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

Chronic Obstructive Pulmonary Disease Complicates Atrial Fibrillation Management

Rhythm control in COPD patients with AF: COPD in patients with AF is associated with reduced long-term success of cardioversion.[8,47] In AF patients undergoing AF ablation, COPD is among several demographic and clinical factors associated with reduced short-term outcome, increased hospitalization, stroke, and all-cause mortality.[9,48–50] In ORBIT-AF, COPD was associated with least improvement in health-related quality of life.[51] There is an increased risk of new-onset AF after flutter ablation in patients with COPD.[52] During rhythm control procedures requiring deep unconscious sedation, COPD patients may be at higher risk of for impaired ventilation with subsequent CO2 retention. Amiodarone is known for its pulmonary toxicity, mainly pulmonary fibrosis. Patients with COPD are at an increased risk for amiodaron-induced pulmonary toxicities.[53]

Rate control in COPD patients with AF: Because of potential side-effects related to bronchoconstriction, beta-blockers are less frequently prescribed in COPD patients.[24] However, studies showed a 28% reduction in mortality and a 38% reduction in exacerbation rate in COPD patients treated by beta-1 selective beta-blockers.[54] Metoprolol did neither shorten nor prolong the time until the first COPD exacerbation among patients with moderate or severe COPD.[55] Initiating treatment with beta-blockers requires dose titration and monitoring over a period of weeks, and beta-blockers may be less well-tolerated in older patients with COPD who have other comorbidities.[24] The Beta-blockeRs tO patieNts With CHronIc Obstructive puLmonary diseasE (BRONCHIOLE) – Study addresses the efficacy of beta-blockers in patients with COPD on patient-related outcomes in patients with COPD.[56]