{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T04:28:09Z","timestamp":1788496089296,"version":"build-2803163510"},"reference-count":32,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2023,1,30]],"date-time":"2023-01-30T00:00:00Z","timestamp":1675036800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Atrial fibrillation (AF) has been linked to an increased risk of ventricular arrhythmias (VAs) and sudden death. We investigated this association in hospitalised patients in France. Methods: All hospitalised patients from 2013 were identified from the French National database and included if they had at least 5 years of follow-up data. Results: Overall, 3,381,472 patients were identified. After excluding 35,834 with a history of VAs and cardiac arrest, 3,345,638 patients were categorised into two groups: no AF (n = 3,033,412; mean age 57.2 \u00b1 21.4; 54.3% female) and AF (n = 312,226; 78.1 \u00b1 10.6; 44.0% female). Over a median follow-up period of 5.4 years (interquartile range (IQR) 5.0\u20135.8 years), the incidence (2.23%\/year vs. 0.56%\/year) and risk (hazard ratio (HR) 3.657 (95% confidence interval (CI) 3.604\u20133.711)) of VAs and cardiac arrest were significantly higher in AF patients compared to non-AF patients. This was still significant after adjusting for confounders, with a HR of 1.167 (95% CI 1.111\u20131.226) and in the 1:1 propensity score-matched analysis (n = 289,332 per group), with a HR of 1.339 (95% CI 1.313\u20131.366). In the mediation analysis, the odds of cardiac arrest were significantly mediated by AF-associated VAs, with an OR of 1.041 (95% CI 1.040\u20131.042). Conclusion: In hospitalised French patients, AF was associated with an increased risk of VAs and sudden death.<\/jats:p>","DOI":"10.3390\/jcm12031075","type":"journal-article","created":{"date-parts":[[2023,1,30]],"date-time":"2023-01-30T03:31:11Z","timestamp":1675049471000},"page":"1075","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Atrial Fibrillation and the Risk of Ventricular Arrhythmias and Cardiac Arrest: A Nationwide Population-Based Study"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9477-7245","authenticated-orcid":false,"given":"Ameenathul M.","family":"Fawzy","sequence":"first","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool L14 3PE, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3449-1800","authenticated-orcid":false,"given":"Arnaud","family":"Bisson","sequence":"additional","affiliation":[{"name":"Service de Cardiologie, Centre Hospitalier R\u00e9gional Universitaire et Facult\u00e9 de M\u00e9decine de Tours, 2 Boulevard Tonnell\u00e9, 37000 Tours, France"},{"name":"Cardiology Department, Centre Hospitalier R\u00e9gional d\u2019Orl\u00e9ans, 45067 Orl\u00e9ans, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6544-3916","authenticated-orcid":false,"given":"Alexandre","family":"Bodin","sequence":"additional","affiliation":[{"name":"Service de Cardiologie, Centre Hospitalier R\u00e9gional Universitaire et Facult\u00e9 de M\u00e9decine de Tours, 2 Boulevard Tonnell\u00e9, 37000 Tours, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julien","family":"Herbert","sequence":"additional","affiliation":[{"name":"Service de Cardiologie, Centre Hospitalier R\u00e9gional Universitaire et Facult\u00e9 de M\u00e9decine de Tours, 2 Boulevard Tonnell\u00e9, 37000 Tours, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7566-1626","authenticated-orcid":false,"given":"Gregory Y. H.","family":"Lip","sequence":"additional","affiliation":[{"name":"Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool L14 3PE, UK"},{"name":"Department of Clinical Medicine, Aalborg University, 9000 Aalborg, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9267-1658","authenticated-orcid":false,"given":"Laurent","family":"Fauchier","sequence":"additional","affiliation":[{"name":"Service de Cardiologie, Centre Hospitalier R\u00e9gional Universitaire et Facult\u00e9 de M\u00e9decine de Tours, 2 Boulevard Tonnell\u00e9, 37000 Tours, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"946","DOI":"10.1161\/01.CIR.98.10.946","article-title":"Impact of Atrial Fibrillation on the Risk of Death","volume":"98","author":"Benjamin","year":"1998","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Lee, E., Choi, E.-K., Han, K.-D., Lee, H., Choe, W.-S., Lee, S.-R., Cha, M.-J., Lim, W.-H., Kim, Y.-J., and Oh, S. (2018). Mortality and causes of death in patients with atrial fibrillation: A nationwide population-based study. