Atrial Fibrillation and the Risk of Sudden Cardiac Death

Chen, Lin Y.; Sotoodehnia, Nona; Bůžková, Petra; Lopez, Faye L.; Yee, Laura M.; Heckbert, Susan R.; Prineas, Ronald J.; Soliman, Elsayed Z.; Adabag, Selçuk; Konety, Suma; Folsom, Aaron R.; Siscovick, David S.; Alonso, Álvaro

doi:10.1001/2013.jamainternmed.744

Cited by 182 publications

(77 citation statements)

References 26 publications

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“…Our study adds to the growing literature regarding the link between AF and ventricular arrhythmias and SCD. Population‐based studies have previously associated history of AF with SCD, 28 and patients with AF appear to derive a greater benefit from primary prevention implantable cardioverter‐defibrillators. 29–31 Recently, a large population‐based case–control study found similar elevations in the risk of VF arrest associated with a preceding diagnosis of AF.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Risk Factors of Ventricular Fibrillation Before Primary Angioplasty in Patients With First ST‐Elevation Myocardial Infarction: A Nationwide Study in Denmark

Jabbari

Engstrøm

Glinge

et al. 2015

JAHA

101

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BackgroundWe aimed to investigate the incidence and risk factors for ventricular fibrillation (VF) before primary percutaneous coronary intervention (PPCI) among patients with ST‐segment elevation myocardial infarction (STEMI) in a prospective nationwide setting.Methods and ResultsIn this case‐control study, patients presenting within the first 12 hours of first STEMI who survived to undergo angiography and subsequent PPCI were enrolled. Over 2 years, 219 cases presenting with VF before PPCI and 441 controls without preceding VF were enrolled. Of the 219 case patients, 182 (83%) had STEMI with out‐of‐hospital cardiac arrest due to VF, and 37 (17%) had cardiac arrest upon arrival to the emergency room. Medical history was collected by standardized interviews and by linkage to national electronic health records. The incidence of VF before PPCI among STEMI patients was 11.6%. Multivariable logistic regression analysis identified novel associations between atrial fibrillation and alcohol consumption with VF. Patients with a history of atrial fibrillation had a 2.80‐fold odds of experiencing VF before PPCI (95% CI 1.10 to 7.30). Compared with nondrinkers, patients who consumed 1 to 7 units, 8 to 14 units, or >15 units of alcohol per week had an odds ratio (OR) of 1.30 (95% CI, 0.80 to 2.20), 2.30 (95% CI, 1.20 to 4.20), or 3.30 (95% CI, 1.80 to 5.90), respectively, for VF. Previously reported associations for preinfarction angina (OR 0.46; 95% CI 0.32 to 0.67), age of <60 years (OR 1.75; 95% CI 1.20 to 2.60), anterior infarction (OR 2.10; 95% CI 1.40 to 3.00), preprocedural thrombolysis in myocardial infarction flow grade 0 (OR 1.65; 95% CI 1.14 to 2.40), and family history of sudden death (OR 1.60; 95% CI 1.10 to 2.40) were all associated with VF.ConclusionSeveral easily assessed risk factors were associated with VF occurring out‐of‐hospital or on arrival at the emergency room before PPCI in STEMI patients, thus providing potential avenues for investigation regarding improved identification and prevention of life‐threatening ventricular arrhythmias.

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Section: Discussionmentioning

confidence: 99%

Incidence and Risk Factors of Ventricular Fibrillation Before Primary Angioplasty in Patients With First ST‐Elevation Myocardial Infarction: A Nationwide Study in Denmark

Jabbari

Engstrøm

Glinge

et al. 2015

JAHA

101

View full text Add to dashboard Cite

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“…SCD is the single most common cause of death among patients with AF, accounting for about a third of all deaths 23, 24, 25, 26. In a recent analysis from the ENGAGE AF‐TIMI 48 trial, the cause for SCD was unknown in most cases and an arrhythmia was documented in only a minority of SCD events (11.5%) 25.…”

Section: Discussionmentioning

confidence: 99%

Digoxin Use and Subsequent Clinical Outcomes in Patients With Atrial Fibrillation With or Without Heart Failure in the ENGAGE AF‐TIMI 48 Trial

