Atrial fibrillation is associated with ventricular tachyarrhythmias or cardiac arrest in heart failure with preserved ejection fraction.

BACKGROUND

Sudden cardiac death accounted for approximately 20% to 35% of deaths among patients with heart failure with preserved ejection fraction (HFpEF) in contemporary trials, yet a reliable risk stratification scheme has not been described for patients with HFpEF.

OBJECTIVE

This study aimed to identify risk factors for ventricular tachyarrhythmias (VTAs) or cardiac arrest in patients with HFpEF.

METHODS

Patients diagnosed as having HFpEF between 2015 and 2022 were included in a retrospective cohort at a single cardiac specialty hospital. Baseline demographics and clinical variables, including hypertension, coronary artery disease, diabetes mellitus, obstructive sleep apnea, chronic obstructive pulmonary disease, atrial fibrillation (AF), anemia, chronic kidney disease, and the occurrence of VTAs or cardiac arrest, were collected from electronic health records based on diagnosis codes.

RESULTS

A total of 951 patients were included in the study, with a mean age of 73.5 years (standard deviation 11.9), 52% being women, 75% with coronary artery disease, and 49% with AF. Of these patients, 46 (5%) had VTAs or cardiac arrest. Stepwise logistic regression analysis revealed that AF (odds ratio 4.12, P < .0001, 95% confidence interval 2.01-8.41) was associated with VTAs or cardiac arrest.

CONCLUSION

AF strongly correlates with VTAs or cardiac arrest among patients with HFpEF. This study adds to a growing body of evidence that HFpEF with AF portends high sudden cardiac death risk. Further prospective analysis is needed to improve risk stratification.