Atrial fibrillation is associated with sudden cardiac death: a systematic review and meta-analysis
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Recent studies suggest that atrial fibrillation (AF) is associated with increased cardiovascular risk and mortality including sudden cardiac death (SCD). According to the Cardiovascular Heath Study cohort, the incident rate of SCD was higher in the AF population (2.9 per 1000 per year) compared with non-AF controls (1.3 per 1000 per year). In this study, we performed a systematic review and meta-analysis to explore the association between AF and SCD.
We comprehensively searched the databases of MEDLINE and EMBASE from inception to January 2017. Included studies were published prospective or retrospective cohort studies that compared the risk of developing SCD, defined by World Health Organization’s criteria, in AF patients versus non-AF patients. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate the risk ratios and 95% confidence intervals.
Twenty-seven studies from January 1991 to February 2017 involving 8401 AF patients and 67,608 non-AF controls were included in this meta-analysis. Compared with controls, AF patients had a significantly higher risk of SCD in overall analysis (pooled risk ratio = 2.04, 95% confidence interval: 1.77–2.35, p < 0.01, I2 = 42.66) as well as subgroups of general population studies, previous myocardial infarction or coronary artery disease, heart failure, hypertrophic cardiomyopathy (HCM), Brugada syndrome, and patients with either a pacemaker or implantable cardioverter defibrillator (ICD). In subgroup analysis of multivariate-adjusted studies, AF also had a significantly higher risk of SCD (pooled risk ratio = 2.22, 95% confidence interval = 1.59–3.09, p < 0.01, I2 = 73.95). Incident rate of SCD in AF was 2-fold higher than controls but not statistically significant (pooled rate ratio = 2.06, 95% confidence interval = 0.66–7.53, p = 0.292, I2 = 88.58).
Our meta-analysis demonstrates a statistically significant increased risk of SCD with AF in the general population and in those with previous myocardial infarction, coronary artery disease, heart failure, HCM, Brugada syndrome, and an implanted rhythm device.
KeywordsAtrial fibrillation Sudden cardiac death
Atherosclerosis Risk in Communities
Chronic Heart Failure Analysis and Registry in the Tohoku District-2 registry in Japan
Cardiovascular Health Study
- ENGAGE AF-TIMI 48
Effective Anticoagulation with Factor Xa Next Generation in Atrial Fibrillation Thrombolysis in Myocardial Infarction 48 Trial
Muerte Subita en Insuficiencia Cardiaca registry
Sudden cardiac arrest
Sudden cardiac death
Studies of Left Ventricular Dysfunction Trials
Sustained ventricular tachycardia
World Health Organization
Pattara Rattanawong is responsible for conception design, data interpretation, and manuscript drafting. Sikarin Upala is responsible for statistical analysis, manuscript revision, final approval, and corresponding. Tanawan Riangwiwat is responsible for data acquisition and data interpretation. Veeravich Jaruvongvanich is responsible for data acquisition and manuscript drafting. Anawin Sanguankeo is responsible for data acquisition and statistic analysis. Wasawat Vutthikraivit is responsible for data interpretation and manuscript drafting. Eugene H Chung is responsible for manuscript revision and critical reading.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
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