Atrial fibrillation pulmonary diseases
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Anahita Deylamsalehi, M.D.[3], Varun Kumar, M.B.B.S.
Overview
In patients with chronic obstructive pulmonary disease (COPD), supraventricular arrhythmias, such as atrial fibrillation are common. One third of death in patients with atrial fibrillation is due to non-vascular diseases such as respiratory diseases. In patients with chronic obstructive pulmonary disease (COPD) FEV1 could be used as a predictor for atrial fibrillation development. In patients who are experiencing acute exacerbations of chronic obstructive pulmonary disease (COPD), presence of concurrent atrial fibrillation has shown to have worst prognosis. In patients refractory to medications, AV nodal ablation and ventricular pacing may be necessary to control the ventricular rate.
Atrial Fibrillation and Pulmonary Diseases
- In patients with chronic obstructive pulmonary disease (COPD), supraventricular arrhythmias, such as atrial fibrillation are common.[1][2]
- One third of death in patients with atrial fibrillation is due to non-vascular diseases such as respiratory diseases. [3]
- A study which investigated seasonal pattern of death among atrial fibrillation patients proposed respiratory infections as a possible cause of higher rate of death among these patients during winter. [4]
- Based on a study done on 369 patients with atrial fibrillation, a statistically significant association between NO2 level and hospitalization due to atrial fibrillation.[5]
- Respiratory diseases such as chronic obstructive pulmonary disease (COPD) can increase the chance of atrial fibrillation development possibly due to the following reasons:
- Alteration in blood gases
- Pulmonary function impairment
- Pulmonary hypertension and subsequent hemodynamic instability
- In patients with chronic obstructive pulmonary disease (COPD) FEV1 could be used as a predictor for atrial fibrillation development, since FEV1 between 60-80% is related to 1.8-times higher chance of atrial fibrillation, compared to FEV1 higher than 80%. Moreover risk of hospitalization due to atrial fibrillation is 1.3-times higher in patients with FEV1 between 60-80% compared to those with FEV1 higher than 80%. [6][7][8]
- Another study also proposes hypercapnia and high systolic pressure of pulmonary artery as predictors of atrial fibrillation development among chronic obstructive pulmonary disease (COPD) patients, in addition to low FEV1 measures.
- In patients who are experiencing acute exacerbations of chronic obstructive pulmonary disease (COPD), presence of concurrent atrial fibrillation has shown to have worst prognosis.[9]
- The first step in the management is to treat the underlying lung disease and correct hypoxia and acid-base imbalances.
- Theophylline and beta adrenergic agonists, which are commonly used to relieve bronchospasm in these patients, may precipitate atrial fibrillation.
- Moreover in patients with bronchospasm, beta blockers, sotalol, propafenone, and adenosine are contraindicated.
- Non-dihydropyridine calcium channel blocker and intravenous flecainide may be used to restore sinus rhythm. However, in hemodynamically unstable patients direct-current cardioversion may be attempted. [10]
- In patients refractory to medications, AV nodal ablation and ventricular pacing may be necessary to control the ventricular rate.
2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation (DO NOT EDIT)[11]
Pulmonary Disease
| Class I |
| "1. A nondihydropyridine calcium antagonist is recommended to control the ventricular rate in patients with atrial fibrillation and chronic obstructive pulmonary disease (COPD. (Level of Evidence: C)" |
| "2. Direct-current cardioversion should be attempted in patients with pulmonary disease who become hemodynamically unstable as a consequence of new onset atrial fibrillation. (Level of Evidence: C)" |
2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation (DO NOT EDIT)[12]
Pulmonary Diseases (DO NOT EDIT) [12]
| Class I |
| "1. Correction of hypoxemia and acidosis is the recommended primary therapeutic measure for patients who develop atrial fibrillation during an acute pulmonary illness or exacerbation of chronic pulmonary disease. (Level of Evidence: C)" |
| "2. A non dihydropyridine calcium channel antagonist (diltiazem or verapamil) is recommended to control the ventricular rate in patients with obstructive pulmonary disease who develop atrial fibrillation. (Level of Evidence: C)" |
| "3. Direct-current cardioversion should be attempted in patients with pulmonary disease who become hemodynamically unstable as a consequence of atrial fibrillation. (Level of Evidence: C)" |
| Class III (Harm) |
| "1. Theophylline and beta-adrenergic agonist agents are not recommended in patients with bronchospastic lung disease who develop atrial fibrillation. (Level of Evidence: C)" |
| "2. Beta blockers, sotalol, propafenone, and adenosine are not recommended in patients with obstructive lung disease who develop atrial fibrillation. (Level of Evidence: C)" |
Sources
- 2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation [14]
- ACC/AHA/Physician Consortium 2008 clinical performance measures for adults with nonvalvular atrial fibrillation or atrial flutter [15]
References
- ↑ Shih HT, Webb CR, Conway WA, Peterson E, Tilley B, Goldstein S (1988) Frequency and significance of cardiac arrhythmias in chronic obstructive lung disease. Chest 94 (1):44-8. PMID: 2454781
- ↑ Hudson LD, Kurt TL, Petty TL, Genton E (1973) Arrhythmias associated with acute respiratory failure in patients with chronic airway obstruction. Chest 63 (5):661-5. PMID: 4122207
- ↑ Gómez-Outes A, Suárez-Gea ML, García-Pinilla JM (2017). "Causes of death in atrial fibrillation: Challenges and opportunities". Trends Cardiovasc Med. 27 (7): 494–503. doi:10.1016/j.tcm.2017.05.002. PMID 28602539.
