Atrial Fibrillation Is an Independent Risk Factor for Ventricular FibrillationCLINICAL PERSPECTIVE: A Large-Scale Population-Based Case-Control Study

Background— Atrial fibrillation (AF) is associated with sudden cardiac death. We aimed to study whether AF is associated with ventricular fibrillation (VF), the most common cause of sudden cardiac death and whether this association is independent of confounders, ie, concomitant disease, use of antiarrhythmic or QT-prolonging drugs, and acute myocardial infarction. Methods and Results— We performed a community-based case-control study. Cases were patients with out-of-hospital cardiac arrest because of ECG-documented VF. Controls were age-/sex-matched non-VF subjects from the community. VF risk in AF patients was studied by means of (conditional) logistic regression, adjusting for all available confounders. We studied 1397 VF cases and 3474 controls. AF occurred in 215 cases (15.4%) and 90 controls (2.6%). AF was associated with a 3-fold increased risk of VF (adjusted odds ratio, 3.1 [2.1–4.5]). VF risk in AF cases was increased to the same extent across all age/sex groups and in AF cases who had no comorbidity (adjusted odds ratio 3.0 [1.6–5.5]) or used no confounding drugs (antiarrhythmics, 2.4 [1.4–4.3]; QT-prolonging drugs, 3.1 [1.8–5.4]). VF risk was similarly increased in AF cases with acute myocardial infarction–related VF (adjusted odds ratio 2.6 [1.4–4.8]), and those with non-acute myocardial infarction–related VF (adjusted odds ratio 4.3 [1.9–10.1]). Conclusions— AF is independently associated with a 3-fold increased risk of VF. Comorbidity, use of antiarrhythmic or QT-prolonging drugs, or acute myocardial infarction does not fully account for this increased risk.