Enhancement of Myocardial Vulnerability by Atrial Fibrillation

Somberg, John C.; Torres, Vilma; Keren, Gad; Butler, Brenda; Tepper, David; Kleinbaum, Herman; Molnár, J.

doi:10.1097/00045391-200401000-00009

Cited by 25 publications

(12 citation statements)

References 27 publications

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“…Somberg et al reported that VT was induced in 25 of 26 dogs by programmed electrical stimulation of the ventricle only during AF, and not in sinus rhythm. 33 As discussed earlier, analysis of device-stored electrograms has revealed a higher incidence of short-long-short cycles preceding ventricular arrhythmias in AF compared with patients in sinus rhythm (50% vs. 16%, P=0.002). 19 Collectively, these observations suggest that atrial tachyarrhythmias may increase susceptibility to ventricular tachyarrhythmias.…”

Section: Possible Mechanisms Underlying the Association Of Af With Scdmentioning

confidence: 73%

Atrial Fibrillation and Its Association With Sudden Cardiac Death

Chen

Benditt

Alonso

2014

Circ J

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2588CHEN LY et al. Circulation JournalOfficial Journal of the Japanese Circulation Society http://www. j-circ.or.jp are only starting to understand -SCD. We will review the evidence for an independent relationship between AF and SCD in different contexts: recipients of implantable cardioverterdefibrillators (ICDs), patients with MI, HF, or hypertension (HT), and finally, in the general population. We will also examine the determinants of SCD in patients with AF and postulate on the mechanisms underlying this novel and intriguing association. AF and Ventricular Tachyarrhythmias in Recipients of ICDsOne of the earliest lines of evidence to suggest that AF may inherently increase the incidence of ventricular tachycardia (VT) or ventricular fibrillation (VF) comes from patients who have received an ICD. In a study comprising 229 patients who received ICDs between 1995 and 1999 for secondary prevention of SCD, 19 those who had persistent AF (n=38) at the time of ICD implant experienced appropriate device therapy for recurrent ventricular tachyarrhythmias more frequently than patients who were in sinus rhythm at the time of ICD implantation (n=191) (63% vs. 38%, P=0.01). From multivariable analysis, AF was an independent predictor of both appropriate ICD therapy (relative risk 1.8; 95% confidence interval [CI] 1.2-2.9) and inappropriate device therapy (relative risk 2.3; 95% CI 1.2-4.5). Analysis of device-stored electrograms revealed a higher incidence of short-long-short cycles preceding ventricular arrhythmias in AF compared with patients in sinus trial fibrillation (AF) is the most common sustained cardiac arrhythmia, and with the aging population its prevalence is increasing over time. 1-3 Additionally, AF is associated with an increased risk of stroke, 4 heart failure (HF), 5 and death. 6-11 The Framingham Heart Study reported that AF increases the risk of death by 1.5-fold in men and 1.9-fold in women. 6 Similarly, the reported Olmsted County, Minnesota experience showed that new-onset AF doubles the risk of mortality. 7 More recently, the Women's Health Study revealed that the risk of all-cause death was doubled and cardiovascular death quadrupled by new-onset AF in initially healthy women. 8 Although the evidence for an independent association of AF with an increased risk of mortality is compelling, there are few data on the causes of death in patients with AF; the most common causes of death in the aforementioned studies were coronary artery disease (CAD) and stroke. 6,7 There is evidence from post-myocardial infarction (MI) or HF patients that AF is associated with an increased risk of sudden cardiac death (SCD). 12-14 However, SCD was not specifically reported in previous population-based studies; 6-8 hence, it is unknown whether AF increases the risk of SCD in the general population. Moreover, because AF and SCD share many common risk factors, such as HF 15,16 and CAD, 17,18 it is possible that any possible association between AF and SCD is confounded or mediated by these shared risk factors.This narrativ...

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Section: Possible Mechanisms Underlying the Association Of Af With Scdmentioning

confidence: 73%

Atrial Fibrillation and Its Association With Sudden Cardiac Death

Chen

Benditt

Alonso

2014

Circ J

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“…Previous studies have observed that atrial fibrillation increases the risk of SCD in patients with heart failure, prior myocardial infarction, and even in general population . Experimental studies also support the concept that atrial fibrillation can facilitate the induction of ventricular tachyarrhythmia, which may be the cause of the association of atrial fibrillation with a higher incidence of SCD …”

Section: Discussionmentioning

confidence: 99%

Prognostic significance of P‐wave morphology in patients with coronary artery disease

Nortamo

Laitinen

Passi

et al. 2019

Cardiovasc electrophysiol

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Introduction The prognostic significance of P‐wave morphology in patients with coronary artery disease (CAD) is not well‐known. Methods A total of 1946 patients with angiographically verified CAD were included in the Innovation to reduce Cardiovascular Complications of Diabetes at the Intersection (ARTEMIS) study. The P‐wave morphology could be analyzed in 1797 patients. Results During 7.4 ± 2.0 years, a total of 168 (9.3%) patients died or experienced resuscitation from sudden cardiac arrest (SCA), 43 (2.4%) patients experienced sudden cardiac death (SCD) or were resuscitated from SCA, 37 (2.1%) patients succumbed to non‐SCD (NSCD), and 88 (4.9%) patients to noncardiac death (NCD). Of the P‐wave parameters, the absolute P‐wave residuum (PWR), the heterogeneity of the P‐wave morphology (PWH), and the P‐wave duration (Pdur) had the closest univariate association with the risk of SCD/SCA (0.0038 ± 0.0026 vs 0.0022 ± 0.0017, P < .001; 11.0 ± 5.2 vs 8.6 ± 3.6, P < .01; 142.7 ± 16.9 vs 134.8 ± 14.3 milliseconds, P < .01; SCD/SCA vs no SCD/SCA, respectively). After adjustments with factors that were associated with the risk of SCD/SCA, such as diabetes, smoking, left bundle branch block, high‐sensitivity C‐reactive protein, and high‐sensitivity troponin T, PWR (P < .001), PWH (P < .05), and Pdur (P < 0.01) still predicted SCD/SCA but not non‐sudden cardiac death. When these parameters were added to the SCD/SCA clinical risk model, the discrimination and reclassification accuracy of the risk model increased significantly (P < .05, P < .001) and the C‐index increased from 0.745 to 0.787. Conclusion The P‐wave morphology parameters independently predict SCD/SCA in patients with CAD.

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“…reported from canine experiments that ventricular tachycardia (VT) was induced in 25 of 26 dogs by programmed electrical stimulation only in AF, and not in sinus rhythm. 25 Gronefeld et al . reported that AF is an independent predictor of implantable cardioverter-defibrillator therapy for VT or ventricular fibrillation (VF).…”

Section: Commentmentioning

confidence: 99%