Atrial fibrillation pulmonary diseases: Difference between revisions

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{{Atrial fibrillation}}
{{Atrial fibrillation}}
{{CMG}}; '''Associate Editor(s)-In-Chief:''' {{CZ}}; [[Varun Kumar, M.B.B.S.]]
{{CMG}}; '''Associate Editor(s)-In-Chief:''' {{CZ}}; {{Anahita}}, [[Varun Kumar, M.B.B.S.]]


==Overview==
==Overview==
In patients with [[COPD]], supraventricular arrhythmias, including [[atrial fibrillation]] are common.<ref name="pmid2454781">Shih HT, Webb CR, Conway WA, Peterson E, Tilley B, Goldstein S (1988) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=2454781 Frequency and significance of cardiac arrhythmias in chronic obstructive lung disease.] ''Chest'' 94 (1):44-8. PMID: [http://pubmed.gov/2454781 2454781]</ref><ref name="pmid4122207">Hudson LD, Kurt TL, Petty TL, Genton E (1973) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=4122207 Arrhythmias associated with acute respiratory failure in patients with chronic airway obstruction.] ''Chest'' 63 (5):661-5. PMID: [http://pubmed.gov/4122207 4122207]</ref> In patients with acute exacerbations of [[COPD]], the presence of [[AF]] has shown to have worst prognosis.<ref name="pmid7872344">Fuso L, Incalzi RA, Pistelli R, Muzzolon R, Valente S, Pagliari G et al. (1995) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7872344 Predicting mortality of patients hospitalized for acutely exacerbated chronic obstructive pulmonary disease.] ''Am J Med'' 98 (3):272-7. PMID: [http://pubmed.gov/7872344 7872344]</ref> The first step in the management is to treat the underlying lung disease and correct [[hypoxia]] and acid-base imbalance. [[Theophylline]] and [[beta adrenergic agonists]], which are commonly used to relieve
 
[[bronchospasm]], may precipitate [[atrial fibrillation]]. In patients with [[bronchospasm]], [[beta blockers]], [[sotalol]], [[propafenone]], and [[adenosine]] are contraindicated. [[CCB|Non-dihydropyridine calcium channel blocker]] and intravenous [[flecainide]]<ref name="pmid8163757">Barranco F, Sanchez M, Rodriguez J, Guerrero M (1994) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8163757 Efficacy of flecainide in patients with supraventricular arrhythmias and respiratory insufficiency.] ''Intensive Care Med'' 20 (1):42-4. PMID: [http://pubmed.gov/8163757 8163757]</ref> may be used to restore sinus rhythm. However, in hemodynamically unstable patients [[Atrial fibrillation cardioversion|direct-current cardioversion]] may be attempted. In patients refractory to drug therapy, [[Atrial fibrillation invasive treatment|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]] ([[Chronic obstructive pulmonary disease|COPD]]), [[supraventricular arrhythmias]], such as [[atrial fibrillation]] are common.<ref name="pmid2454781">Shih HT, Webb CR, Conway WA, Peterson E, Tilley B, Goldstein S (1988) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=2454781 Frequency and significance of cardiac arrhythmias in chronic obstructive lung disease.] ''Chest'' 94 (1):44-8. PMID: [http://pubmed.gov/2454781 2454781]</ref><ref name="pmid4122207">Hudson LD, Kurt TL, Petty TL, Genton E (1973) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=4122207 Arrhythmias associated with acute respiratory failure in patients with chronic airway obstruction.] ''Chest'' 63 (5):661-5. PMID: [http://pubmed.gov/4122207 4122207]</ref>  
*In [[patients]] who are experiencing acute exacerbations of [[chronic obstructive pulmonary disease]] ([[Chronic obstructive pulmonary disease|COPD]]), presence of concurrent [[atrial fibrillation]] has shown to have worst [[prognosis]].<ref name="pmid7872344">Fuso L, Incalzi RA, Pistelli R, Muzzolon R, Valente S, Pagliari G et al. (1995) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7872344 Predicting mortality of patients hospitalized for acutely exacerbated chronic obstructive pulmonary disease.] ''Am J Med'' 98 (3):272-7. PMID: [http://pubmed.gov/7872344 7872344]</ref>  
*The first step in the management is to [[treatment|treat]] the underlying [[Respiratory disease|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 [[Contraindication|contraindicated]].  
*[[CCB|Non-dihydropyridine calcium channel blocker]] and [[Intravenous therapy|intravenous]] [[flecainide]] may be used to restore [[sinus rhythm]]. However, in [[Hemodynamics|hemodynamically unstable]] [[patients]] [[Atrial fibrillation cardioversion|direct-current cardioversion]] may be attempted. <ref name="pmid8163757">Barranco F, Sanchez M, Rodriguez J, Guerrero M (1994) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8163757 Efficacy of flecainide in patients with supraventricular arrhythmias and respiratory insufficiency.] ''Intensive Care Med'' 20 (1):42-4. PMID: [http://pubmed.gov/8163757 8163757]</ref>
*In [[patients]] refractory to [[medications]], [[Atrial fibrillation invasive treatment|AV nodal ablation]] and [[ventricle|ventricular]] pacing may be necessary to control the [[ventricle|ventricular rate]].


