Loss-of-Function Variants Are Associated With Arrhythmogenic Cardiomyopathy Phenotypes When Identified Through Exome Sequencing of a General Clinical Population.

Background: The gene has recently garnered attention as a likely cause of arrhythmogenic cardiomyopathy, which is considered an actionable genetic condition. However, the association with disease in an unselected clinical population is unknown. We hypothesized that individuals with loss-of-function variants in () would have increased odds for arrhythmogenic cardiomyopathy-associated phenotypes versus variant-negative controls in the Geisinger MyCode cohort.

Methods: We identified rare, putative among 171 948 individuals with exome sequencing linked to health records. Associations with arrhythmogenic cardiomyopathy phenotypes from available diagnoses and cardiac evaluations were investigated.

Results: Sixty individuals (0.03%; median age 58 years [47-70 interquartile range], 43% male) harbored 27 unique . These individuals had significantly increased odds ratios for dilated cardiomyopathy (odds ratio, 4.9 [95% CI, 2.6-7.6]; <0.001), supraventricular tachycardia (odds ratio, 3.2 [95% CI, 1.1-5.6]; =0.048), and left-dominant arrhythmogenic cardiomyopathy (odds ratio, 4.2 [95% CI, 1.4-7.9]; =0.03). Echocardiography revealed reduced left ventricular ejection fraction (52±13% versus 57±9%; =0.001) associated with . Overall, at least 9% of patients demonstrated evidence of penetrant disease.

Conclusions: variants are associated with increased odds of ventricular arrhythmia and dysfunction in an unselected clinical population. These findings support genomic screening of for actionable secondary findings.