Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Journal of Interventional Cardiac Electrophysiology
Published in: Journal of Interventional Cardiac Electrophysiology 2/2018

01-03-2018 | MULTIMEDIA REPORT

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

Authors: Pattara Rattanawong, Sikarin Upala, Tanawan Riangwiwat, Veeravich Jaruvongvanich, Anawin Sanguankeo, Wasawat Vutthikraivit, Eugene H. Chung

Published in: Journal of Interventional Cardiac Electrophysiology | Issue 2/2018

Login to get access

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.
Appendix
Available only for authorised users
Literature
1.
2.
Chugh SS, Havmoeller R, Narayanan K, Singh D, Rienstra M, Benjamin EJ, et al. Worldwide epidemiology of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation. 2014;129(8):837–47.CrossRefPubMed
3.
Chen LY, Sotoodehnia N, Buzkova P, Lopez FL, Yee LM, Heckbert SR, et al. Atrial fibrillation and the risk of sudden cardiac death: the atherosclerosis risk in communities study and cardiovascular health study. JAMA Intern Med. 2013;173(1):29–35.CrossRefPubMedPubMedCentral
4.
Eisen A, Ruff CT, Braunwald E, Nordio F, Corbalan R, Dalby A, et al. Sudden cardiac death in patients with atrial fibrillation: insights from the ENGAGE AFTIMI 48 trial. J Am Heart Assoc. 2016;5(7).
5.
Reinier K, Marijon E, Uy-Evanado A, Teodorescu C, Narayanan K, Chugh H, et al. The association between atrial fibrillation and sudden cardiac death: the relevance of heart failure. JACC Heart Fail. 2014;2(3):221–7.CrossRefPubMed
6.
7.
Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25(9):603–5.CrossRefPubMed
8.
9.
10.
Sterne JA, Egger M. Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis. J Clin Epidemiol. 2001;54(10):1046–55.CrossRefPubMed
11.
Patsopoulos NA, Evangelou E, Ioannidis JP. Sensitivity of between-study heterogeneity in meta-analysis: proposed metrics and empirical evaluation. Int J Epidemiol. 2008;37(5):1148–57.CrossRefPubMed
12.
Al-Zaiti SS, Fallavollita JA, Canty JM Jr, Carey MG. Electrocardiographic predictors of sudden and non-sudden cardiac death in patients with ischemic cardiomyopathy. Heart Lung. 2014;43(6):527–33.CrossRefPubMedPubMedCentral
13.
Algra A, Tijssen JG, Roelandt JR, Pool J, Lubsen J. Contribution of the 24 hour electrocardiogram to the prediction of sudden coronary death. Br Heart J. 1993;70(5):421–7.CrossRefPubMedPubMedCentral
14.
Berton G, Cordiano R, Cucchini F, Cavuto F, Pellegrinet M, Palatini P. Atrial fibrillation during acute myocardial infarction: association with all-cause mortality and sudden death after 7-year of follow-up. Int J Clin Pract. 2009;63(5):712–21.CrossRefPubMed
15.
Calo L, Giustetto C, Martino A, Sciarra L, Cerrato N, Marziali M, et al. A new electrocardiographic marker of sudden death in Brugada syndrome: the s-wave in lead I. J Am Coll Cardiol. 2016;67(12):1427–40.CrossRefPubMed
16.
Deo R, Vittinghoff E, Lin F, Tseng ZH, Hulley SB, Shlipak MG. Risk factor and prediction modeling for sudden cardiac death in women with coronary artery disease. Arch Intern Med. 2011;171(19):1703–9.CrossRefPubMedPubMedCentral
17.
Genovesi S, Valsecchi MG, Rossi E, Pogliani D, Acquistapace I, De Cristofaro V, et al. Sudden death and associated factors in a historical cohort of chronic haemodialysis patients. Nephrol Dial Transplant. 2009;24(8):2529–36.CrossRefPubMed
18.
Giustetto C, Cerrato N, Gribaudo E, Scrocco C, Castagno D, Richiardi E, et al. Atrial fibrillation in a large population with Brugada electrocardiographic pattern: prevalence, management, and correlation with prognosis. Heart Rhythm. 2014;11(2):259–65.CrossRefPubMed
19.
Grimm W, Hoffmann JJ, Muller HH, Maisch B. Implantable defibrillator event rates in patients with idiopathic dilated cardiomyopathy, nonsustained ventricular tachycardia on Holter and a left ventricular ejection fraction below 30%. J Am Coll Cardiol. 2002;39(5):780–7.CrossRefPubMed
20.
