title: The association between atrial fibrillation and sudden cardiac death: the relevance of heart failure.
abstract: OBJECTIVE
  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.
authors: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
authors: Kyndaron
authors: K
authors: Reinier
authors: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California; Paris Cardiovascular Research Center, Paris, France.
authors: Eloi
authors: E
authors: Marijon
authors: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
authors: Audrey
authors: A
authors: Uy-Evanado
authors: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
authors: Carmen
authors: C
authors: Teodorescu
authors: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
authors: Kumar
authors: K
authors: Narayanan
authors: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
authors: Harpriya
authors: H
authors: Chugh
authors: Department of Pathology, Oregon Health and Science University, Portland, Oregon.
authors: Karen
authors: K
authors: Gunson
authors: Department of Emergency Medicine, Oregon Health and Science University, Portland, Oregon.
authors: Jonathan
authors: J
authors: Jui
authors: The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California. Electronic address: sumeet.chugh@cshs.org.
authors: Sumeet S
authors: SS
authors: Chugh
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000209:etiology*; D016022:Case-Control Studies; D016757:Death, Sudden, Cardiac / Q000453:epidemiology / Q000209:etiology*; D003925:Diabetic Angiopathies / Q000150:complications / Q000453:epidemiology; D004812:Epidemiologic Methods; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000150:complications / Q000453:epidemiology; D009922:Oregon / Q000453:epidemiology; D011446:Prospective Studies; D020521:Stroke / Q000150:complications / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000453:epidemiology
keywords: arrhythmia; cardiac arrest; diastolic; ejection fraction; ventricular fibrillation