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

Gaps in Evidence

There are several diagnostic and therapeutic uncertainties and controversies related to the management of COPD in AF patients (Table 3). In accordance with current recommendations, the severity of COPD in AF patients has been determined in most clinical studies with the FEV1 and the frequency of symptoms. However, given the potentially relevant role of hypoxaemia, inflammation, and autonomic nervous system activation in COPD patients for AF progression, a more detailed characterization of AF patients with concomitant COPD considering these variables may result in a better disease-orientated assessment of COPD, which better reflects COPD-related AF risk and the need for COPD treatment.[67] Additionally, it is unknown which questionnaires can be used to assess dyspnoea (intensity and quality) and whether CPET can support in the diagnosis and management of patients with comorbid AF and COPD. The prevalence estimates of COPD in AF patients are based on cross-sectional studies, where often clinical history or diagnostic questionnaires formed the basis of COPD diagnosis and the diagnosis was not always excluded in the non-COPD groups. Large prospective longitudinal population-based studies evaluating the association between untreated COPD and incident AF or randomized controlled trials confirming that treatment of COPD prevents incident and recurrent AF are not available.

Take home figure.

A summary of different atrial arrhythmogenic mechanisms in patients with chronic obstructive pulmonary disease (left). Clinical facts and observations (right).