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JACC Heart Fail. 2014 Jun;2(3):221-7. doi: 10.1016/j.jchf.2013.12.006. Epub 2014 Apr 30.

The association between atrial fibrillation and sudden cardiac death: the relevance of heart failure.

Author information

1
The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
2
The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; Paris Cardiovascular Research Center, Paris, France.
3
Department of Pathology, Oregon Health and Science University, Portland, Oregon.
4
Department of Emergency Medicine, Oregon Health and Science University, Portland, Oregon.
5
The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California. Electronic address: sumeet.chugh@cshs.org.

Abstract

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.

KEYWORDS:

arrhythmia; cardiac arrest; diastolic; ejection fraction; ventricular fibrillation

PMID:
24952687
DOI:
10.1016/j.jchf.2013.12.006
[Indexed for MEDLINE]
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