Response to letter regarding article, "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".

We appreciate the interest of Julien and Sylvain in our article on the causes of death in a contemporary atrial fibrillation population.1 In response to their comments, we would like to point out that although our data show that a large proportion of deaths are attributable to cardiac mortality, either sudden cardiac death or heart failure, caution needs to be exercised in presuming any direct causal relationship between atrial fibrillation and either sudden cardiac death or heart failure death. The inter-relationship between these entities is likely to be complex,2 and clearly more research is needed to delineate the most …