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Background  Although most cases of atrial septal defect (ASD) are sporadic, familial cases have been reported, which may be caused by mutation of transcription factor GATA binding protein 4 ( GATA4 ). Herein we combined whole-exome sequencing and bioinformatics strategies to identify a novel mutation in  GATA4  accounting for the etiology in a Chinese family with ASD.    Methods  We identified kindred spanning 3 generations in which 3 of 12 (25.0%) individuals had ASD. Punctilious records for the subjects included complete physical examination, transthoracic echocardiography, electrocardiograph and surgical confirming. Whole-exome capture and high-throughput sequencing were performed on the proband III.1. Sanger sequencing was used to validate the candidate variants, and segregation analyses were performed in the family members.    Results  Direct sequencing of  GATA4  from the genomic DNA of family members identified a T-to-C transition at nucleotide 929 in exon 5 that predicted a methionine to threonine substitution at codon 310 (M310T) in the nuclear localization signal (NLS) region. Two affected members (II.2 and III.3) and the proband (III.1) who was recognized as a carrier exhibited this mutation, whereas the other unaffected family members or control individuals did not. More importantly, the mutation  GATA4  (c.T929C: p.M310T) has not been reported previously in either familial or sporadic cases of congenital heart defects (CHD).    Conclusions  We identified for the first time a novel M310T mutation in the  GATA4  gene that is located in the NLS region and leads to family ASD with arrhythmias. However, the mechanism by which this pathogenic mutation contributes to the development of heart defect and tachyarrhythmias remains to be ascertained.

The M310T mutation in the GATA4 gene is a novel pathogenic target of the familial atrial septal defect