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Atrial fibrillation is associated with sudden cardiac death: a systematic review and meta-analysis

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Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusions

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.

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Abbreviations

AF:

Atrial fibrillation

ARIC:

Atherosclerosis Risk in Communities

CHART-2:

Chronic Heart Failure Analysis and Registry in the Tohoku District-2 registry in Japan

CHS:

Cardiovascular Health Study

ENGAGE AF-TIMI 48:

Effective Anticoagulation with Factor Xa Next Generation in Atrial Fibrillation Thrombolysis in Myocardial Infarction 48 Trial

HCM:

Hypertrophic cardiomyopathy

ICD:

Implantable cardioverter-defibrillator

MUSIC:

Muerte Subita en Insuficiencia Cardiaca registry

SCA:

Sudden cardiac arrest

SCD:

Sudden cardiac death

SOLVD:

Studies of Left Ventricular Dysfunction Trials

sVT:

Sustained ventricular tachycardia

VF:

Ventricular fibrillation

WHO:

World Health Organization

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Author notes

  1. Sikarin Upala and Eugene H Chung contributed equally to this work.

Authors and Affiliations

  1. University of Hawaii Internal Medicine Residency Program, Honolulu, HI, USA

    Pattara Rattanawong, Tanawan Riangwiwat & Veeravich Jaruvongvanich

  2. Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand

    Pattara Rattanawong & Wasawat Vutthikraivit

  3. Section of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Chicago, Chicago, IL, USA

    Sikarin Upala

  4. Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

    Sikarin Upala & Anawin Sanguankeo

  5. Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Anawin Sanguankeo

  6. Department of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA

    Wasawat Vutthikraivit

  7. Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA

    Eugene H. Chung

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  1. Pattara Rattanawong
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Contributions

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.

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Rattanawong, P., Upala, S., Riangwiwat, T. et al. Atrial fibrillation is associated with sudden cardiac death: a systematic review and meta-analysis. J Interv Card Electrophysiol 51, 91–104 (2018). https://doi.org/10.1007/s10840-017-0308-9

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