ABSTRACT
Background
There is a paucity of data on the association between respiratory function and atrial
fibrillation (AF). This study aimed to assess the relationship between forced expiratory
volume (FEV1), forced vital capacity (FVC), and FEV1/FVC and incident AF.
Methods
We performed an analysis of prospectively collected data from the UK Biobank. We included
all participants with available spirometry and excluded those with a prior AF. Incident
AF was ascertained through hospitalization and death records, and dose-response associations
were assessed using multivariable Cox regression analysis with adjustment for known
AF risk factors.
Results
We studied 348,219 white individuals (54.1% female) with a median age of 58.1 (IQR
50.8-63.5) years. Over a median follow-up time of 11.5 years (IQR: 11.0-12.6 years),
a total of 18,188 incident AF events occurred. After standardization to sex, age,
and height, the risk of AF consistently increased with decreasing FEV1 percentage
predicted, FEV1 z-score, and FVC z-score. The risk of AF linearly increased with decreasing
FEV1/FVC ratio, and those that had airway obstruction as defined by an FEV1/FVC ratio
< 0.70 had a 23% greater risk of incident AF (aHR 1.23, 95% CI 1.19-1.28) compared
to those without airway obstruction. Patients with known chronic obstructive pulmonary
disease and asthma were at 40% (aHR 1.40, 95% CI 1.29-1.51) and 17% (aHR 1.17, 95%
CI 1.12-1.22) increased risk of incident AF.
Conclusion
These findings indicate that reduced ventilatory function is associated with increased
risk of AF independently of age, sex, smoking, and other known AF risk factors.
Graphical abstract
Graphical Abstract
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Canadian Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
REFERENCES
- Global epidemiology of atrial fibrillation.Nat Rev Cardiol. 2014; 11: 639-654
- Global Burden of Cardiovascular Diseases and Risk Factors, 1990-2019: Update From the GBD 2019 Study.J Am Coll Cardiol. 2020; 76: 2982-3021
- Modifiable Risk Factors and Atrial Fibrillation.Circulation. 2017; 136: 583-596
- Absolute and attributable risks of atrial fibrillation in relation to optimal and borderline risk factors: the Atherosclerosis Risk in Communities (ARIC) study.Circulation. 2011; 123: 1501-1508
- Characteristics and outcomes of adults with chronic obstructive pulmonary disease and atrial fibrillation.Heart. 2018; 104: 1850-1858
- Chronic obstructive pulmonary disease and atrial fibrillation: an interdisciplinary perspective.Eur Heart J. 2021; 42: 532-540
- A prospective study of the clinical outcomes and prognosis associated with comorbid COPD in the atrial fibrillation population.Int J Chron Obstruct Pulmon Dis. 2019; 14: 371-380
- Airflow obstruction, lung function, and incidence of atrial fibrillation: the Atherosclerosis Risk in Communities (ARIC) study.Circulation. 2014; 129: 971-980
- Reduced forced expiratory volume is associated with increased incidence of atrial fibrillation: the Malmo Preventive Project.Europace. 2014; 16: 182-188
- Reduced lung function and risk of atrial fibrillation in the Copenhagen City Heart Study.Eur Respir J. 2003; 21: 1012-1016
- Incidence of and risk factors for atrial fibrillation in older adults.Circulation. 1997; 96: 2455-2461
- Independent risk factors for atrial fibrillation in a population-based cohort. The Framingham Heart Study.JAMA. 1994; 271: 840-844
- General considerations for lung function testing.Eur Respir J. 2005; 26: 153-161
- UK biobank: an open access resource for identifying the causes of a wide range of complex diseases of middle and old age.PLoS Med. 2015; 12e1001779
- Ventilatory function as a predictor of mortality in lifelong non-smokers: evidence from large British cohort studies.BMJ Open. 2017; 7e015381
- Multi-ethnic reference values for spirometry for the 3-95-yr age range: the global lung function 2012 equations.Eur Respir J. 2012; 40: 1324-1343
Townsend P, Philimore P, Beattie A. Health and Deprivation: Inequality and the North: Croom Helm; 1988.
