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Respiratory function assessment in patients with atrial fibrillation: A needed extension of combined comorbidity management?

Published:February 10, 2023DOI:https://doi.org/10.1016/j.cjca.2023.02.006
Respiratory function assessment in patients with atrial fibrillation: A needed extension of combined comorbidity management?
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      Atrial fibrillation (AF) is often associated with multiple traditional comorbidities such as hypertension, heart failure, diabetes and obesity.
      • Pathak R.K.
      • Mahajan R.
      • Lau D.H.
      • Sanders P.
      The implications of obesity for cardiac arrhythmia mechanisms and management.
      Can J Cardiol. 2015; 31: 203-210
      Besides sleep apnea,
      • Linz D.
      • McEvoy R.D.
      • Cowie M.R.
      • Somers V.K.
      • Nattel S.
      • Lévy P.
      • Kalman J.M.
      • Sanders P.
      Associations of Obstructive Sleep Apnea With Atrial Fibrillation and Continuous Positive Airway Pressure Treatment: A Review.
      JAMA Cardiol. 2018; 3: 532-540
      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.
      • Simons S.O.
      • Elliott A.
      • Sastry M.
      • Hendriks J.M.
      • Arzt M.
      • Rienstra M.
      • Kalman J.M.
      • Heidbuchel H.
      • Nattel S.
      • Wesseling G.
      • Schotten U.
      • van Gelder I.C.
      • Franssen F.M.E.
      • Sanders P.
      • Crijns H.J.G.M.
      • Linz D.
      Chronic obstructive pulmonary disease and atrial fibrillation: an interdisciplinary perspective.
      Eur Heart J. 2021; 42: 532-540
      In addition, COPD is associated with higher symptom burden and worse quality of life. COPD is also associated with increased hospital admissions and all-cause mortality in AF patients.
      • Warming P.E.
      • Garcia R.
      • Hansen C.J.
      • Simons S.O.
      • Torp-Pedersen C.
      • Linz D.
      • Tfelt-Hansen J.
      The association of temporal sequence in atrial fibrillation and chronic obstructive pulmonary disease diagnosis and mortality risk.
      Eur Heart J Qual Care Clin Outcomes. 2022; https://doi.org/10.1093/ehjqcco/qcac059
      Importantly, this liaison between AF and COPD is not merely the result of shared risk factors, but there is increasing evidence that direct COPD-related mechanisms contribute to AF onset and AF progression. Gas exchange abnormalities (i.e. hypoxaemia and hypercapnia) may promote atrial remodelling by hypoxemia-induced systemic inflammation and pulmonary hypertension. As a consequence, right ventricular hypertrophy and diastolic dysfunction may induce further cardiac remodelling.
      • Hiram R.
      • Naud P.
      • Xiong F.
      • Al-U'datt D.
      • Algalarrondo V.
      • Sirois M.G.
      • Tanguay J.F.
      • Tardif J.C.
      • Nattel S.
      Right Atrial Mechanisms of Atrial Fibrillation in a Rat Model of Right Heart Disease.
      J Am Coll Cardiol. 2019; 74: 1332-1347
      Also, dynamic hyperinflation with subsequent thoracic pressure swings is hypothesized to increase sympathetic nerve activity. This complex interplay of mechanisms of cardiac remodelling and transient sympathetic nerve activity creates a complex and dynamic arrhythmogenic substrate for AF in patients with COPD.
      • Simons S.O.
      • Elliott A.
      • Sastry M.
      • Hendriks J.M.
      • Arzt M.
      • Rienstra M.
      • Kalman J.M.
      • Heidbuchel H.
      • Nattel S.
      • Wesseling G.
      • Schotten U.
      • van Gelder I.C.
      • Franssen F.M.E.
      • Sanders P.
      • Crijns H.J.G.M.
      • Linz D.
      Chronic obstructive pulmonary disease and atrial fibrillation: an interdisciplinary perspective.
      Eur Heart J. 2021; 42: 532-540
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        Associations of Obstructive Sleep Apnea With Atrial Fibrillation and Continuous Positive Airway Pressure Treatment: A Review.
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        View in Article
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      Article info

      Publication history

      Accepted: February 7, 2023
      Received in revised form: February 6, 2023
      Received: February 4, 2023

      Publication stage

      In Press Journal Pre-Proof

      Footnotes

      Disclosures

      None.

      Funding.

      None.

      Identification

      DOI: https://doi.org/10.1016/j.cjca.2023.02.006

      Copyright

      © 2023 Published by Elsevier Inc. on behalf of the Canadian Cardiovascular Society.

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