Gronefeld GC, Mauss O, Li YG, Klingenheben T, Hohnloser SH. Association between atrial fibrillation and appropriate implantable cardioverter defibrillator therapy: results from a prospective study. J Cardiovasc Electrophysiol. 2000;11(11):1208–14.CrossRefPubMed
21.
Kofflard MJ, Ten Cate FJ, van der Lee C, van Domburg RT. Hypertrophic cardiomyopathy in a large community-based population: clinical outcome and identification of risk factors for sudden cardiac death and clinical deterioration. J Am Coll Cardiol. 2003;41(6):987–93.CrossRefPubMed
22.
Marijon E, Trinquart L, Otmani A, Waintraub X, Kacet S, Clementy J, et al. Competing risk analysis of cause-specific mortality in patients with an implantable cardioverter-defibrillator: the EVADEF cohort study. Am Heart J. 2009;157(2):391–7.e1.CrossRefPubMed
23.
Mazzanti A, Ng K, Faragli A, Maragna R, Chiodaroli E, Orphanou N, et al. Arrhythmogenic right ventricular cardiomyopathy: clinical course and predictors of arrhythmic risk. J Am Coll Cardiol. 2016;68(23):2540–50.CrossRefPubMed
24.
Middlekauff HR, Stevenson WG, Stevenson LW. Prognostic significance of atrial fibrillation in advanced heart failure. A study of 390 patients. Circulation. 1991;84(1):40–8.CrossRefPubMed
25.
Minami Y, Haruki S, Yashiro B, Suzuki T, Ashihara K, Hagiwara N. Enlarged left atrium and sudden death risk in hypertrophic cardiomyopathy patients with or without atrial fibrillation. J Cardiol. 2016;68(6):478–84.CrossRefPubMed
26.
Mosterd A, Cost B, Hoes AW, de Bruijne MC, Deckers JW, Hofman A, et al. The prognosis of heart failure in the general population: the Rotterdam Study. Eur Heart J. 2001;22(15):1318–27.CrossRefPubMed
27.
Okin PM, Bang CN, Wachtell K, Hille DA, Kjeldsen SE, Dahlof B, et al. Relationship of sudden cardiac death to new-onset atrial fibrillation in hypertensive patients with left ventricular hypertrophy. Circ Arrhythm Electrophysiol. 2013;6(2):243–51.CrossRefPubMed
28.
Pedersen OD, Abildstrom SZ, Ottesen MM, Rask-Madsen C, Bagger H, Kober L, et al. Increased risk of sudden and non-sudden cardiovascular death in patients with atrial fibrillation/flutter following acute myocardial infarction. Eur Heart J. 2006;27(3):290–5.CrossRefPubMed
29.
Piccini JP, Zhang M, Pieper K, Solomon SD, Al-Khatib SM, Van de Werf F, et al. Predictors of sudden cardiac death change with time after myocardial infarction: results from the VALIANT trial. Eur Heart J. 2010;31(2):211–21.CrossRefPubMed
30.
Satake H, Fukuda K, Sakata Y, Miyata S, Nakano M, Kondo M, et al. Current status of primary prevention of sudden cardiac death with implantable cardioverter defibrillator in patients with chronic heart failure--a report from the CHART-2 Study. Circ J. 2015;79(2):381–90.CrossRefPubMed
31.
Sorajja P, Ommen SR, Nishimura RA, Gersh BJ, Berger PB, Tajik AJ. Adverse prognosis of patients with hypertrophic cardiomyopathy who have epicardial coronary artery disease. Circulation. 2003;108(19):2342–8.CrossRefPubMed
32.
Tereshchenko LG, McNitt S, Han L, Berger RD, Zareba W. ECG marker of adverse electrical remodeling post-myocardial infarction predicts outcomes in MADIT II study. PLoS One. 2012;7(12):e51812.CrossRefPubMedPubMedCentral
33.
Tokioka K, Kusano KF, Morita H, Miura D, Nishii N, Nagase S, et al. Electrocardiographic parameters and fatal arrhythmic events in patients with Brugada syndrome: combination of depolarization and repolarization abnormalities. J Am Coll Cardiol. 2014;63(20):2131–8.CrossRefPubMed
34.
Urena M, Webb JG, Eltchaninoff H, Munoz-Garcia AJ, Bouleti C, Tamburino C, et al. Late cardiac death in patients undergoing transcatheter aortic valve replacement: incidence and predictors of advanced heart failure and sudden cardiac death. J Am Coll Cardiol. 2015;65(5):437–48.CrossRefPubMed
35.
Vazquez R, Bayes-Genis A, Cygankiewicz I, Pascual-Figal D, Grigorian-Shamagian L, Pavon R, et al. The MUSIC Risk score: a simple method for predicting mortality in ambulatory patients with chronic heart failure. Eur Heart J. 2009;30(9):1088–96.CrossRefPubMed
36.
