Background: Genome-wide association studies (GWASs) identified common single nucleotide polymorphisms (SNPs) in more than 100 genomic regions associated with atrial fibrillation (AF). We aimed to identify novel AF genes in Taiwanese population by multi-stage GWAS.

Methods: In exploratory stage, we did GWAS with whole genome genotypes (4,512,191 SNPs) in 516 AF Patients from National Taiwan University AF registry (NTUAFR) and 5160 normal sinus rhythm controls from Taiwan Biobank. Significant loci were replicated in 1002 independent patients and 2003 controls, and in UK biobank. Expression quantitative trait locus (eQTL) mapping and transcriptome-wide association study (TWAS) were performed to implicate functional significance.

Results: Stage I GWAS revealed 3 loci associated with AF with genome-wide significance level, including one close to PITX2 gene (chromosome 4q25, rs2723329, minor allele frequency [MAF] 0.50 vs 0.41, P=1.53×10-10), another close to RAP1A gene (also to previous KCND3; chromosome 1p13.2, rs7525578, MAF 0.17 vs 0.07, P= 1.24×10-26) and one novel locus close to HNF4G gene (chromosome 8q21.13, rs2980218, MAF 0.44 vs 0.35, P=2.19×10-9). They were validated in stage II population. The eQTL analyses showed significant colocalization of 1p13.2 locus with RAP1A gene expression in fibroblasts and 8q21.13 locus with HNF4G expression in lymphocytes. There's significant association of RAP1A gene expression in fibroblasts and HNF4G in lymphocytes and brain with AF.

Conclusions: GWAS in Taiwan revealed PITX2 and RAP1A/KCND3 loci and novel AF locus (HNF4G) with most significant locus in the RAP1A locus. RAP1A and HNF4G genes may implicate fibrosis, metabolic and neurogenic pathways in pathogenesis of AF.

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