Arrhythmias & electrophysiology
Atrial fibrillation and the risk of sudden cardiac death: incidence, impact and implications
Authors' conclusion
A significant proportion of SCDs occur in patients with AF, but the risk appears mediated by heart failure hospitalisations rather than AF itself.
Study context
- Population
- Patients with suspected or known coronary artery disease referred for elective angiography and patients with acute coronary syndrome (ACS), 2007–2018955 sudden cardiac death (SCD) events during follow-up · ACS 9,622 · elective 11,799
- Comparison
- Atrial fibrillation (AF) vs no AF for SCD risk
- Outcome
- 10-year SCD incidence
- Follow-up
- 10-year
Main finding
As reported in the abstract
ACS
Elective
Further findings
| Outcome | Subdistribution hazard (95% CI) |
|---|---|
| SCD (competing risk models adjusted for baseline risk factors including left ventricular ejection fraction)AF · ACS | 1.33 (1.05–1.67) |
| SCD (competing risk models adjusted for baseline risk factors including left ventricular ejection fraction)AF · elective | 1.37 (1.10–1.71) |
SCD (competing risk models adjusted for baseline risk factors including left ventricular ejection fraction)
- No longer evident in the elective cohort after adjusting for incident heart failure hospitalisations
- AF preceded incident heart failure hospitalisations in 57.5% of cases, by an average of 1.4 years
- AF preceded incident heart failure hospitalisations in 57.5% of cases by an average of 1.4 years
Distribution of SCD cases
- SCD cases in patients with known AF (paroxysmal, persistent or permanent)
- 33%
- SCD victims with AF on their last ECG
- 21%
Original publication
Atrial fibrillation and the risk of sudden cardiac death: incidence, impact and implications. Heart. Published 15 July 2025. doi:10.
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