Association Between Atrial Fibrillation and Sudden Cardiac Death: Pathophysiological and Epidemiological Insights

Circ Res. 2020 Jul 3;127(2):301-309. doi: 10.1161/CIRCRESAHA.120.316756. Epub 2020 Jul 2.

Abstract

Emerging evidence suggests that atrial fibrillation (AF) may be associated with an increased risk of sudden cardiac death (SCD). However, AF shares risk factors with numerous cardiac conditions, including coronary heart disease and heart failure-the 2 most common substrates for SCD-making the AF-SCD relationship particularly challenging to address. A careful consideration of confounding factors is essential, since interventions for AF will be effective in reducing SCD only if there is a causal association between these 2 conditions. In this translational review, we detail the plausible underlying pathophysiological mechanisms through which AF may promote or lead to SCD, as well as the existing epidemiological evidence supporting an association between AF and SCD. While the role of AF in predicting SCD in the general population appears limited and not established, AF might be integrated to improve risk stratification in some specific phenotypes. Optimal AF management, including that of its associated conditions, appears to be of interest to prevent AF-related SCD, especially because the AF-SCD relationship is in part driven by heart failure.

Keywords: atrial fibrillation; heart failure; sudden cardiac death; ventricular fibrillation.