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Sudden Cardiac Death in Patients With Atrial Fibrillation: Insights From the ENGAGE AF‐TIMI 48 Trial

BACKGROUND: 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. METHODS AND RESULTS: SCD was defined as witnessed death ≤60 minutes from the o...

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Autores principales: Eisen, Alon, Ruff, Christian T., Braunwald, Eugene, Nordio, Francesco, Corbalán, Ramón, Dalby, Anthony, Dorobantu, Maria, Mercuri, Michele, Lanz, Hans, Rutman, Howard, Wiviott, Stephen D., Antman, Elliott M., Giugliano, Robert P.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5015407/
https://www.ncbi.nlm.nih.gov/pubmed/27402235
http://dx.doi.org/10.1161/JAHA.116.003735
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author Eisen, Alon
Ruff, Christian T.
Braunwald, Eugene
Nordio, Francesco
Corbalán, Ramón
Dalby, Anthony
Dorobantu, Maria
Mercuri, Michele
Lanz, Hans
Rutman, Howard
Wiviott, Stephen D.
Antman, Elliott M.
Giugliano, Robert P.
author_facet Eisen, Alon
Ruff, Christian T.
Braunwald, Eugene
Nordio, Francesco
Corbalán, Ramón
Dalby, Anthony
Dorobantu, Maria
Mercuri, Michele
Lanz, Hans
Rutman, Howard
Wiviott, Stephen D.
Antman, Elliott M.
Giugliano, Robert P.
author_sort Eisen, Alon
collection PubMed
description BACKGROUND: 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. METHODS AND RESULTS: 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; P (interaction)=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). CONCLUSION: 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. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00781391.
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spelling pubmed-50154072016-09-19 Sudden Cardiac Death in Patients With Atrial Fibrillation: Insights From the ENGAGE AF‐TIMI 48 Trial Eisen, Alon Ruff, Christian T. Braunwald, Eugene Nordio, Francesco Corbalán, Ramón Dalby, Anthony Dorobantu, Maria Mercuri, Michele Lanz, Hans Rutman, Howard Wiviott, Stephen D. Antman, Elliott M. Giugliano, Robert P. J Am Heart Assoc Original Research BACKGROUND: 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. METHODS AND RESULTS: 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; P (interaction)=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). CONCLUSION: 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. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00781391. John Wiley and Sons Inc. 2016-07-08 /pmc/articles/PMC5015407/ /pubmed/27402235 http://dx.doi.org/10.1161/JAHA.116.003735 Text en © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs (http://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Research
Eisen, Alon
Ruff, Christian T.
Braunwald, Eugene
Nordio, Francesco
Corbalán, Ramón
Dalby, Anthony
Dorobantu, Maria
Mercuri, Michele
Lanz, Hans
Rutman, Howard
Wiviott, Stephen D.
Antman, Elliott M.
Giugliano, Robert P.
Sudden Cardiac Death in Patients With Atrial Fibrillation: Insights From the ENGAGE AF‐TIMI 48 Trial
title Sudden Cardiac Death in Patients With Atrial Fibrillation: Insights From the ENGAGE AF‐TIMI 48 Trial
title_full Sudden Cardiac Death in Patients With Atrial Fibrillation: Insights From the ENGAGE AF‐TIMI 48 Trial
title_fullStr Sudden Cardiac Death in Patients With Atrial Fibrillation: Insights From the ENGAGE AF‐TIMI 48 Trial
title_full_unstemmed Sudden Cardiac Death in Patients With Atrial Fibrillation: Insights From the ENGAGE AF‐TIMI 48 Trial
title_short Sudden Cardiac Death in Patients With Atrial Fibrillation: Insights From the ENGAGE AF‐TIMI 48 Trial
title_sort sudden cardiac death in patients with atrial fibrillation: insights from the engage af‐timi 48 trial
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5015407/
https://www.ncbi.nlm.nih.gov/pubmed/27402235
http://dx.doi.org/10.1161/JAHA.116.003735
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