Terzano C, Romani S, Conti V, Paone G, Oriolo F, Vitarelli A
Respiratory Diseases Unit, School of Specialization in Respiratory Diseases, University of Rome "Sapienza", Policlinico Umberto I, Rome, Italy.
Eur Rev Med Pharmacol Sci. 2014 Oct;18(19):2908-17.
Chronic obstructive pulmonary disease (COPD) has been associated with a high frequency of arrhythmias. Atrial fibrillation (AF) is one of the most common arrhythmias and causes substantial morbidity and mortality. Emerging risk factors for the development of AF include a variety of breathing disorders like COPD. Few studies have analyzed the role of reduced lung function and respiratory acidosis in predicting AF. Aim of the current study was to investigate the role of hypercapnia, pulmonary systolic hypertension and lung function impairment in COPD patients, as risk factors for atrial fibrillation development.
We evaluated a population of individuals consecutively hospitalized for COPD exacerbation and hypercapnic respiratory failure between January 2012 and January 2013; among them we selected a subgroup of patients presenting a paroxysmal episode of atrial fibrillation. All patients underwent pulmonary function tests, haemogasanalysis, electrocardiogram and transthoracic echocardiography.
Among the 193 subjects evaluated, 35 individuals with AF and COPD were enrolled in the study. Risk of new AF was higher in those subjects with lower FEV1 and higher PaCO2 values, also there was a significantly increased prevalence of AF in patients with higher value of Pulmonary Artery Systolic Pressure (PASP), obtained by transthoracic echocardiography. Linear correlation between variables revealed a direct relationships between hypercapnia and PASP and left and right atrial areas.
Impaired pulmonary function, hypercapnia and high values of PASP are independent predictors of incident AF.
慢性阻塞性肺疾病（COPD）与心律失常的高发生率相关。心房颤动（AF）是最常见的心律失常之一，会导致严重的发病和死亡。AF发生的新出现的危险因素包括多种呼吸障碍，如COPD。很少有研究分析肺功能降低和呼吸性酸中毒在预测AF中的作用。本研究的目的是调查高碳酸血症、肺动脉收缩压和肺功能损害在COPD患者中作为心房颤动发生危险因素的作用。
我们评估了2012年1月至2013年1月期间因COPD急性加重和高碳酸血症呼吸衰竭而连续住院的人群；其中我们选择了出现阵发性心房颤动发作的患者亚组。所有患者均接受了肺功能测试、血气分析、心电图和经胸超声心动图检查。
在评估的193名受试者中，35名患有AF和COPD的个体被纳入研究。FEV1较低和PaCO2值较高的受试者发生新发AF的风险更高，通过经胸超声心动图获得的肺动脉收缩压（PASP）值较高的患者中AF的患病率也显著增加。变量之间的线性相关性显示高碳酸血症与PASP以及左、右心房面积之间存在直接关系。
肺功能受损、高碳酸血症和高PASP值是新发AF的独立预测因素。
