Journal Scan Summary
Relationship of Sudden Cardiac Death to New-Onset Atrial Fibrillation in Hypertensive Patients With Left Ventricular Hypertrophy
June 4, 2013
Okin PM, Bang CN, Wachtell K, et al.
Circ Arrhythm Electrophysiol 2013;6:243-251.
What is the association of new-onset atrial fibrillation (AF) with sudden cardiac death (SCD) in hypertensive patients with electrocardiographic (ECG) evidence of left ventricular hypertrophy (LVH)?
This was a post-hoc retrospective analysis of data collected in the LIFE (Losartan Intervention For Endpoint reduction in hypertension) study in which 9,193 hypertensive patients with ECG evidence of LVH (and no history of AF and in sinus rhythm of their baseline ECG) were randomized to losartan or atenolol-based treatment. New-onset AF was identified either from protocol-mandated in-study ECGs or by adverse event reports of AF. SCD was a prespecified secondary endpoint in the LIFE study. The relation of new-onset AF to the risk of having SCD was assessed using Cox proportional hazards models. Statistical analyses adjusted for prevalence of SCD risk factors and treatment effects.
New-onset AF occurred in 701 patients (7.9%) and SCD in 151 patients (1.7%). In multivariate Cox analyses, new-onset was associated with a >3-fold increased risk of SCD (hazard ratio, 3.13; 95% confidence interval, 1.87-5.24; p < 0.001).
There is an increased risk of SCD associated with new-onset AF in hypertensive patients with ECG evidence of LVH, after controlling for other known and suspected risk factors for SCD.
This post-hoc analysis of the LIFE study offers an interesting observation that the development of new-onset AF in hypertensive patients with LVH identifies patients at an increased risk for SCD, even after controlling for traditional risk factors, treatment effects, and in-treatment blood pressure. These findings warrant further study and may have implications for the prevention of the development of new AF as a therapeutic target in hypertensive patients with LVH.
Prashant Vaishnava, M.D. (Disclosure)
Arrhythmias, Cardiac Rhythm Management, Afib, General Cardiology, Heart Failure/Transplant