Hari K. Dandapantula

Electrocardiographic predictors of arrhythmic death -"what is the role of atrial fibrillation?".

To the Editor: We read the article “Electrocardiographic predictors of arrhythmic death” by McLaughlin et al.1 with lot of enthusiasm. This review article is concise and well written but left us with few unanswered questions. What, in author’s opinion, is the role of new onset/perimyocardial infarction related atrial fibrillation in development and occurrence of sudden cardiac death? Why atrial fibrillation was not mentioned in their article, even though there has been a recent interest in the topic of atrial fibrillation and arrhythmic death? Atrial fibrillation is consistently shown to be associated with increased risk of sudden cardiac deaths in various studies. In a prospective study by Gronefeld et al.2 presence of atrial fibrillation was found to be an independent predictor of recurrent ventricular arrhythmia and sudden cardiac death. In another study by Pedersen et al.3 the adjusted risk ratio of atrial fibrillation/atrial flutter for sudden cardiac death was 1.31 with 95% CI 1.07– 1.60; P < 0.009. In a study of survivors of primary ventricular fibrillation by Dekker et al.4 atrial fibrillation was diagnosed in 21% of cases and 0% of control subjects. In the RACE study by Hagens