Yashiro B, Minami Y, Terajima Y, Hagiwara N. Prognostic difference between paroxysmal and non-paroxysmal atrial fibrillation in patients with hypertrophic cardiomyopathy. J Cardiol. 2014;63(6):432–7.CrossRefPubMed
37.
Zehender M, Buchner C, Meinertz T, Just H. Prevalence, circumstances, mechanisms, and risk stratification of sudden cardiac death in unipolar singlechamber ventricular pacing. Circulation. 1992;85(2):596–605.CrossRefPubMed
38.
Chen LY, Benditt DG, Alonso A. Atrial fibrillation and its association with sudden cardiac death. Circ J. 2014;78(11):2588–93.CrossRefPubMed
39.
Bardai A, Blom MT, van Hoeijen DA, van Deutekom HW, Brouwer HJ, Tan HL. Atrial fibrillation is an independent risk factor for ventricular fibrillation: a largescale population-based case-control study. Circ Arrhythm Electrophysiol. 2014;7(6):1033–9.CrossRefPubMed
40.
Chugh SS, Reinier K, Teodorescu C, Evanado A, Kehr E, Al Samara M, et al. Epidemiology of sudden cardiac death: clinical and research implications. Prog Cardiovasc Dis. 2008;51(3):213–28.CrossRefPubMedPubMedCentral
41.
Roy D, Brugada P, Wellens HJ. Atrial tachycardia facilitating initiation of ventricular tachycardia. Pacing Clin Electrophysiol. 1983;6(1 Pt 1):47–52.CrossRefPubMed
42.
Stein KM, Euler DE, Mehra R, Seidl K, Slotwiner DJ, Mittal S, et al. Do atrial tachyarrhythmias beget ventricular tachyarrhythmias in defibrillator recipients? J Am Coll Cardiol. 2002;40(2):335–40.CrossRefPubMed
43.
Suzuki M, Hirayama T, Marumoto K, Okayama H, Iwata T. Paroxysmal atrial fibrillation as a cause of potentially lethal ventricular arrhythmia with myocardial ischemia in hypertrophic cardiomyopathy--a case report. Angiology. 1998;49(8):653–7.CrossRefPubMed
44.
Farshi R, Kistner D, Sarma JS, Longmate JA, Singh BN. Ventricular rate control in chronic atrial fibrillation during daily activity and programmed exercise: a crossover open-label study of five drug regimens. J Am Coll Cardiol. 1999;33(2):304–10.CrossRefPubMed
45.
Blitzer M, Costeas C, Kassotis J, Reiffel JA. Rhythm management in atrial fibrillation--with a primary emphasis on pharmacological therapy: part 1. Pacing Clin Electrophysiol. 1998;21(3):590–602.CrossRefPubMed
46.
Garcia-Alberola A, Yli-Mayry S, Block M, Haverkamp W, Martinez-Rubio A, Kottkamp H, et al. RR interval variability in irregular monomorphic ventricular tachycardia and atrial fibrillation. Circulation. 1996;93(2):295–300.CrossRefPubMed
47.
Cranefield PF, Aronson RS. Torsade de pointes and other pause-induced ventricular tachycardias: the short-long-short sequence and early after depolarizations. Pacing Clin Electrophysiol. 1988;11(6 Pt 1):670–8.CrossRefPubMed
48.
Rienstra M, Smit MD, Nieuwland W, Tan ES, Wiesfeld AC, Anthonio RL, et al. Persistent atrial fibrillation is associated with appropriate shocks and heart failure in patients with left ventricular dysfunction treated with an implantable cardioverter defibrillator. Am Heart J. 2007;153(1):120–6.CrossRefPubMed
49.
Zareba W, Steinberg JS, McNitt S, Daubert JP, Piotrowicz K, Moss AJ, et al. Implantable cardioverter-defibrillator therapy and risk of congestive heart failure or death in MADIT II patients with atrial fibrillation. Heart Rhythm. 2006;3(6):631–7.CrossRefPubMed
50.
Marijon E, Le Heuzey JY, Connolly S, Yang S, Pogue J, Brueckmann M, et al. Causes of death and influencing factors in patients with atrial fibrillation: a competing-risk analysis from the randomized evaluation of long-term anticoagulant therapy study. Circulation. 2013;128(20):2192–201.CrossRefPubMed
51.
Odutayo A, Wong CX, Hsiao AJ, Hopewell S, Altman DG, Emdin CA. Atrial fibrillation and risks of cardiovascular disease, renal disease, and death: systematic review and meta-analysis. BMJ. 2016;354:i4482.CrossRefPubMed
52.
Ohsawa M, Okamura T, Ogasawara K, Ogawa A, Fujioka T, Tanno K, et al. Relative and absolute risks of all-cause and cause-specific deaths attributable to atrial fibrillation in middle-aged and elderly community dwellers. Int J Cardiol. 2015;184:692–8.CrossRefPubMed
