Relationship of Sudden Cardiac Death to New-Onset Atrial Fibrillation in Hypertensive Patients With Left Ventricular Hypertrophy

Okin, Peter M.; Bang, Casper N.; Wachtell, Kristian; Hille, Darcy A.; Kjeldsen, Sverre E.; Dahlöf, Björn; Devereux, Richard B.

doi:10.1161/circep.112.977777

Cited by 61 publications

(35 citation statements)

References 56 publications

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“…An analysis of device-stored electrograms revealed a higher incidence of short-long-short cycles preceding VAs in AF compared to non-AF patients (55% vs 31%, p = 0.01). The relationship between new-onset AF and risk of SCD was also been evaluated in 8,831 hypertensive patients with electrocardiographic left ventricular hypertrophy without history of AF enrolled in the L osartan I ntervention F or E ndpoint reduction (LIFE) study20. After adjustment for potential confounders, AF remained as an important risk factor of SCD with a HR 3.13 (95% CI 1.87–5.24).…”

Section: Discussionmentioning

confidence: 99%

Risk and Prediction of Sudden Cardiac Death and Ventricular Arrhythmias for Patients with Atrial Fibrillation – A Nationwide Cohort Study

Chao

Liu

Tuan

et al. 2017

Sci Rep

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Sudden cardiac death (SCD) is the most devastating manifestation of ventricular arrhythmias (VAs), and is the leading cause of mortality among atrial fibrillation (AF) patients. The goal of the present study was to investigate the incidence of SCD/VAs amongst patients with and without AF. We also aimed to identify important risk factors of SCD/VAs among AF patients. Using the “National Health Insurance Research Database” in Taiwan, a total of 352,656 AF and 352,656 non-AF patients without antecedent SCD/VAs were identified. The annual risk of SCD/VAs was higher in AF than non-AF groups (0.97% versus 0.47%) with an adjusted hazard ratio (HR) of 1.64. The increased risk of SCD/VAs in AF patients was consistently observed in different age strata, various comorbidities and patients without use of class I/III anti-arrhythmic drugs or digoxin. Among AF patients, age ≥75 years, congestive heart failure, hypertension, diabetes mellitus, previous stroke/transient ischemic attack, vascular diseases, chronic kidney disease and chronic obstructive pulmonary disease were important risk factors for SCD/VAs. In conclusion, the risk of SCD/VAs amongst AF patients was 1.64-fold higher compared to non-AF patients, which was associated with the number of clinical risk factors associated with the particular AF patient.

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Section: Discussionmentioning

confidence: 99%

Risk and Prediction of Sudden Cardiac Death and Ventricular Arrhythmias for Patients with Atrial Fibrillation – A Nationwide Cohort Study

Chao

Liu

Tuan

et al. 2017

Sci Rep

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“…AF is associated with an increased risk of stroke, heart failure (HF), and all‐cause mortality . Recent data suggest that AF is also independently associated with an increased risk of sudden cardiac death (SCD) . In patients with established AF treated with anticoagulation, SCD accounts for >20% of all deaths .…”

Section: Introductionmentioning

confidence: 99%

Sudden Cardiac Death in Patients With Atrial Fibrillation: Insights From the ENGAGE AF‐TIMI 48 Trial

Eisen

Ruff

Braunwald

et al. 2016

JAHA

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BackgroundRecent findings suggest that atrial fibrillation is associated with sudden cardiac death (SCD). We examined the incidence, characteristics, and factors associated with SCD in patients with atrial fibrillation.Methods and Results SCD was defined as witnessed death ≤60 minutes from the onset of new symptoms or unwitnessed death 1 to 24 hours after being observed alive, without another known cause of death. Predictors of SCD were examined using multivariate competing risks models. Over 2.8 years (median), 2349 patients died (40.5 per 1000 patient‐years), of which 1668 (71%) were cardiovascular deaths. SCD was the most common cause of cardiovascular death (n=749; median age 73 years; 70.6% male). Most SCD events occurred out of hospital (92.8%) and without prior symptoms (66.0%). Predictors of SCD included low ejection fraction, heart failure, and prior myocardial infarction (P<0.001 for each). Additional significant baseline predictors of SCD, but not of other causes of death, included male sex, electrocardiographic left ventricular hypertrophy, higher heart rate, nonuse of beta blockers, and use of digitalis. The latter was associated with SCD in patients with or without heart failure (adjusted hazard ratio 1.55 [95% CI 1.29–1.86] and 1.56 [95% CI 1.14–2.11], respectively; P interaction=0.73). The rate of SCD was numerically but not statistically lower with edoxaban (1.20% per year with lower dose edoxaban; 1.28% per year with higher dose edoxaban) compared with warfarin (1.40% per year).Conclusion SCD is the most common cause of cardiovascular death in patients with atrial fibrillation and has several distinct predictors, some of which are modifiable. These findings may be considered in planning research and treatment strategies for patients with atrial fibrillation.Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT00781391.

