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

Kyndaron Reinier, Eloi Marijon, Audrey Uy-Evanado, Carmen Teodorescu, Kumar Narayanan, Harpriya Chugh, Karen Gunson, Jonathan Jui, Sumeet S. Chugh

Research output: Contribution to journalArticle

32 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)221-227
Number of pages7
JournalJACC: Heart Failure
Volume2
Issue number3
DOIs
Publication statusPublished - 2014

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Keywords

  • Arrhythmia
  • Cardiac arrest
  • Diastolic
  • Ejection fraction
  • Ventricular fibrillation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Reinier, K., Marijon, E., Uy-Evanado, A., Teodorescu, C., Narayanan, K., Chugh, H., ... Chugh, S. S. (2014). The association between atrial fibrillation and sudden cardiac death: The relevance of heart failure. JACC: Heart Failure, 2(3), 221-227. https://doi.org/10.1016/j.jchf.2013.12.006