Atrial Fibrillation Is Associated with Increased Mortality in Patients Presenting with Ventricular Tachyarrhythmias

Michael Behnes,Martin Borggrefe,Jonas Rusnak,Thomas Bertsch,Gabriel Taton,Dominik Ellguth,Tobias Schupp,Linda Reiser,Siegfried Lang,Niko Engelke,Philipp Kuche,Thomas Reichelt,Christoph Nienaber ,Christel Weiß ,Ibrahim El‐Battrawy ,Dennis Ferdinand,Muharrem Akin,Armin Bollow,Kambis Mashayekhi,İbrahim Akın

doi:10.1038/s41598-019-49325-4

Abstract

Heterogenous data about the prognostic impact of atrial fibrillation (AF) in patients with ventricular tachyarrhythmias exist. Therefore, this study evaluates this impact of AF in patients presenting with ventricular tachyarrhythmias. 1,993 consecutive patients presenting with ventricular tachyarrhythmias (i.e. ventricular tachycardia and fibrillation (VT, VF)) on admission at one institution were included (from 2002 until 2016). All medical data of index and follow-up hospitalizations were collected during the complete follow-up period for each patient. Statistics comprised univariable Kaplan-Meier and multivariable Cox regression analyses in the unmatched consecutive cohort and after propensity-score matching for harmonization. The primary prognostic endpoint was long-term all-cause mortality at 2.5 years. AF was present in 31% of patients presenting with index ventricular tachyarrhythmias on admission (70% paroxysmal, 9% persistent, 21% permanent). VT was more common (67% versus 59%; p = 0.001) than VF (33% versus 41%; p = 0.001) in AF compared to non-AF patients. Long-term all-cause mortality at 2.5 years occurred more often in AF compared to non-AF patients (mortality rates 40% versus 24%, log rank p = 0.001; HR = 1.825; 95% CI 1.548–2.153; p = 0.001), which may be attributed to higher rates of all-cause mortality at 30 days, in-hospital mortality and mortality after discharge (p < 0.05) (secondary endpoints). Mortality differences were observed irrespective of index ventricular tachyarrhythmia (VT or VF), LV dysfunction or presence of an ICD. In conclusion, this study identifies AF as an independent predictor of death in patients presenting consecutively with ventricular tachyarrhythmias.

Highlights

Ventricular tachyarrhythmias, such as ventricular tachycardia (VT) or fibrillation (VF) and consecutive SCD3–6
Within the unmatched study population of 1,993 consecutive patients presenting with ventricular tachyarrhythmias on admission at our institution, a history of AF was present in 31% of patients
The rate of VT was significantly higher in AF patients (67% versus 59%; p = 0.001), whereas VF was more common in non-AF patients (41% versus 33%; p = 0.001) (Table 1, left columns)

Summary

Introduction

Ventricular tachyarrhythmias, such as ventricular tachycardia (VT) or fibrillation (VF) and consecutive SCD3–6. Several community-based studies demonstrated a higher incidence of future SCD in AF patients at long-term follow-up[7,8,9,10]. A sub-analysis of the Engage AF-TIMI 48 trial showed a rate of SCD estimated at 45% of cardiovascular deaths in pre-selected AF patients being investigated initially for the effectiveness of edoxaban compared to warfarin for stroke prevention[9]. The Oregon-SUD study found a higher rate of AF related to SCD in 652 SCD patients compared to age- and sex- matched CAD controls[11]. No data is currently available, whether the presence of AF may be associated independently with mortality in consecutive real-life patients presenting on admission with ventricular tachyarrhythmias.

Methods

Results

Conclusion