- ↑ Murphy NF, Stewart S, MacIntyre K, Capewell S, McMurray JJ (2004). "Seasonal variation in morbidity and mortality related to atrial fibrillation". Int J Cardiol. 97 (2): 283–8. doi:10.1016/j.ijcard.2004.03.041. PMID 15458696.
- ↑ Saifipour A, Azhari A, Pourmoghaddas A, Hosseini SM, Jafari-Koshki T, Rahimi M; et al. (2019). "Association between ambient air pollution and hospitalization caused by atrial fibrillation". ARYA Atheroscler. 15 (3): 106–112. doi:10.22122/arya.v15i3.1843. PMC 6698081 Check
|pmc=value (help). PMID 31452658. - ↑ Buch P, Friberg J, Scharling H, Lange P, Prescott E (2003). "Reduced lung function and risk of atrial fibrillation in the Copenhagen City Heart Study". Eur Respir J. 21 (6): 1012–6. doi:10.1183/09031936.03.00051502. PMID 12797497.
- ↑ Li J, Agarwal SK, Alonso A, Blecker S, Chamberlain AM, London SJ; et al. (2014). "Airflow obstruction, lung function, and incidence of atrial fibrillation: the Atherosclerosis Risk in Communities (ARIC) study". Circulation. 129 (9): 971–80. doi:10.1161/CIRCULATIONAHA.113.004050. PMC 3963836. PMID 24344084.
- ↑ Ariansen I, Edvardsen E, Borchsenius F, Abdelnoor M, Tveit A, Gjesdal K (2011). "Lung function and dyspnea in patients with permanent atrial fibrillation". Eur J Intern Med. 22 (5): 466–70. doi:10.1016/j.ejim.2011.06.010. PMID 21925054.
- ↑ Fuso L, Incalzi RA, Pistelli R, Muzzolon R, Valente S, Pagliari G et al. (1995) Predicting mortality of patients hospitalized for acutely exacerbated chronic obstructive pulmonary disease. Am J Med 98 (3):272-7. PMID: 7872344
- ↑ Barranco F, Sanchez M, Rodriguez J, Guerrero M (1994) Efficacy of flecainide in patients with supraventricular arrhythmias and respiratory insufficiency. Intensive Care Med 20 (1):42-4. PMID: 8163757
- ↑ January, C. T.; Wann, L. S.; Alpert, J. S.; Calkins, H.; Cleveland, J. C.; Cigarroa, J. E.; Conti, J. B.; Ellinor, P. T.; Ezekowitz, M. D.; Field, M. E.; Murray, K. T.; Sacco, R. L.; Stevenson, W. G.; Tchou, P. J.; Tracy, C. M.; Yancy, C. W. (2014). "2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society". Circulation. doi:10.1161/CIR.0000000000000041. ISSN 0009-7322.
- ↑ 12.0 12.1 Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA; et al. (2011). "2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 Guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in partnership with the European Society of Cardiology and in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society". J Am Coll Cardiol. 57 (11): e101–98. doi:10.1016/j.jacc.2010.09.013. PMID 21392637.
- ↑ Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2006) ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 114 (7):e257-354. DOI:10.1161/CIRCULATIONAHA.106.177292 PMID: 16908781
- ↑ Fuster V, Rydén LE, Cannom DS, Crijns HJ, Curtis AB, Ellenbogen KA et al. (2011) 2011 ACCF/AHA/HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 123 (10):e269-367. DOI:10.1161/CIR.0b013e318214876d PMID: 21382897
- ↑ Estes NA, Halperin JL, Calkins H, Ezekowitz MD, Gitman P, Go AS et al. (2008) ACC/AHA/Physician Consortium 2008 clinical performance measures for adults with nonvalvular atrial fibrillation or atrial flutter: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures and the Physician Consortium for Performance Improvement (Writing Committee to Develop Clinical Performance Measures for Atrial Fibrillation): developed in collaboration with the Heart Rhythm Society. Circulation 117 (8):1101-20. DOI:10.1161/CIRCULATIONAHA.107.187192 PMID: 18283199