Prevalence of sudden cardiac death in dogs with atrial fibrillation

Abstract

Background: Atrial fibrillation (AF) is associated with increased risk of sudden cardiac death (SCD) in humans, independent of secondary risk factors such as thrombogenic disorders. In dogs, SCD is described in a number of heart diseases, but an association between AF and SCD is unreported.

Hypothesis: (a) A higher proportion of dogs with AF will experience SCD, and (b) SCD will be associated with complex ventricular arrhythmias.

Animals: One-hundred forty-two dogs with AF, and 127 dogs without AF.

Methods: Retrospective, multicenter, case-control study. Dogs included in the AF group were compared to a control group of dogs in sinus rhythm, matched for echocardiographic diagnosis. Descriptive statistics were used to identify proportions of each group suffering SCD, compared using chi-squared testing. Risk factors for SCD in dogs with AF were evaluated at the univariable and multivariable level using binary logistic regression. Significance was P < .05.

Results: A significantly higher proportion of dogs with AF suffered SCD than dogs in the control group (14.8% vs 5.5%; P = .01). Younger age at diagnosis, larger left atrial size, and a history of syncope all were independent predictors of SCD in dogs with AF (χ² , 16.3; P = .04).

Conclusions and clinical importance: Atrial fibrillation was associated with a higher prevalence of SCD in dogs. A history of syncope may be a useful predictor of SCD risk.

Keywords: Holter analysis; cardiology; echocardiography; ventricular arrhythmia.

FIGURE 1

Flowchart to illustrate recruitment of eligible cases for inclusion in the study. DCM dilated cardiomyopathy; ARVC Arrhythmogenic right ventricular cardiomyopathy; MVD mitral valve disease; CHD congenital heart disease; AF atrial fibrillation

FIGURE 2

Kaplan‐Meier curve to show survival to all‐cause mortality for dogs with atrial fibrillation compared to a control group of dogs in sinus rhythm. Median survival time for dogs with atrial fibrillation was 492 days (95% CI, 363‐621 days), significantly shorter dogs in sinus rhythm, at 593 days (95% CI, 343‐717 days; P = .0165)