Chronic Obstructive Pulmonary Disease and Atrial Fibrillation

An Interdisciplinary Perspective

Sami O. Simons; Adrian Elliott; Manuel Sastry; Jeroen M. Hendriks; Michael Arzt; Michiel Rienstra; Jonathan M. Kalman; Hein Heidbuchel; Stanley Nattel; Geertjan Wesseling; Ulrich Schotten; Isabelle C. van Gelder; Frits M.E. Franssen; Prashanthan Sanders; Harry J.G.M. Crijns; Dominik Linz


Eur Heart J. 2021;42(5):532-540. 

In This Article

Epidemiology of Chronic Obstructive Pulmonary Disease in Atrial Fibrillation Patients

The global prevalence of COPD ranges at around 11%.[3] The estimated prevalence of COPD in patients with AF has been found to be higher, reaching 23% in patients older than 65 years.[3–5] The prevalence of AF in stable COPD ranges from 4.7% to 15%, with significantly higher rates of about 20–30% in very severe COPD.[32] Moreover, severity of airflow limitation has been related to increased incidence of AF in the Copenhagen Heart Study[33] and the Atherosclerosis Risk in Community (ARIC) cohort study.[34]

Among patients with AF, acute exacerbation of COPD has been shown to be associated with a higher risk of AF-related hospitalizations in the first 90-day post-acute exacerbation period.[26,35] About 30% of COPD hospitalizations revealed co-existent arrhythmias, with 22.1% being AF.[36]

Conversely, the prevalence and incidence estimate of arrhythmic disorders in COPD are variable and often lack detail regarding the type of arrhythmia. Chronic obstructive pulmonary disease patients had a 28% increased AF risk, which further increased with frequent exacerbations and an enlarged left atrium.[28] The presence of COPD increases the hazard ratio for incident AF about five times in patients with CHA2DS2VASc score ≤1, while the prognostic significance of COPD was lower in patients with CHA2DS2VASc score ≥2.[37] Available evidence is strongest for the association between AF and COPD, but also (multifocal) atrial tachycardia, atrial flutter, ventricular tachycardia, and conduction disorders have been related to COPD.[38]