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de-Miguel-Diez J, Lopez-de-Andres A, Zamorano-Leon JJ, Hernández-Barrera V, Cuadrado-Corrales N, Jimenez-Sierra A, Jimenez-Garcia R, Carabantes-Alarcon D. Detrimental Impact of Atrial Fibrillation among Patients Hospitalized for Acute Exacerbation of COPD: Results of a Population-Based Study in Spain from 2016 to 2021. J Clin Med 2024; 13:2803. [PMID: 38792346 PMCID: PMC11121781 DOI: 10.3390/jcm13102803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 05/06/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024] Open
Abstract
Background/Objectives: To analyze changes in the prevalence of atrial fibrillation (AF) in patients hospitalized for acute exacerbation of chronic obstructive pulmonary disease (AE-COPD); to evaluate hospital outcomes according to AF status, assessing sex differences; to identify factors associated with AF presence; and to analyze variables associated with in-hospital mortality (IHM) in AE-COPD patients with AF. Methods: We used data from the Registry of Specialized Care Activity-Basic Minimum Data Set (RAE-CMBD) to select patients aged ≥40 years with COPD in Spain (2016-2021). We stratified the study population according to AF presence and sex. The propensity score matching (PSM) methodology was employed to create comparable groups based on age, admission year, and comorbidities at the time of hospitalization. Results: We identified 399,196 hospitalizations that met the inclusion criteria. Among them, 20.58% had AF. The prevalence of AF rose from 2016 to 2021 (18.26% to 20.95%), though the increase was only significant in men. The median length of hospital stay (LOHS) and IHM were significantly higher in patients with AF than in those without AF. After PSM, IHM remained significantly higher for man and women with AF. Older age, male sex, and several comorbidities were factors associated with AF. Additionally, older age, male sex, different comorbidities including COVID-19, hospitalization in the year 2020, mechanical ventilation, and intensive care unit (ICU) admission were associated with higher IHM in patients with AE-COPD and AF. Conclusions: AF prevalence was high in patients hospitalized for AE-COPD, was higher in men than in women, and increased over time. AF presence was associated with worse outcomes. The variables associated with IHM in hospitalized AE-COPD patients with AF were older age, male sex, different comorbidities including COVID-19 presence, hospitalization in the year 2020, need of mechanical ventilation, and ICU admission.
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Affiliation(s)
- Javier de-Miguel-Diez
- Respiratory Care Department, Hospital General Universitario Gregorio Marañón, 28040 Madrid, Spain;
| | - Ana Lopez-de-Andres
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (J.J.Z.-L.); (N.C.-C.); (R.J.-G.); (D.C.-A.)
| | - José J. Zamorano-Leon
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (J.J.Z.-L.); (N.C.-C.); (R.J.-G.); (D.C.-A.)
| | - Valentín Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, 28922 Madrid, Spain;
| | - Natividad Cuadrado-Corrales
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (J.J.Z.-L.); (N.C.-C.); (R.J.-G.); (D.C.-A.)
| | | | - Rodrigo Jimenez-Garcia
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (J.J.Z.-L.); (N.C.-C.); (R.J.-G.); (D.C.-A.)
| | - David Carabantes-Alarcon
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (J.J.Z.-L.); (N.C.-C.); (R.J.-G.); (D.C.-A.)
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Bucci T, Romiti GF, Shantsila A, Teo W, Park H, Shimizu W, Corica B, Proietti M, Tse H, Chao T, Frost F, Lip GYH. Risk of Death and Cardiovascular Events in Asian Patients With Atrial Fibrillation and Chronic Obstructive Pulmonary Disease: A Report From the Prospective APHRS Registry. J Am Heart Assoc 2024; 13:e032785. [PMID: 38533983 PMCID: PMC11179754 DOI: 10.1161/jaha.123.032785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/27/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is associated with an increased risk of adverse events in patients with atrial fibrillation (AF); however, few data are available on this topic in Asian populations. METHODS AND RESULTS Prospective observational study conducted on patients with AF enrolled in the Asia-Pacific Heart Rhythm Society (APHRS) AF Registry. The diagnosis of COPD was based on data reported in the case report form by the investigators. Cox-regression models were used to assess the 1-year risk of a primary composite outcome of all-cause death, thromboembolic events, acute coronary syndrome, and heart failure. Analysis on single outcomes and cardiovascular death was also performed. Interaction analysis was used to assess the risk of composite outcome and all-cause death in different subgroups. The study included 4094 patients with AF (mean±SD age 68.5±12 years, 34.6% female), of whom 112 (2.7%) had COPD. Patients with COPD showed a higher incidence of the primary composite outcome (25.1% versus 6.3%, P<0.001), all-cause death (14.9% versus 2.6%, P<0.001), cardiovascular death (2.0% versus 0.6%, P<0.001), and heart failure (8.3% versus 6.0%, P<0.001). On multiple Cox-regression analysis, COPD was associated with a higher risk of the primary composite outcome (hazard ratio [HR], 3.17 [95% CI, 2.05-4.90]), all-cause death (HR, 3.59 [95% CI, 2.04-6.30]), and heart failure (HR, 3.32 [95% CI, 1.56-7.03]); no statistically significant differences were found for other outcomes. The association between COPD and mortality was significantly modified by the use of beta blockers (Pint=0.018). CONCLUSIONS In Asian patients with AF, COPD is associated with worse prognosis. In patients with AF and COPD, the use of beta blockers was associated with a lower mortality. REGISTRATION INFORMATION clinicaltrials.gov Identifier: NCT04807049.