==2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation (DO NOT EDIT)<ref name="JanuaryWann2014">{{cite journal|last1=January|first1=C. T.|last2=Wann|first2=L. S.|last3=Alpert|first3=J. S.|last4=Calkins|first4=H.|last5=Cleveland|first5=J. C.|last6=Cigarroa|first6=J. E.|last7=Conti|first7=J. B.|last8=Ellinor|first8=P. T.|last9=Ezekowitz|first9=M. D.|last10=Field|first10=M. E.|last11=Murray|first11=K. T.|last12=Sacco|first12=R. L.|last13=Stevenson|first13=W. G.|last14=Tchou|first14=P. J.|last15=Tracy|first15=C. M.|last16=Yancy|first16=C. W.|title=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|journal=Circulation|year=2014|issn=0009-7322|doi=10.1161/CIR.0000000000000041}}</ref>==
==2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation (DO NOT EDIT)<ref name="JanuaryWann2014">{{cite journal|last1=January|first1=C. T.|last2=Wann|first2=L. S.|last3=Alpert|first3=J. S.|last4=Calkins|first4=H.|last5=Cleveland|first5=J. C.|last6=Cigarroa|first6=J. E.|last7=Conti|first7=J. B.|last8=Ellinor|first8=P. T.|last9=Ezekowitz|first9=M. D.|last10=Field|first10=M. E.|last11=Murray|first11=K. T.|last12=Sacco|first12=R. L.|last13=Stevenson|first13=W. G.|last14=Tchou|first14=P. J.|last15=Tracy|first15=C. M.|last16=Yancy|first16=C. W.|title=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|journal=Circulation|year=2014|issn=0009-7322|doi=10.1161/CIR.0000000000000041}}</ref>==
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| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' A [[Calcium channel blocker#Non-dihydropyridine|nondihydropyridine calcium antagonist]] is recommended to control the ventricular rate in patients with [[AF]] and [[chronic obstructive pulmonary disease]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' A [[Calcium channel blocker#Non-dihydropyridine|nondihydropyridine calcium antagonist]] is recommended to control the [[ventricle|ventricular rate]] in [[patients]] with [[atrial fibrillation]] and [[chronic obstructive pulmonary disease]] ([[chronic obstructive pulmonary disease|COPD]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Direct-current [[cardioversion]] should be attempted in patients with pulmonary disease who become [[hemodynamic|hemodynamically]] unstable as a consequence of new onset [[AF]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Direct-current [[cardioversion]] should be attempted in [[patients]] with [[pulmonary disease]] who become [[hemodynamic|hemodynamically]] unstable as a consequence of new onset [[atrial fibrillation]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
|}


Line 41: Line 48:
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Correction of [[hypoxemia]] and [[acidosis]] is the recommended primary therapeutic measure for patients who develop [[AF]] during an acute [[pulmonary illness]] or exacerbation of chronic [[pulmonary disease]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' Correction of [[hypoxemia]] and [[acidosis]] is the recommended [[treatment|primary therapeutic measure]] for [[patients]] who develop [[atrial fibrillation]] during an acute [[Pulmonology|pulmonary illness]] or exacerbation of [[Chronic (medical)|chronic]] [[pulmonary disease]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''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 [[AF]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' A non [[dihydropyridine]] [[calcium channel antagonist]] ([[diltiazem]] or [[verapamil]]) is recommended to control the [[ventricle|ventricular rate]] in [[patients]] with [[obstructive pulmonary disease]] who develop [[atrial fibrillation]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|-
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' [[Direct-current cardioversion]] should be attempted in patients with [[pulmonary disease]] who become hemodynamically unstable as a consequence of [[AF]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''3.''' [[Direct-current cardioversion]] should be attempted in [[patients]] with [[pulmonary disease]] who become [[Hemodynamics|hemodynamically]] unstable as a consequence of [[atrial fibrillation]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
|}


Line 52: Line 59:
|colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (Harm)
|colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (Harm)
|-
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' [[Theophylline]] and [[beta-adrenergic agonist]] agents are not recommended in patients with bronchospastic lung disease who develop [[AF]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' [[Theophylline]] and [[beta-adrenergic agonist]] agents are not recommended in [[patients]] with [[Pulmonology|bronchospastic lung disease]] who develop [[atrial fibrillation]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|-
|-
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''2.''' [[Beta blockers]], [[sotalol]], [[propafenone]], and [[adenosine]] are not recommended in patients with [[obstructive lung disease]] who develop [[AF]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''2.''' [[Beta blockers]], [[sotalol]], [[propafenone]], and [[adenosine]] are not recommended in [[patients]] with [[obstructive lung disease]] who develop [[atrial fibrillation]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
|}
|}


Revision as of 06:26, 16 September 2021
Resident
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Sinus rhythm
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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

Atrial Fibrillation and Pulmonary Diseases

2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation (DO NOT EDIT)[5]

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)[6]

Pulmonary Diseases (DO NOT EDIT) [6]

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

References

  1. ↑ 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
  2. ↑ 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
  3. ↑ 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
  4. ↑ 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
  5. ↑ 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.
  6. ↑ 6.0 6.1 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.
  7. ↑ 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
  8. ↑ 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
  9. ↑ 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

CME Category::Cardiology

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