October 3, 2019Scientific ReportsOpen Access

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

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Why the study?

Heterogeneous data exist regarding the prognostic impact of atrial fibrillation in patients presenting with ventricular tachyarrhythmias.

Does the presence of atrial fibrillation increase mortality in patients presenting with ventricular tachyarrhythmias?

Structured PICO

Does the presence of atrial fibrillation increase mortality in patients presenting with ventricular tachyarrhythmias?

Population

1,993 consecutive patients presenting with ventricular tachyarrhythmias (ventricular tachycardia and fibrillation) on admission at one institution between 2002 and 2016.

Intervention

Presence of atrial fibrillation (AF)

Comparator

Absence of atrial fibrillation (non-AF)

Outcome

Long-term all-cause mortality at 2.5 yearshard clinical

Atrial fibrillation is an independent predictor of increased short- and long-term all-cause mortality in patients presenting with ventricular tachyarrhythmias, irrespective of LVEF or ICD presence.

Limitations

Retrospective data analysis/registry design
Single-center study
Potential confounding due to heterogeneous comorbidities despite propensity score matching

Implication

AF associated with higher mortality in ventricular tachyarrhythmia patients; leaves open whether AF is causal or a modifiable marker.

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.