Eisen

Ruff

Braunwald

et al. 2017

JAHA

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BackgroundDigoxin is widely used in patients with atrial fibrillation despite the lack of randomized controlled trials. Observational studies report conflicting results regarding its association with mortality, perhaps because of residual confounding by the presence of heart failure (HF).Methods and ResultsIn the ENGAGE AF‐TIMI 48 (Effective Anticoagulation With Factor Xa Next Generation in Atrial Fibrillation‐Thrombolysis in Myocardial Infarction 48) trial, clinical outcomes of patients with atrial fibrillation with and without HF were examined by baseline digoxin use during a median follow‐up of 2.8 years. HF was defined at baseline as prior or current clinical stage C or D HF. Of 21 105 patients enrolled, 6327 (30%) were treated with digoxin at baseline. Among patients without HF (n=8981), digoxin use (20%) was independently associated with sudden cardiac death (adjusted hazard ratio, 1.51; 95% CI, 1.10–2.08), with no significant interaction by age, sex, left ventricular ejection fraction, renal function, or concomitant medications (P>0.05 for each). Consistent results were observed using propensity matching (adjusted hazard ratio for sudden cardiac death, 1.90; 95% CI, 1.36–2.65). Among patients with HF (n=12 124), digoxin use (37%) was associated with an increase in all‐cause death, cardiovascular death, sudden cardiac death, and death caused by HF/cardiogenic shock (P<0.01 for each), but not with noncardiovascular death, stroke/systemic embolism, or myocardial infarction.ConclusionsIn this observational analysis of patients with atrial fibrillation without investigator‐reported HF, digoxin use was significantly associated with sudden cardiac death. While residual confounding cannot be excluded, the association between digoxin use and worse clinical outcomes highlights the need to examine digoxin use, particularly when prescribed to control heart rate in patients with atrial fibrillation in a randomized trial.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT00781391.

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“…A substudy of the Atherosclerosis Risk in Communities trial demonstrated that AF increased the risk of sudden cardiac death significantly more for blacks than nonblack participants, with more than a twofold difference in the relative risks associated with AF. 16 Another recent study compared the effect of race on inhospital outcomes of AF in patients hospitalized with CHF. Although there was no racial difference in inhospital mortality, black patients had a longer length of stay compared with whites and were less likely to be discharged on warfarin.…”

Section: Discussionmentioning

confidence: 99%

Effect of Race on Outcomes (Stroke and Death) in Patients >65 Years With Atrial Fibrillation

Kabra

Cram

Girotra

et al. 2015

The American Journal of Cardiology

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Atrial fibrillation (AF) is associated with stroke and death. We sought to determine whether there are any racial differences in the outcomes of death and stroke in patients with AF. We used Medicare administrative data from January 1, 2010, to December 31, 2011, to identify 517,941 patients with newly diagnosed AF. Of these, 452,986 patients (87%) were non-Hispanic white, 36,425 (7%) were black, and 28,530 (6%) were Hispanic. The association between race and outcomes of death and stroke were measured using Cox proportional hazard models. Over a median follow-up period of 20.3 months, blacks had a significantly higher hazard of death (hazard ratio [HR] = 1.46; 95% confidence interval [CI] 1.43 to 1.48; p <0.001) and stroke (HR = 1.66; 95% CI 1.57 to 1.75; p <0.001), compared with white patients. After controlling for pre-existing co-morbidities, the higher hazard of death in blacks was eliminated (HR 0.95; 95% CI 0.93 to 0.96; p <0.001) and the relative hazard of stroke was reduced (HR = 1.46; 95% CI 1.38 to 1.55; p <0.001). Similarly, Hispanics had a higher risk of death (HR = 1.11; 95% CI 1.09 to 1.14; p <0.001) and stroke (HR = 1.21; 95% CI 1.13 to 1.29; p <0.001) compared with whites. The relative hazard of death was lower in Hispanics (HR 0.82; 95% CI 0.80 to 0.84; p <0.001) compared with whites, after controlling for pre-existing co-morbidities, and the relative hazard of stroke was also attenuated (HR = 1.11; 95% CI 1.03 to 1.18; p <0.001). In conclusion, in patients >65 years with newly diagnosed AF, the risks of death and stroke are higher in blacks and Hispanics compared with whites. The increased risk was eliminated or significantly reduced after adjusting for preexisting co-morbidities. AF may be a marker for underlying co-morbidities in black and Hispanic patients who may be at a higher mortality risk.

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Atrial Fibrillation and the Risk of Sudden Cardiac Death

Abstract: Background: It is unknown whether atrial fibrillation (AF) is associated with an increased risk of sudden cardiac death (SCD) in the general population. This association was examined in 2 population-based cohorts.

Cited by 182 publications

References 26 publications

Incidence and Risk Factors of Ventricular Fibrillation Before Primary Angioplasty in Patients With First ST‐Elevation Myocardial Infarction: A Nationwide Study in Denmark

Incidence and Risk Factors of Ventricular Fibrillation Before Primary Angioplasty in Patients With First ST‐Elevation Myocardial Infarction: A Nationwide Study in Denmark

Digoxin Use and Subsequent Clinical Outcomes in Patients With Atrial Fibrillation With or Without Heart Failure in the ENGAGE AF‐TIMI 48 Trial

Effect of Race on Outcomes (Stroke and Death) in Patients >65 Years With Atrial Fibrillation

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