TY - JOUR
T1 - The association between atrial fibrillation and sudden cardiac death
T2 - The relevance of heart failure
AU - Reinier, Kyndaron
AU - Marijon, Eloi
AU - Uy-Evanado, Audrey
AU - Teodorescu, Carmen
AU - Narayanan, Kumar
AU - Chugh, Harpriya
AU - Gunson, Karen
AU - Jui, Jonathan
AU - Chugh, Sumeet S.
N1 - Funding Information:
Dr. Marijon is funded by research grant support from the Bettencourt Schueller Foundation , the Philip Foundation , French Federation of Cardiology , and the French National Institute of Health and Medical Research . Dr. Chugh is the Pauline and Harold Price Professor of Cardiac Electrophysiology at the Heart Institute, Cedars-Sinai Medical Center. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
PY - 2014/6
Y1 - 2014/6
N2 - Objectives: The purpose of this study was to evaluate the role of congestive heart failure (CHF) in the association between atrial fibrillation (AF) and sudden cardiac death (SCD). Background: Recent studies have reported the possibility of an independent association between AF and SCD. We hypothesized that a history of CHF is a significant confounder of this association. Methods: In a prospective case-control analysis from the community (The Oregon-SUDS [Sudden Unexpected Death Study], 2002 to 2012), SCD cases (n = 652) with clinical records available (including electrocardiography and/or echocardiography) were compared with age- and sex-matched control patients with coronary artery disease. The association between AF and SCD was analyzed using multivariable logistic regression and propensity score matching. Results: Cases (age 67.3 ± 11.7 years, 65% male) were more likely than control patients (age 67.2 ± 11.4 years, 65% male) to have a history of AF (p = 0.0001), myocardial infarction (p = 0.007), CHF (p < 0.0001), stroke (p < 0.0001), and diabetes (p < 0.0001). In multivariate analysis without considering CHF, AF was a significant predictor of SCD (odds ratio [OR]: 1.6; 95% confidence interval [CI]: 1.2 to 2.0; p = 0.002). However, in a model that included CHF, the AF-SCD association was no longer significant (OR: 1.1; 95% CI: 0.8 to 1.5; p = 0.45), whereas CHF was a significant predictor of SCD (OR: 3.1; 95% CI: 2.4 to 4.1; p < 0.0001). Results on the basis of propensity score matching were consistent. Conclusions: Our findings suggest that a history of CHF, including both systolic and diastolic symptomatic dysfunction, may partially explain the AF-SCD association.
AB - Objectives: The purpose of this study was to evaluate the role of congestive heart failure (CHF) in the association between atrial fibrillation (AF) and sudden cardiac death (SCD). Background: Recent studies have reported the possibility of an independent association between AF and SCD. We hypothesized that a history of CHF is a significant confounder of this association. Methods: In a prospective case-control analysis from the community (The Oregon-SUDS [Sudden Unexpected Death Study], 2002 to 2012), SCD cases (n = 652) with clinical records available (including electrocardiography and/or echocardiography) were compared with age- and sex-matched control patients with coronary artery disease. The association between AF and SCD was analyzed using multivariable logistic regression and propensity score matching. Results: Cases (age 67.3 ± 11.7 years, 65% male) were more likely than control patients (age 67.2 ± 11.4 years, 65% male) to have a history of AF (p = 0.0001), myocardial infarction (p = 0.007), CHF (p < 0.0001), stroke (p < 0.0001), and diabetes (p < 0.0001). In multivariate analysis without considering CHF, AF was a significant predictor of SCD (odds ratio [OR]: 1.6; 95% confidence interval [CI]: 1.2 to 2.0; p = 0.002). However, in a model that included CHF, the AF-SCD association was no longer significant (OR: 1.1; 95% CI: 0.8 to 1.5; p = 0.45), whereas CHF was a significant predictor of SCD (OR: 3.1; 95% CI: 2.4 to 4.1; p < 0.0001). Results on the basis of propensity score matching were consistent. Conclusions: Our findings suggest that a history of CHF, including both systolic and diastolic symptomatic dysfunction, may partially explain the AF-SCD association.
KW - Arrhythmia
KW - Cardiac arrest
KW - Diastolic
KW - Ejection fraction
KW - Ventricular fibrillation
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U2 - 10.1016/j.jchf.2013.12.006
DO - 10.1016/j.jchf.2013.12.006
M3 - Article
C2 - 24952687
AN - SCOPUS:84901689713
SN - 2213-1779
VL - 2
SP - 221
EP - 227
JO - JACC: Heart Failure
JF - JACC: Heart Failure
IS - 3
ER -