Published Online
on April 23, 2009

A more recent version of this article appeared on August 1, 2009

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Original Article

Familial Aggregation of Atrial Fibrillation – A Study in Danish Twins.

Ingrid Elisabeth Christophersen¹; Lasse Steen Ravn¹; Esben Budtz–Joergensen²; Aksel Skytthe³; Stig Haunsoe⁴; Jesper Hastrup Svendsen⁴ and Kaare Christensen^3,5

¹ Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark;
² University of Copenhagen, Copenhagen, Denmark;
³ Institute of Public Health, University of Southern Denmark, Odense, Denmark;
⁴ Rigshospitalet, Copenhagen University Hospital & University of Copenhagen, Copenhagen, Denmark

⁵ E-mail: kchristensen{at}health.sdu.dk

Background—Heritability may play a role in non-familial atrial fibrillation (AF). We hypothesized that a monozygotic (MZ) twin whose co-twin was diagnosed with AF would have an increased risk of the disease compared to a dizygotic (DZ) twin in the same situation.

Methods and Results—A sample of 1137 same-sex twin pairs (356 MZ and 781 DZ pairs) where one or both members were diagnosed with AF were identified in The Danish Twin Registry. Concordance rates were twice as high for MZ pairs than for DZ pairs regardless of gender, 22.0% vs. 11.6% (p<0.0001). In a Cox regression of event free survival times, we compared the time span between occurrences of disease in MZ and DZ twins. The unaffected twin was included, when his or her twin-sibling (the index twin) was diagnosed with AF. After adjustment for age at entry, MZ twins had a significantly shorter event free survival time (hazard ratio: 2.0 (95% confidence interval (CI): 1.3 - 3.0)) thereby indicating a genetic component. Using biometric models, we estimated the heritability of AF to be 62 % (55 % - 68 %), due to additive genetics. There were no significant differences across genders.

Conclusion—All the analyses of twin similarities in the present study indicate that genetic factors play a substantial role in the risk of AF for both genders. The recurrence risk for co-twins (12-22%) is clinically relevant and suggests that co-twins of AF-affected twins belong to a high-risk group for AF.

Key Words: arrhythmia • genetics • risk factors • Atrial Fibrillation • Twin study