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“…The LIFE Study 3,6,29,30,32,33 enrolled 9,193 hypertensive patients with ECG LVH by Cornell voltage-duration product 34 and/or Sokolow-Lyon voltage criteria 35 on a screening electrocardiograph in a prospective, double-blind, randomized study that compared cardiovascular morbidity and mortality with losartan-vs. atenolol-based treatment, 32 as previously described. 3,6,29,30,32,33 A total of 362 patients had a history of AF (n = 342) and/or AF on their LIFE baseline electrocardiograph (n = 135), leaving 8,831 patients without AF by history or baseline electrocardiogram in the present post hoc, retrospective analysis.…”

Section: Subjectsmentioning

confidence: 99%

“…3,6,29,30,32,33 A total of 362 patients had a history of AF (n = 342) and/or AF on their LIFE baseline electrocardiograph (n = 135), leaving 8,831 patients without AF by history or baseline electrocardiogram in the present post hoc, retrospective analysis.…”

Section: Subjectsmentioning

confidence: 99%

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Racial Differences in Incident Atrial Fibrillation Among Hypertensive Patients During Antihypertensive Therapy

Okin

Bang

Wachtell

et al. 2014

American Journal of Hypertension

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Atrial fibrillation (AF) is a common arrhythmia 1,2 that is increasing in prevalence. 2 The incidence of AF increases with age 1 and is increased in patients with heart failure, left ventricular hypertrophy (LVH), and coronary heart disease and is particularly strongly related to hypertension. [3][4][5][6][7][8][9][10][11][12] The increased risk of death, 3-5 sudden cardiac death, 6 heart failure, 5 and stroke 3,7,8 in patients with AF and the significant risks associated with antiarrhythmic and antithrombotic therapies aimed at preventing AF recurrences and decreasing the risk of embolic sequella [13][14][15] highlight the importance of preventing AF and the need to better understand the epidemiologic risk factors that may predispose to AF. 16,17 Racial or ethnic differences in the prevalence and incidence of AF are of significant importance. Blacks appear to have a lower risk of incident and prevalent AF in the general population, 1,11,18-24 among heart failure patients, 25 and after cardiac surgery, 26 despite a greater burden of traditional AF risk factors. Indeed, traditional risk factors appear to have similar strengths of association with new AF in blacks and whites, despite the lower risk of AF in blacks. 21,22 The lower risk of AF in blacks has been potentially attributed in part to possible racial differences in left atrial size, 23 cardiac autonomic tone, 27 the sensitivity of methods used to detect AF, 20 and underascertainment of AF in blacks, 21 possibly because of potential differences in access to care. Recent work has also suggested that the lower risk of AF in blacks may be in part attributable to genetic factors, with an increased estimated degree of European ancestry in blacks associated with an increased risk of incident AF. 28 Hypertensive patients with LVH are at a particularly high risk of AF. 2,3,5,11,12,29 background Blacks have a higher prevalence of risk factors for atrial fibrillation (AF), such as hypertension, obesity, and heart failure, than nonblacks. Although population-based studies have demonstrated a lower prevalence and incidence of AF in blacks, the relationship of incident AF to race among hypertensive patients undergoing blood pressure lowering has been less extensively examined.

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Relationship of Sudden Cardiac Death to New-Onset Atrial Fibrillation in Hypertensive Patients With Left Ventricular Hypertrophy

Cited by 61 publications

References 56 publications

Risk and Prediction of Sudden Cardiac Death and Ventricular Arrhythmias for Patients with Atrial Fibrillation – A Nationwide Cohort Study

Risk and Prediction of Sudden Cardiac Death and Ventricular Arrhythmias for Patients with Atrial Fibrillation – A Nationwide Cohort Study

Sudden Cardiac Death in Patients With Atrial Fibrillation: Insights From the ENGAGE AF‐TIMI 48 Trial

Racial Differences in Incident Atrial Fibrillation Among Hypertensive Patients During Antihypertensive Therapy

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