53.
Baldasseroni S, Orso F, Fabbri G, De Bernardi A, Cirrincione V, Gonzini L, et al. Age-dependent prognostic significance of atrial fibrillation in outpatients with chronic heart failure: data from the Italian Network on Congestive Heart Failure Registry. Cardiology. 2010;116(2):79–88.CrossRefPubMed
54.
Borleffs CJ, van Rees JB, van Welsenes GH, van der Velde ET, van Erven L, Bax JJ, et al. Prognostic importance of atrial fibrillation in implantable cardioverterdefibrillator patients. J Am Coll Cardiol. 2010;55(9):879–85.CrossRefPubMed
55.
Kleemann T, Hochadel M, Strauss M, Skarlos A, Seidl K, Zahn R. Comparison between atrial fibrillation-triggered implantable cardioverter-defibrillator (ICD) shocks and inappropriate shocks caused by lead failure: different impact on prognosis in clinical practice. J Cardiovasc Electrophysiol. 2012;23(7):735–40.CrossRefPubMed
56.
Barold S, Herweg B. Cardiac resynchronization in patients with atrial fibrillation. J Atr Fibrillation. 2015;8(4):1383.PubMedPubMedCentral
57.
Gasparini M, Leclercq C, Lunati M, Landolina M, Auricchio A, Santini M, et al. Cardiac resynchronization therapy in patients with atrial fibrillation: the CERTIFY study (Cardiac Resynchronization Therapy in Atrial Fibrillation Patients Multinational Registry). JACC Heart Fail. 2013;1(6):500–7.CrossRefPubMed
58.
Maron BJ, Shen WK, Link MS, Epstein AE, Almquist AK, Daubert JP, et al. Efficacy of implantable cardioverter-defibrillators for the prevention of sudden death in patients with hypertrophic cardiomyopathy. N Engl J Med. 2000;342(6):365–73.CrossRefPubMed
59.
Robinson K, Frenneaux MP, Stockins B, Karatasakis G, Poloniecki JD, McKenna WJ. Atrial fibrillation in hypertrophic cardiomyopathy: a longitudinal study. J Am Coll Cardiol. 1990;15(6):1279–85.CrossRefPubMed
60.
Siontis KC, Geske JB, Ong K, Nishimura RA, Ommen SR, Gersh BJ. Atrial fibrillation in hypertrophic cardiomyopathy: prevalence, clinical correlations, and mortality in a large high-risk population. J Am Heart Assoc. 2014;3(3):e001002.CrossRefPubMedPubMedCentral
61.
Rodriguez-Manero M, Namdar M, Sarkozy A, Casado-Arroyo R, Ricciardi D, de Asmundis C, et al. Prevalence, clinical characteristics and management of atrial fibrillation in patients with Brugada syndrome. Am J Cardiol. 2013;111(3):362–7.CrossRefPubMed
Metadata
Title
Atrial fibrillation is associated with sudden cardiac death: a systematic review and meta-analysis
Authors
Pattara Rattanawong
Sikarin Upala
Tanawan Riangwiwat
Veeravich Jaruvongvanich
Anawin Sanguankeo
Wasawat Vutthikraivit
Eugene H. Chung
Publication date
01-03-2018
Publisher
Springer US
Published in
Journal of Interventional Cardiac Electrophysiology / Issue 2/2018
Print ISSN: 1383-875X
Electronic ISSN: 1572-8595
DOI
https://doi.org/10.1007/s10840-017-0308-9

Other articles of this Issue 2/2018

Journal of Interventional Cardiac Electrophysiology 2/2018 Go to the issue

OriginalPaper

Multisite cardiac resynchronization therapy for traditional and non-traditional indications

OriginalPaper

Coronary sinus morphology in pediatric patients with supraventricular tachycardia

OriginalPaper

N-3 polyunsaturated fatty acids for prevention of postoperative atrial fibrillation: updated meta-analysis and systematic review

Case Reports

Successful replacement of the longest worldwide in situ Nanostim leadless cardiac pacemaker for a Micra Transcatheter Pacing System

OriginalPaper

Impact of antibiotic prophylaxis on catheter-associated urinary tract infections during atrial fibrillation ablation

OriginalPaper

Efficacy of ultrasound-guided axillary/subclavian venous approaches for pacemaker and defibrillator lead implantation: a randomized study

ACC 2024 Congress Coverage

Year in Review: Heart failure and cardiomyopathies

Heart Failure Video

Watch this official video from ACC.24. Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Watch now

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits