Atrial Fibrillation
Positive Monogenic Risk
Monogenic risk for Atrial Fibrillation results from a pathogenic variant in the LMNA gene. These individuals are at increased risk for arrhythmia and cardiomyopathy, muscular dystrophy, lipodystrophy, and progeria. For participants with monogenic risk, recommendations include:
- Referral to a genetic counselor.
- Cardiac screening (see below) and/or cardiology consultation:
- Check pulse for irregularities.
- 12 lead electrocardiogram (ECG).
- Cardiac monitoring (2-14 days monitor e.g., Holter or Ziopatch, 30-day event monitor or implantable loop recorder).
- Echocardiogram.
- Wearable device with heart monitoring capabilities (if available and affordable).
High PRS
A high PRS is associated with approximately double the risk for developing Atrial Fibrillation relative to a person not in the high-risk category. The data is based on populations of African, European, and Hispanic/Latino descent. Information is insufficient or not available for populations of other descent. For participants with a high PRS, recommendations include:
- Ask about heart palpitations, irregular heart rhythm or rate, a feeling of skipped beats or irregular beats that last for a few seconds or more, fainting, or unusual dizzy spells.
- Assess for other risks factors for atrial fibrillation; age>65, hypertension, diabetes, heart failure, smoking, prior stroke, renal insufficiency, hyperthyroidism, obesity, sleep apnea, and heavy alcohol use.
- In those aged ≥ 40 years, consider stepwise cardiac screening such as:
- Check pulse for irregularities.
- 12 lead electrocardiogram (ECG).
- Cardiac monitoring (2-14 days monitor e.g., Holter or Ziopatch, 30-day event monitor or implantable loop recorder).
- Echocardiogram.
- Wearable device with heart monitoring capabilities (if available and affordable).
Positive Family History
A positive family history of Atrial Fibrillation is defined as onset of Atrial fibrillation in one or more parents before the age of 75 years. For participants with a positive family history, recommendations include:
- Consider monogenic testing with an arrhythmia gene panel that includes TTN, LMNA, and others.
- In those aged ≥ 40 years, consider cardiac screening such as:
- Check pulse for irregularities.
- 12 lead electrocardiogram (ECG).
- Cardiac monitoring (2-14 days monitor (e.g., Holter or Ziopatch), 30-day event monitor or implantable loop recorder).
- Echocardiogram.
- Wearable device with heart monitoring capabilities (if available and affordable).