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

Differentiation Between Chronic Obstructive Pulmonary Disease-related and Atrial Fibrillation-related Symptoms in Atrial Fibrillation Patients

The overlapping symptom-profile in AF patients with concomitant COPD with or without heart failure creates a diagnostic challenge. Chronic obstructive pulmonary disease-related symptoms may be misinterpreted as symptoms caused by AF, which may trigger unnecessary invasive or pharmacological rhythm control interventions. On the other hand, the acute onset of AF-related symptoms can be misdiagnosed as an exacerbation of COPD or heart failure.

Chronic obstructive pulmonary disease patients generally demonstrate a ventilatory limitation due to their expiratory flow limitation which can be determined by spirometry.[46] To identify further mechanisms of exercise limitation, particularly in AF patients with COPD and other concomitant cardiovascular comorbidities, assessment of oxygen saturation, natriuretic peptides echocardiography, and cardiopulmonary exercise testing (CPET) may be useful tools in addition to spirometry to differentiate between cardiac and non-cardiac causes of exercise limitation and symptoms of dyspnoea. Cardiopulmonary exercise testing is sensitive to changes in ventricular function, ventricular rate as well as dynamic hyperinflation and diffusion capacity.