What Is Atrial Fibrillation?
Atrial fibrillation can be defined as an irregular and rapid heartbeat resulting in blood clot formation in the heart. Atrial fibrillation increases the risk of developing a stroke, heart failure, and other cardiac problems. In atrial fibrillation, the heart's upper chambers beat rapidly and irregularly, out of sync with the lower chambers. Many people may not have any symptoms of atrial fibrillation. However, rapid heartbeat, shortness of breath, or weakness are commonly manifested symptoms. Atrial fibrillation episodes can be intermittent or recurrent. Even though atrial fibrillation is typically not a life-threatening condition, it is a significant medical issue that needs to be treated properly to avoid stroke.
What Is COPD?
COPD stands for chronic obstructive pulmonary disease. It is a serious and chronic inflammatory condition affecting the lungs. Airflow from the lungs becomes restricted due to chronic obstructive pulmonary disease. The signs and symptoms include wheezing, coughing, the presence of mucus in the cough, and difficulty breathing. It is frequently caused due to prolonged exposure to irritant gases or particulates, most frequently from cigarette smoke. People with COPD are more likely to get heart disease, lung cancer, and several other diseases.
What Is the Relation Between Atrial Fibrillation and COPD?
Patients with atrial fibrillation (AF) frequently have chronic obstructive pulmonary disease (COPD), which has similar risk factors and raises the morbidity and death rates overall in the population. Additionally, COPD may worsen atrial fibrillation and reduce the effectiveness of treatment. It is believed that 25 percent of atrial fibrillation patients have COPD. A cardiologist and a pulmonologist must work closely together in an interdisciplinary manner to diagnose and treat COPD in patients with atrial fibrillation. Atrial fibrillation has affected about 33.5 million people worldwide. Moreover, COPD is the most prevalent chronic lung condition characterized by persistent limitation of airflow. Up to 25 percent of people with atrial fibrillation have chronic obstructive pulmonary disease. In addition, those with COPD are twice as likely to experience new-onset atrial fibrillation than those without COPD.
The relationship between atrial fibrillation and COPD is not entirely clear. COPD and atrial fibrillation have common risk factors contributing to the development of both conditions. Additionally, pathophysiological pathways associated with COPD may directly influence the development of atrial fibrillation. Furthermore, COPD is related to increased symptom burden, lower quality of life, and worse heart and bleeding outcomes in patients with atrial fibrillation.
What Is the Prevalence of COPD in Atrial Fibrillation Patients?
-
COPD has a global prevalence of roughly 11 percent.
-
The reported prevalence of COPD in individuals with atrial fibrillation is higher, exceeding 23 percent in patients over 65.
-
In stable COPD, the prevalence of atrial fibrillation ranges between 4.7 to 15 percent. However, the prevalence is much higher, reaching about 20 to 30 percent in severe COPD patients.
-
In contrast, estimates of the prevalence and incidence of arrhythmic disorders in COPD are inconsistent and frequently lack specificity regarding the type of arrhythmia.
How Is COPD in Atrial Fibrillation Patients Diagnosed?
Everyone with characteristic respiratory symptoms and smoking history should be suspected of having a chronic obstructive pulmonary disease.
-
Spirometry: Spirometry is the cornerstone of COPD diagnosis. Chronic obstructive pulmonary disease occurs when the ratio of forced expiratory volume to forced vital capacity is less than 0.70 after bronchodilator inhalation.
-
Handheld Micro-spirometer: The handheld micro-spirometer is mostly used to rule out COPD. Chronic obstructive pulmonary disease is unlikely if the ratio of forced expiratory volume in 1 second to forced volume in 6 seconds is more than 0.73.
-
Cardiopulmonary Exercise Testing: It is a diagnostic tool for identifying characteristics contributing to exercise intolerance, determining if exercise is safe, and establishing an individual training program in multimorbid patients.
What Is the Difference Between COPD-Related and Atrial Fibrillation-Related Symptoms in Atrial Fibrillation Patients?
The similar symptom profile in individuals with atrial fibrillation and concurrent COPD with or without cardiac failure poses a diagnostic problem. Chronic obstructive pulmonary disease symptoms may be mistaken for atrial fibrillation symptoms, prompting unnecessary diagnosis and treatment procedures. On the other hand, the acute start of atrial fibrillation-related symptoms can be mistaken as an aggravation of COPD or heart failure.
Patients with chronic obstructive pulmonary disease typically have a ventilatory limitation due to an expiratory flow limitation. Evaluation of oxygen saturation, natriuretic peptides echocardiography, and cardiopulmonary exercise screening may be effective tools in addition to spirometry to distinguish between cardiac and non-cardiac causes of exercise limitation and symptoms of dyspnea in atrial fibrillation patients with COPD and other concomitant cardiovascular comorbidities.
What Is the Treatment of COPD in Atrial Fibrillation Patients?
Treatment of COPD in atrial fibrillation patients can be done in the following ways:
-
Pharmacological Management: Bronchodilators are the cornerstone of COPD therapy. Recent studies have demonstrated that bronchodilators can be used safely in COPD patients with cardiovascular disease. Inhaled corticosteroids can also be used. Inhaled corticosteroids do not appear to enhance the incidence of atrial fibrillation, even though fixed regimens with beta2-agonists are commonly used in COPD patients. However, corticosteroids and Theophylline have been linked to an elevated incidence of atrial fibrillation in some cases.
-
Correction of Hypoxaemia and Hypercapnia: Guidelines recommend addressing hypoxemia and hypercapnia since they are linked to the onset of atrial fibrillation. COPD patients with atrial fibrillation who are stable should be examined for respiratory insufficiency. Although the effect of these treatment methods on the new onset of atrial fibrillation or progression of atrial fibrillation has not been examined, it appears prudent to rectify the underlying hypoxemia with oxygen therapy and hypercapnia with non-invasive ventilation.
-
Lifestyle Interventions: Risk-factor treatment, including weight loss and exercise prescription within a goal-directed program, increases the long-term effectiveness of atrial fibrillation ablation in obese patients.
-
Integrated Care Approach: The diagnosis and treatment of COPD in patients with atrial fibrillation involve close interdisciplinary coordination among the electrophysiologist, cardiologist, and pulmonologist, as well as structured follow-up. This may be best administered through an integrated care approach and necessitate multidisciplinary sessions to discuss the most appropriate management.
Conclusion:
Every atrial fibrillation patient with chronic dyspnea or impaired exercise tolerance should be suspected of having chronic obstructive pulmonary disease. Heart failure should be evaluated as an essential differential diagnosis in such cases. In addition, prospective studies in atrial fibrillation patients are needed to confirm the link between COPD and atrial fibrillation, the benefits of treating either COPD or atrial fibrillation in this population, and to explain the need for a routine COPD screening.
