syncope. On the basis of this finding, we studied whether there is a relationship between saddleback ST-elevation and lone AF.

Methods and results We examined 168 (mean age 50 ± 8 years, 130 males) lone AF patients and 541 (mean age 50 ± 6 years, 274 males) healthy subjects. The prevalence of saddleback ST-elevation was higher in the lone AF group than the control group (10 vs. 0.4%, P < 0.001). None had a coved-type ST-elevation in baseline ECG or during drug challenge with ajmaline or flecainide (n = 13), a family history of sudden cardiac death, ventricular tachyarrhythmias, syncope, or any other features diagnostic to the Brugada syndrome. Familial clustering of lone AF (i.e. AF in >30% of first-degree relatives) was more common among the subjects with saddleback ST-elevation (24 vs. 7%, P = 0.03).

Conclusion Saddleback-type ST-segment elevation is a relatively common finding among patients with lone AF. The familial clustering of the disorder indicates that genetic factors may be involved in the pathogenesis of the ECG abnormality and lone AF in these patients.

Key Words: Atrial fibrillation • Inherited arrhythmias • Electrocardiogram


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