- International physical activity questionnaire: 12-country reliability and validity.Med Sci Sports Exerc. 2003; 35: 1381-1395
- Risk Thresholds for Total and Beverage-Specific Alcohol Consumption and Incident Atrial Fibrillation.JACC Clin Electrophysiol. 2021; 7: 1561-1569
- Association between physical activity and risk of incident arrhythmias in 402 406 individuals: evidence from the UK Biobank cohort.Eur Heart J. 2020; 41: 1479-1486
- Atrial fibrillation.Nat Rev Dis Primers. 2016; 216016
- Decreasing cardiac chamber sizes and associated heart dysfunction in COPD: role of hyperinflation.Chest. 2010; 138: 32-38
- Intra-atrial pressure increases rate and organization of waves emanating from the superior pulmonary veins during atrial fibrillation.Circulation. 2003; 108: 668-671
- Pulmonary hypertension and chronic lung disease: where are we headed?.Eur Respir Rev. 2019; 28
- Right Atrial Mechanisms of Atrial Fibrillation in a Rat Model of Right Heart Disease.J Am Coll Cardiol. 2019; 74: 1332-1347
- Atrial arrhythmogenesis in a rabbit model of chronic obstructive pulmonary disease.Transl Res. 2020; 223: 25-39
- Acute Exacerbation of Chronic Obstructive Pulmonary Disease and Subsequent Risk of Emergency Department Visits and Hospitalizations for Atrial Fibrillation.Circ Arrhythm Electrophysiol. 2018; 11e006322
- Prediction of Atrial Fibrillation Using Machine Learning: A Review.Front Physiol. 2021; 12752317
Global Initiative for Chronic Obstructive Lung Disease. GLOBAL STRATEGY FOR PREVENTION, DIAGNOSIS AND MANAGEMENT OF COPD: 2022 Report. In; 2021.
- Chronic inflammation and asthma.Mutat Res. 2010; 690: 24-39
- Role of the autonomic nervous system in atrial fibrillation: pathophysiology and therapy.Circ Res. 2014; 114: 1500-1515
- Associations of Asthma and Asthma Control With Atrial Fibrillation Risk: Results From the Nord-Trøndelag Health Study (HUNT).JAMA Cardiol. 2018; 3: 721-728
Article info
Publication history
Accepted:
February 5,
2023
Received in revised form:
February 3,
2023
Received:
August 7,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
ACKNOWLEDGEMENTS
Availability of data and material: All data generated or analyzed in this study are included in the published article and the supplementary files.
Funding: This study received no funding
Financial disclosures: Dr Noubiap is supported by a Postgraduate Scholarship from the University of Adelaide. Dr Tu is supported by a Postgraduate scholarship from the National Health and Medical Research Council of Australia. Drs Emami and Middeldorp are supported by the University of Adelaide. Dr Elliott is supported by a Future Leader Fellowship from the National Heart Foundation of Australia. Dr Sanders is supported by a Practitioner Fellowships from the National Health and Medical Research Council of Australia and by the National Heart Foundation of Australia.
Conflict of Interest Disclosures: Dr Sanders reports having served on the advisory board of Medtronic, Abbott Medical, Boston Scientific, CathRx and PaceMate. Dr Sanders reports that the University of Adelaide has received on his behalf research funding, lecture and/or consulting fees from Medtronic, Abbott Medical, Boston Scientific, BD and Microport. The remaining authors have nothing to disclose.
Authors’ contributions: Conception and design: JJN, PS, SJT. Access to data: JJN, ME, SJT. Data analysis and interpretation: SJT, JJN. Manuscript drafting: JJN. Manuscript revision: JJN, SJT, ME, MEM, AE, PS. Approval of the final manuscript: JJN, SJT, ME, MEM, AE, PS.
Identification
Copyright
© 2023 Published by Elsevier Inc. on behalf of the Canadian Cardiovascular Society.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Respiratory function assessment in patients with atrial fibrillation: A needed extension of combined comorbidity management?Canadian Journal of Cardiology
- PreviewAtrial fibrillation (AF) is often associated with multiple traditional comorbidities such as hypertension, heart failure, diabetes and obesity.1 Besides sleep apnea,2 chronic obstructive pulmonary disease (COPD) is another emerging respiratory risk factor for AF. COPD is associated with increased AF incidence, AF progression and reduced treatment response to rhythm control strategies such as cardioversion, antiarrhythmic drug treatment and catheter ablation.3 In addition, COPD is associated with higher symptom burden and worse quality of life.
- Full-Text
- Preview
