From the Guidelines
COPD can indeed worsen atrial fibrillation (AFib) due to various mechanisms, including chronic inflammation, hypoxemia, pulmonary hypertension, and medication interactions, as supported by the European Society of Cardiology guidelines 1.
Key Mechanisms
- Chronic inflammation in COPD can affect the heart's electrical system
- Hypoxemia (low oxygen levels) can trigger arrhythmias
- Pulmonary hypertension that develops in COPD puts strain on the right side of the heart
- Medications used to treat COPD, particularly beta-agonists like albuterol, can sometimes trigger or worsen AFib
Management Considerations
- Optimizing COPD treatment with appropriate inhalers, including long-acting bronchodilators like tiotropium or salmeterol
- Using rate-controlling medications for AFib, such as beta-blockers, though these must be used cautiously in COPD
- Considering anticoagulation therapy to prevent stroke
- Regular follow-ups with both pulmonary and cardiac specialists to ensure optimal management of both conditions
Relevant Guidelines
The European Society of Cardiology guidelines recommend correction of hypoxaemia and acidosis as initial management for patients who develop AF during an acute pulmonary illness or exacerbation of chronic pulmonary disease 1. Additionally, a non-dihydropyridine calcium channel antagonist (diltiazem or verapamil) should be considered to control the ventricular rate in patients with obstructive pulmonary disease who develop AF 1.
Recent Studies
A recent narrative review on drug-induced atrial fibrillation highlights the importance of considering medication interactions in patients with COPD and AFib, particularly with drugs like theophylline and beta-adrenergic agonists 1.
From the Research
Relationship between COPD and Afib
- COPD is highly prevalent among patients with atrial fibrillation (AF), with an estimated prevalence of ∼25% 2.
- The presence of COPD may promote AF and impair treatment efficacy, and observational data suggest that COPD promotes AF progression, increases AF recurrence after cardioversion, and reduces the efficacy of catheter-based antiarrhythmic therapy 2.
- Acute exacerbation of COPD transiently increases AF risk due to hypoxia-mediated mechanisms, inflammation, increased use of beta-2 agonists, and autonomic changes 2.
Impact of COPD on Afib Outcomes
- Data from non-randomized studies suggest that COPD is associated with increased AF recurrence after electrical cardioversion and catheter ablation 2.
- The treatment of COPD may improve AF outcomes, but it remains unclear which metric should be used to determine COPD severity and guide treatment in AF patients 2.
- Future prospective cohort studies in AF patients are needed to confirm the relationship between COPD and AF, and to clarify the need and cost-effectiveness of routine COPD screening 2.
Management of COPD
- The primary goals of COPD treatment are to control symptoms, improve quality of life, and reduce exacerbations and mortality 3, 4.
- Pulmonology referral is recommended for patients with COPD with symptoms despite first-line inhaled therapy, frequent exacerbations, any hospitalizations, or moderate-to-severe disease 4.
- A multidisciplinary approach to management is recommended, including evaluation of patients' nutritional status and mental health, and treatment of underlying co-morbidities 5.