Download Atrial Fibrillation and Sudden Death: Are they linked?

Atrial Fibrillation and Sudden Death:
Are they linked?
Mariell Jessup MD
Professor of Medicine
University of Pennsylvania
Philadelphia, Pennsylvania
AF doubles in incidence with each decade of age, afflicting up to 10% of patients
older than the age of 80 years.
Subanalyses of major primary and secondary prevention ICD trials have all
shown preserved efficacy of ICDs in the elderly.
Heart failure (HF) is one of the most significant factors for patients at risk for
SCD and AF.
AF can be found in up to 40% of patients who have symptomatic HF.
Cardiology Clinics 2009; 27:151
AF affects more than 2 million Americans and 6 million in Europe.
AF in the ICD population leads to special problems, such as the delivery of
inappropriate ICD therapies.
Offers special opportunities for assessing therapy effectiveness by direct
interrogation of AF burden.
Many of the factors that predispose people to AF are the same risk factors that put
them at risk for SCD.
Among patients with HF in
general, AF has not been
consistently shown to
increase mortality.
Specific data on the
additional risk for AF in
patients with ICDs are
limited and conflicting.
Inappropriate shocks comprise 12%
to 30% of all shock
therapies delivered.
Supraventricular tachyarrhythmia is
the most common
independent predictor of
inappropriate shocks, and
of these, AF is the most
frequent type (44%–51%).
AF is sometimes considered as a trigger for ventricular
arrhythmia.
Multiple reports have consistently identified an association
between AF and appropriate ICD therapy.
Atrial Fibrillation and Sudden
Death: Are they linked?
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The same risk factors that lead to AF cause SCD.
AF may confer a higher independent mortality.
The presence of AF in ICD patients is ominous.
Treatment of AF may prompt sudden death.
– Especially with anti-arrhythmics or ablation.
• Sleep apnea is a special link of AF and SCD
• Genetic abnormalities and special sub-groups will
become increasingly important in the future.