{"id":34145,"date":"2013-01-14T16:05:41","date_gmt":"2013-01-14T21:05:41","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=news&#038;p=34145"},"modified":"2013-01-14T16:05:41","modified_gmt":"2013-01-14T21:05:41","slug":"atrial-fibrillation-linked-to-increased-risk-for-sudden-cardiac-death","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2013\/01\/14\/atrial-fibrillation-linked-to-increased-risk-for-sudden-cardiac-death\/","title":{"rendered":"Atrial Fibrillation Linked to Increased Risk for Sudden Cardiac Death"},"content":{"rendered":"<p>Although atrial fibrillation (AF) is well known to be associated with an increase in the risk of stroke and coronary heart disease, a similar association with sudden cardiac death (SCD) has been suspected but not demonstrated in the past. Now, a new study examining data from two large population studies offers evidence that AF is also an independent risk factor for SCD.<\/p>\n<p>In <a href=\"http:\/\/archinte.jamanetwork.com\/article.aspx?articleid=1399855\">a paper published in\u00a0<em>JAMA Internal Medicine<\/em><\/a>\u00a0(formerly\u00a0<em>Archives of Internal Medicine)<\/em>, Lin Chen and colleagues analyzed data from 15,439 participants in the\u00a0Atherosclerosis Risk in Communities (ARIC) Study and 5,479 participants in the Cardiovascular Health Study (CHS). The analysis shows that AF patients were at significantly elevated risk for SCD.\u00a0The increase in SCD was roughly similar to the expected increase in nonsudden cardiac death.<\/p>\n<p>SCD hazard ratios adjusted for risk factors:<\/p>\n<ul>\n<li>ARIC: 3.26 (CI 2.17-4.91), p&lt;0.001<\/li>\n<li>CHS: 2.14 (CI 1.60-2.87), p&lt;0.001<\/li>\n<li>Combined: 2.47 (CI 1.95-3.13), p&lt;0.001<\/li>\n<\/ul>\n<p>The authors concluded that their finding, if confirmed, &#8220;adds to our evolving understanding that AF is not a benign condition. Not only does AF predispose to stroke, heart failure, and death, but the arrhythmia per se may increase the risk of death from ventricular tachyarrhythmias.&#8221;<\/p>\n<p><a href=\"http:\/\/archinte.jamanetwork.com\/article.aspx?articleid=1399868\">In an invited commentary<\/a>, \u00a0Kyndaron Reinier and Sumeet Chugh write that despite the statistical adjustments the study may have been unable to demonstrate a cause-and-effect relationship between AF and SCD, since the findings &#8220;may be due to shared risk factors.&#8221;\u00a0They also point out that some of the SCD cases may have been really caused by a cerebrovascular accident.<\/p>\n<p>They urge caution regarding attempts to apply the findings of the study to clinical practice:<\/p>\n<blockquote><p>&#8220;&#8230;it is important that we are cautious about extending these findings into the clinical domain. Until such time that a causal association is confirmed between AF and SCD,\u00a0it is difficult for these results to influence clinical management of AF or SCD. Whether it is control of the heart rate, control of the rhythm, or stroke prophylaxis, present management of the patient with AF should be governed largely by current evidence-based guidelines aimed at reduction of AF symptoms and hospitalization and the need\u00a0to minimize risk of future cerebrovascular accidents.&#8221;<\/p><\/blockquote>\n","protected":false},"excerpt":{"rendered":"<p>Although atrial fibrillation (AF) is well known to be associated with an increase in the risk of stroke and coronary heart disease, a similar association with sudden cardiac death (SCD) has been suspected but not demonstrated in the past. Now, a new study examining data from two large population studies offers evidence that AF is [&hellip;]<\/p>\n","protected":false},"author":196,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[13,1],"tags":[365,341,898,897],"class_list":["post-34145","post","type-post","status-publish","format-standard","hentry","category-electrophysiology","category-general","tag-af","tag-atrial-fibrillation","tag-scd","tag-sudden-cardiac-death"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/34145","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/196"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=34145"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/34145\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=34145"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=34145"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=34145"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}