Death of a child and the risk of atrial fibrillation: a nationwide cohort study in Sweden.

Aims The role of psychological stress in the aetiology of atrial fibrillation (AF) is unclear. The death of a child is one of the most severe sources of stress. We aimed to investigate whether the death of a child is associated with an increased risk of AF. Methods and results We studied parents with children born during 1973-2014 included the Swedish Medical Birth Register (n = 3 924 237). Information on death of a child, AF and socioeconomic, lifestyle and health-related covariates was obtained through linkage to nationwide population and health registers. We examined the link between death of a child and AF risk using Poisson regression. Parents who lost a child had a 15% higher risk of AF than unexposed parents [incidence rate ratio (IRR) and 95% confidence intervals (CI): 1.15 (1.10-1.20)]. An increased risk of AF was observed not only if the child died due to cardiovascular causes [IRR (95% CI): 1.35 (1.17-1.56)], but also in case of deaths due to other natural [IRR (95% CI): 1.15 (1.09-1.21)] or unnatural [IRR (95% CI): 1.10 (1.02-1.19)] causes. The risk of AF was highest in the 1st week after the loss [IRR (95% CI): 2.87 (1.44-5.75)] and remained 10-40% elevated on the long term. Conclusions Death of a child was associated with a modestly increased risk of AF. Our finding that an increased risk was observed also after loss of a child due to unnatural deaths suggests that stress-related mechanisms may also be implicated in the development of AF.