title: Sudden Cardiac Death in Patients With Atrial Fibrillation: Insights From the ENGAGE AF-TIMI 48 Trial.
abstract: Recent findings suggest that atrial fibrillation is associated with sudden cardiac death (SCD). We examined the incidence, characteristics, and factors associated with SCD in patients with atrial fibrillation.
  
  
  
  SCD was defined as witnessed death ≤60 minutes from the onset of new symptoms or unwitnessed death 1 to 24 hours after being observed alive, without another known cause of death. Predictors of SCD were examined using multivariate competing risks models. Over 2.8 years (median), 2349 patients died (40.5 per 1000 patient-years), of which 1668 (71%) were cardiovascular deaths. SCD was the most common cause of cardiovascular death (n=749; median age 73 years; 70.6% male). Most SCD events occurred out of hospital (92.8%) and without prior symptoms (66.0%). Predictors of SCD included low ejection fraction, heart failure, and prior myocardial infarction (P<0.001 for each). Additional significant baseline predictors of SCD, but not of other causes of death, included male sex, electrocardiographic left ventricular hypertrophy, higher heart rate, nonuse of beta blockers, and use of digitalis. The latter was associated with SCD in patients with or without heart failure (adjusted hazard ratio 1.55 [95% CI 1.29-1.86] and 1.56 [95% CI 1.14-2.11], respectively; Pinteraction=0.73). The rate of SCD was numerically but not statistically lower with edoxaban (1.20% per year with lower dose edoxaban; 1.28% per year with higher dose edoxaban) compared with warfarin (1.40% per year).
  
  
  
  SCD is the most common cause of cardiovascular death in patients with atrial fibrillation and has several distinct predictors, some of which are modifiable. These findings may be considered in planning research and treatment strategies for patients with atrial fibrillation.
  
  
  
  URL: https://www.clinicaltrials.gov. Unique identifier: NCT00781391.
authors.affiliation: TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA Department of Medicine, Harvard Medical School, Boston, MA.
authors.forename: Alon
authors.initials: A
authors.lastname: Eisen
authors.affiliation: TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA Department of Medicine, Harvard Medical School, Boston, MA.
authors.forename: Christian T
authors.initials: CT
authors.lastname: Ruff
authors.affiliation: TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA Department of Medicine, Harvard Medical School, Boston, MA.
authors.forename: Eugene
authors.initials: E
authors.lastname: Braunwald
authors.affiliation: TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA Department of Medicine, Harvard Medical School, Boston, MA.
authors.forename: Francesco
authors.initials: F
authors.lastname: Nordio
authors.affiliation: Hospital Clinico Pontificia Universidad Catolica de Chile, Santiago, Chile.
authors.forename: Ramón
authors.initials: R
authors.lastname: Corbalán
authors.affiliation: Milpark Hospital, Johannesburg, South Africa.
authors.forename: Anthony
authors.initials: A
authors.lastname: Dalby
authors.affiliation: Emergency Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
authors.forename: Maria
authors.initials: M
authors.lastname: Dorobantu
authors.affiliation: Daiichi-Sankyo, Parsippany, NJ.
authors.forename: Michele
authors.initials: M
authors.lastname: Mercuri
authors.affiliation: Daiichi-Sankyo, Parsippany, NJ.
authors.forename: Hans
authors.initials: H
authors.lastname: Lanz
authors.affiliation: Daiichi-Sankyo, Parsippany, NJ.
authors.forename: Howard
authors.initials: H
authors.lastname: Rutman
authors.affiliation: TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA Department of Medicine, Harvard Medical School, Boston, MA.
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Wiviott
authors.affiliation: TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA Department of Medicine, Harvard Medical School, Boston, MA.
authors.forename: Elliott M
authors.initials: EM
authors.lastname: Antman
authors.affiliation: TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA Department of Medicine, Harvard Medical School, Boston, MA rgiugliano@partners.org.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Giugliano
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology*; D002316:Cardiotonic Agents / Q000627:therapeutic use; D016757:Death, Sudden, Cardiac / Q000453:epidemiology*; D004071:Digitalis Glycosides / Q000627:therapeutic use; D065427:Factor Xa Inhibitors / Q000627:therapeutic use; D005260:Female; D006333:Heart Failure / Q000453:epidemiology* / Q000503:physiopathology; D006339:Heart Rate; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000453:epidemiology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000453:epidemiology*; D058687:Out-of-Hospital Cardiac Arrest / Q000453:epidemiology*; D016016:Proportional Hazards Models; D065840:Protective Factors; D011725:Pyridines / Q000627:therapeutic use; D012307:Risk Factors; D013318:Stroke Volume; D013844:Thiazoles / Q000627:therapeutic use
chemical_list: D000319:Adrenergic beta-Antagonists; D002316:Cardiotonic Agents; D004071:Digitalis Glycosides; D065427:Factor Xa Inhibitors; D011725:Pyridines; D013844:Thiazoles; C552171:edoxaban
keywords: atrial fibrillation; sudden cardiac death