Department of Respiratory Medicine, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands.
Division of Respiratory & Age-related Health, Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Universiteitssingel 40, 6229 ER Maastricht, the Netherlands.
Eur Heart J. 2021 Feb 1;42(5):532-540. doi: 10.1093/eurheartj/ehaa822.
Chronic obstructive pulmonary disease (COPD) is highly prevalent among patients with atrial fibrillation (AF), shares common risk factors, and adds to the overall morbidity and mortality in this population. Additionally, it may promote AF and impair treatment efficacy. The prevalence of COPD in AF patients is high and is estimated to be ∼25%. Diagnosis and treatment of COPD in AF patients requires a close interdisciplinary collaboration between the electrophysiologist/cardiologist and pulmonologist. Differential diagnosis may be challenging, especially in elderly and smoking patients complaining of unspecific symptoms such as dyspnoea and fatigue. Routine evaluation of lung function and determination of natriuretic peptides and echocardiography may be reasonable to detect COPD and heart failure as contributing causes of dyspnoea. Acute exacerbation of COPD transiently increases AF risk due to hypoxia-mediated mechanisms, inflammation, increased use of beta-2 agonists, and autonomic changes. Observational data suggest that COPD promotes AF progression, increases AF recurrence after cardioversion, and reduces the efficacy of catheter-based antiarrhythmic therapy. However, it remains unclear whether treatment of COPD improves AF outcomes and which metric should be used to determine COPD severity and guide treatment in AF patients. Data from non-randomized studies suggest that COPD is associated with increased AF recurrence after electrical cardioversion and catheter ablation. Future prospective cohort studies in AF patients are needed to confirm the relationship between COPD and AF, the benefits of treatment of either COPD or AF in this population, and to clarify the need and cost-effectiveness of routine COPD screening.
慢性阻塞性肺疾病（COPD）在心房颤动（AF）患者中高度流行，与共同的危险因素有关，并增加了该人群的整体发病率和死亡率。此外，它可能会促进 AF 的发生并影响治疗效果。COPD 在 AF 患者中的患病率较高，估计约为 25%。COPD 的诊断和治疗需要电生理学家/心脏病专家和肺病专家之间的密切跨学科合作。鉴别诊断可能具有挑战性，尤其是在抱怨呼吸困难和疲劳等非特异性症状的老年和吸烟患者中。常规评估肺功能并确定利钠肽和超声心动图可能有助于发现 COPD 和心力衰竭，因为它们是导致呼吸困难的原因。由于缺氧介导的机制、炎症、β-2 受体激动剂的使用增加和自主神经变化，COPD 的急性加重会暂时增加 AF 的风险。观察性数据表明，COPD 促进 AF 的进展，增加电复律后的 AF 复发，并降低导管抗心律失常治疗的效果。然而，目前尚不清楚治疗 COPD 是否能改善 AF 的结局，以及应该使用哪种指标来确定 COPD 的严重程度并指导 AF 患者的治疗。非随机研究的数据表明，COPD 与电复律和导管消融后的 AF 复发有关。需要在 AF 患者中进行未来的前瞻性队列研究，以确认 COPD 和 AF 之间的关系，在该人群中治疗 COPD 或 AF 的益处，并阐明常规 COPD 筛查的必要性和成本效益。