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0209687"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"i4482","DOI":"10.1136\/bmj.i4482","article-title":"Atrial fibrillation and risks of cardiovascular disease, renal disease, and death: Systematic review and meta-analysis","volume":"354","author":"Odutayo","year":"2016","journal-title":"BMJ"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1278","DOI":"10.1016\/j.amjmed.2016.06.045","article-title":"Causes of Death and Influencing Factors in Patients with Atrial Fibrillation","volume":"129","author":"Fauchier","year":"2016","journal-title":"Am. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1007\/s10840-017-0308-9","article-title":"Atrial fibrillation is associated with sudden cardiac death: A systematic review and meta-analysis","volume":"51","author":"Rattanawong","year":"2018","journal-title":"J. Interv. Card. Electrophysiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1001\/2013.jamainternmed.744","article-title":"Atrial Fibrillation and the Risk of Sudden Cardiac Death: The Atherosclerosis Risk in Communities Study and Cardiovascular Health Study","volume":"173","author":"Chen","year":"2013","journal-title":"JAMA Intern. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e003735","DOI":"10.1161\/JAHA.116.003735","article-title":"Sudden Cardiac Death in Patients with Atrial Fibrillation: Insights from the ENGAGE AF-TIMI 48 Trial","volume":"5","author":"Eisen","year":"2016","journal-title":"J. Am. Heart Assoc."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2192","DOI":"10.1161\/CIRCULATIONAHA.112.000491","article-title":"Causes of death and influencing factors in patients with Atrial fibrillation: A competing-risk analysis from the randomized evaluation of long-term anticoagulant therapy study","volume":"128","author":"Marijon","year":"2013","journal-title":"Circulation"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1037\/0022-3514.51.6.1173","article-title":"The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations","volume":"51","author":"Baron","year":"1986","journal-title":"J. Pers. Soc. Psychol."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Pearl, J. (2010). An Introduction to Causal Inference. Int. J. Biostat., 6.","DOI":"10.2202\/1557-4679.1203"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1161\/CIRCEP.114.002094","article-title":"Atrial fibrillation is an independent risk factor for ventricular fibrillation: A large-scale population-based case-control study","volume":"7","author":"Bardai","year":"2014","journal-title":"Circ. Arrhythmia Electrophysiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"18111","DOI":"10.1038\/s41598-021-97335-y","article-title":"Atrial fibrillation is associated with increased risk of lethal ventricular arrhythmias","volume":"11","author":"Kim","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2080","DOI":"10.1001\/jama.2011.659","article-title":"Risk of Death and Cardiovascular Events in Initially Healthy Women With New-Onset Atrial Fibrillation","volume":"305","author":"Conen","year":"2011","journal-title":"JAMA"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"srep46445","DOI":"10.1038\/srep46445","article-title":"Risk and Prediction of Sudden Cardiac Death and Ventricular Arrhythmias for Patients with Atrial Fibrillation\u2014A Nationwide Cohort Study","volume":"7","author":"Chao","year":"2017","journal-title":"Sci. Rep."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1016\/S0008-6363(97)00293-9","article-title":"Experimental evidence for proarrhythmic mechanisms of antiarrhythmic drugs","volume":"37","author":"Nattel","year":"1998","journal-title":"Cardiovasc. Res."},{"key":"ref_16","first-page":"iv37","article-title":"Drug-induced QT-interval prolongation and proarrhythmic risk in the treatment of atrial arrhythmias","volume":"9","author":"Shantsila","year":"2007","journal-title":"EP Eur."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1161\/CIRCULATIONAHA.116.025312","article-title":"Atrial Fibrillation and Ventricular Arrhythmias: Sex Differences in Electrophysiology, Epidemiology, Clinical Presentation, and Clinical Outcomes","volume":"135","author":"Gillis","year":"2017","journal-title":"Circulation"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"808","DOI":"10.1016\/j.hlc.2016.11.021","article-title":"Temporal Trends in Sudden Cardiac Death From 1997 to 2010: A Data Linkage Study","volume":"26","author":"Feng","year":"2017","journal-title":"Heart Lung Circ."