Goudis Christos A
Cardiology Department, Serres General Hospital, Serres, Greece.
J Cardiol. 2017 May;69(5):699-705. doi: 10.1016/j.jjcc.2016.12.013. Epub 2017 Feb 8.
Chronic obstructive pulmonary disease (COPD) is independently associated with atrial fibrillation (AF). Decreased oxygenation, hypercapnia, pulmonary hypertension, diastolic dysfunction, oxidative stress, inflammation, changes in atrial size by altered respiratory physiology, increased arrhythmogenicity from nonpulmonary vein foci commonly located in the right atrium, and respiratory drugs have been implicated in the pathogenesis of AF in COPD. The understanding of the relationship between COPD and AF is of particular importance, as the presence of the arrhythmia has significant impact on mortality, especially in COPD exacerbations. On the other hand, COPD in AF is associated with AF progression, success of cardioversion, recurrence of AF after catheter ablation, and increased cardiovascular and all-cause mortality. Treatment of the underlying pulmonary disease and correction of hypoxia and acid-base imbalance represents first-line therapy for COPD patients who develop AF. Cardioselective β-blockers are safe and can be routinely used in COPD. In addition, AF ablation was proved to be efficient and safe, and improves quality of life in these patients. This review presents the association between COPD and AF, describes the pathophysiological mechanisms implicated in AF development in COPD, underlines the prognostic significance of AF in COPD patients and vice versa, and highlights emerging therapeutic approaches in this setting.
慢性阻塞性肺疾病（COPD）与心房颤动（AF）独立相关。氧合降低、高碳酸血症、肺动脉高压、舒张功能障碍、氧化应激、炎症、呼吸生理改变导致的心房大小变化、右心房常见的非肺静脉病灶引起的心律失常增加以及呼吸药物都与COPD患者AF的发病机制有关。了解COPD与AF之间的关系尤为重要，因为心律失常的存在对死亡率有显著影响，尤其是在COPD急性加重期。另一方面，AF患者中的COPD与AF进展、复律成功率、导管消融术后AF复发以及心血管和全因死亡率增加有关。治疗基础肺部疾病以及纠正缺氧和酸碱失衡是发生AF的COPD患者的一线治疗方法。心脏选择性β受体阻滞剂是安全的，可常规用于COPD患者。此外，AF消融被证明是有效且安全的，可改善这些患者的生活质量。本综述阐述了COPD与AF之间的关联，描述了COPD患者AF发生所涉及的心病理生理机制，强调了AF在COPD患者中的预后意义以及反之亦然，并突出了在这种情况下新出现的治疗方法。
