TY - JOUR

T1 - Chronic obstructive pulmonary disease and atrial fibrillation an interdisciplinary perspective

AU - Simons, Sami O.

AU - Elliott, Adrian

AU - Sastry, Manuel

AU - Hendriks, Jeroen M.

AU - Arzt, Michael

AU - Rienstra, Michiel

AU - Kalman, Jonathan M.

AU - Heidbuchel, Hein

AU - Nattel, Stanley

AU - Wesseling, Geertjan

AU - Schotten, Ulrich

AU - van Gelder, Isabelle C.

AU - Franssen, Frits M. E.

AU - Sanders, Prashanthan

AU - Crijns, Harry J. G. M.

AU - Linz, Dominik

PY - 2021

Y1 - 2021

N2 - Chronic obstructive pulmonary disease (COPD) is highly prevalent among patients with atrial fibrillation (AF), shares common risk factors, and adds to the overall morbidity and mortality in this population. Additionally, it may promote AF and impair treatment efficacy. The prevalence of COPD in AF patients is high and is estimated to be similar to 25%. Diagnosis and treatment of COPD in AF patients requires a close interdisciplinary collaboration between the electrophysiologist/cardiologist and pulmonologist. Differential diagnosis may be challenging, especially in elderly and smoking patients complaining of unspecific symptoms such as dyspnoea and fatigue. Routine evaluation of lung function and determination of natriuretic peptides and echocardiography may be reasonable to detect COPD and heart failure as contributing causes of dyspnoea. Acute exacerbation of COPD transiently increases AF risk due to hypoxia-mediated mechanisms, inflammation, increased use of beta-2 agonists, and autonomic changes. Observational data suggest that COPD promotes AF progression, increases AF recurrence after cardioversion, and reduces the efficacy of catheter-based antiarrhythmic therapy. However, it remains unclear whether treatment of COPD improves AF outcomes and which metric should be used to determine COPD severity and guide treatment in AF patients. Data from non-randomized studies suggest that COPD is associated with increased AF recurrence after electrical cardioversion and catheter ablation. Future prospective cohort studies in AF patients are needed to confirm the relationship between COPD and AF, the benefits of treatment of either COPD or AF in this population, and to clarify the need and cost-effectiveness of routine COPD screening.

AB - Chronic obstructive pulmonary disease (COPD) is highly prevalent among patients with atrial fibrillation (AF), shares common risk factors, and adds to the overall morbidity and mortality in this population. Additionally, it may promote AF and impair treatment efficacy. The prevalence of COPD in AF patients is high and is estimated to be similar to 25%. Diagnosis and treatment of COPD in AF patients requires a close interdisciplinary collaboration between the electrophysiologist/cardiologist and pulmonologist. Differential diagnosis may be challenging, especially in elderly and smoking patients complaining of unspecific symptoms such as dyspnoea and fatigue. Routine evaluation of lung function and determination of natriuretic peptides and echocardiography may be reasonable to detect COPD and heart failure as contributing causes of dyspnoea. Acute exacerbation of COPD transiently increases AF risk due to hypoxia-mediated mechanisms, inflammation, increased use of beta-2 agonists, and autonomic changes. Observational data suggest that COPD promotes AF progression, increases AF recurrence after cardioversion, and reduces the efficacy of catheter-based antiarrhythmic therapy. However, it remains unclear whether treatment of COPD improves AF outcomes and which metric should be used to determine COPD severity and guide treatment in AF patients. Data from non-randomized studies suggest that COPD is associated with increased AF recurrence after electrical cardioversion and catheter ablation. Future prospective cohort studies in AF patients are needed to confirm the relationship between COPD and AF, the benefits of treatment of either COPD or AF in this population, and to clarify the need and cost-effectiveness of routine COPD screening.

KW - Atrial fibrillation

KW - Chronic obstructive pulmonary disease

KW - Spirometry

KW - Hyperinflation

KW - Hypoxia

KW - 2016 ESC GUIDELINES

KW - CATHETER ABLATION

KW - EXERTIONAL DYSPNEA

KW - RESPIRATORY EVENTS

KW - CLINICAL-OUTCOMES

KW - HEART-FAILURE

KW - LUNG-FUNCTION

KW - RISK-FACTORS

KW - HATCH SCORE

KW - COPD

U2 - 10.1093/eurheartj/ehaa822

DO - 10.1093/eurheartj/ehaa822

M3 - Review

C2 - 33206945

VL - 42

SP - 532

EP - 540

JO - European Heart Journal

JF - European Heart Journal

SN - 0195-668X

IS - 5

ER -