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Linde, C., Bongiorni, M.G., Birgersdotter-Green, U., Curtis, A.B., Deisenhofer, I., Furokawa, T., Gillis, A.M., Haugaa, K.H., Lip, G.Y.H., and Van Gelder, I. (2018). Sex differences in cardiac arrhythmia: A consensus document of the European Heart Rhythm Association, endorsed by the Heart Rhythm Society and Asia Pacific Heart Rhythm Society. EP Eur., 20.","DOI":"10.1093\/europace\/euy067"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"14","DOI":"10.31083\/j.rcm2301014","article-title":"Sex differences in ventricular arrhythmia: Epidemiology, pathophysiology and catheter ablation","volume":"23","author":"Krisai","year":"2022","journal-title":"Rev. Cardiovasc. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1016\/j.cardiores.2007.02.029","article-title":"Do statins have an antiarrhythmic activity?","volume":"75","author":"Kostapanos","year":"2007","journal-title":"Cardiovasc. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1097\/MJT.0b013e3181e9087a","article-title":"The effect of statin therapy on ventricular tachyarrhythmias: A meta-analysis","volume":"19","author":"Wanahita","year":"2012","journal-title":"Am. J. Ther."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1016\/j.ihj.2021.12.010","article-title":"Angiographic profile and outcomes in persistent non-valvular atrial fibrillation: A study from tertiary care center in North India","volume":"74","author":"Sharma","year":"2022","journal-title":"Indian Heart J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1161\/CIRCIMAGING.108.795328","article-title":"Prevalence of coronary artery disease assessed by multislice computed tomography coronary angiography in patients with paroxysmal or persistent atrial fibrillation","volume":"2","author":"Nucifora","year":"2009","journal-title":"Circ. Cardiovasc. Imaging"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1469","DOI":"10.1161\/CIRCRESAHA.114.302225","article-title":"Emerging directions in the genetics of atrial fibrillation","volume":"114","author":"Tucker","year":"2014","journal-title":"Circ. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1038\/ng.516","article-title":"Genetic variation in SCN10A influences cardiac conduction","volume":"42","author":"Chambers","year":"2010","journal-title":"Nat. Genet."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1016\/j.jvc.2017.08.003","article-title":"Sudden cardiac death in a dog during Holter recording\u2014R on T phenomenon","volume":"19","author":"Gunasekaran","year":"2017","journal-title":"J. Vet. Cardiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1161\/01.CIR.49.1.32","article-title":"The effects of cycle length on cardiac refractory periods in man","volume":"49","author":"Denes","year":"1974","journal-title":"Circulation"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1016\/0002-9149(84)90022-5","article-title":"Facilitation of ventricular tachycardia induction with abrupt changes in ventricular cycle length","volume":"53","author":"Denker","year":"1984","journal-title":"Am. J. Cardiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1004","DOI":"10.1161\/CIRCRESAHA.113.302549","article-title":"Role of the autonomic nervous system in modulating cardiac arrhythmias","volume":"114","author":"Shen","year":"2014","journal-title":"Circ. Res."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1002\/clc.20826","article-title":"Sinus Rhythm Restoration and Treatment Success: Insight From Recent Clinical Trials","volume":"34","author":"Saliba","year":"2011","journal-title":"Clin. Cardiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1932","DOI":"10.1016\/j.jacc.2022.03.337","article-title":"The Increasing Role of Rhythm Control in Patients With Atrial Fibrillation: JACC State-of-the-Art Review","volume":"79","author":"Camm","year":"2022","journal-title":"J. Am. Coll. Cardiol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/3\/1075\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:19:43Z","timestamp":1760120383000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/3\/1075"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,30]]},"references-count":32,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["jcm12031075"],"URL":"https:\/\/doi.org\/10.3390\/jcm12031075","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,30]]}}}