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Affiliation(s)
- Tommaso Bucci
- Liverpool Centre of Cardiovascular Science at University of LiverpoolLiverpool John Moores University and Liverpool Heart & Chest HospitalLiverpoolUK
- Department of General and Specialized SurgerySapienza University of RomeRomeItaly
| | - Giulio Francesco Romiti
- Liverpool Centre of Cardiovascular Science at University of LiverpoolLiverpool John Moores University and Liverpool Heart & Chest HospitalLiverpoolUK
- Department of Translational and Precision MedicineSapienza University of RomeRomeItaly
| | - Alena Shantsila
- Liverpool Centre of Cardiovascular Science at University of LiverpoolLiverpool John Moores University and Liverpool Heart & Chest HospitalLiverpoolUK
| | - Wee‐Siong Teo
- Department of CardiologyNational Heart CentreSingaporeSingapore
| | - Hyung‐Wook Park
- Department of Cardiovascular MedicineChonnam National University HospitalGwangjuKorea
| | - Wataru Shimizu
- Department of Cardiovascular MedicineNippon Medical SchoolTokyoJapan
| | - Bernadette Corica
- Liverpool Centre of Cardiovascular Science at University of LiverpoolLiverpool John Moores University and Liverpool Heart & Chest HospitalLiverpoolUK
- Department of Translational and Precision MedicineSapienza University of RomeRomeItaly
| | - Marco Proietti
- Department of Clinical Sciences and Community HealthUniversity of MilanMilanItaly
- Division of Subacute CareIRCCS Istituti Clinici Scientifici MaugeriMilanItaly
| | - Hung‐Fat Tse
- Department of Medicine, School of Clinical Medicine; Queen Mary HospitalThe University of Hong KongHong KongSARChina
| | - Tze‐Fan Chao
- Institute of Clinical Medicine, and Cardiovascular Research CenterNational Yang Ming Chiao Tung UniversityTaipeiTaiwan
- Division of Cardiology, Department of MedicineTaipei Veterans General HospitalTaipeiTaiwan
| | - Frederick Frost
- Liverpool Centre of Cardiovascular Science at University of LiverpoolLiverpool John Moores University and Liverpool Heart & Chest HospitalLiverpoolUK
| | - Gregory Y. H. Lip
- Liverpool Centre of Cardiovascular Science at University of LiverpoolLiverpool John Moores University and Liverpool Heart & Chest HospitalLiverpoolUK
- Danish Center for Health Services Research, Department of Clinical MedicineAalborg UniversityAalborgDenmark
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3
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Shantsila E, Choi EK, Lane DA, Joung B, Lip GY. Atrial fibrillation: comorbidities, lifestyle, and patient factors. THE LANCET REGIONAL HEALTH. EUROPE 2024; 37:100784. [PMID: 38362547 PMCID: PMC10866737 DOI: 10.1016/j.lanepe.2023.100784] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 09/25/2023] [Accepted: 11/02/2023] [Indexed: 02/17/2024]
Abstract
Modern anticoagulation therapy has dramatically reduced the risk of stroke and systemic thromboembolism in people with atrial fibrillation (AF). However, AF still impairs quality of life, increases the risk of stroke and heart failure, and is linked to cognitive impairment. There is also a recognition of the residual risk of thromboembolic complications despite anticoagulation. Hence, AF management is evolving towards a more comprehensive understanding of risk factors predisposing to the development of this arrhythmia, its' complications and interventions to mitigate the risk. This review summarises the recent advances in understanding of risk factors for incident AF and managing these risk factors. It includes a discussion of lifestyle, somatic, psychological, and socioeconomic risk factors. The available data call for a practice shift towards a more individualised approach considering an increasingly broader range of health and patient factors contributing to AF-related health burden. The review highlights the needs of people living with co-morbidities (especially with multimorbidity), polypharmacy and the role of the changing population demographics affecting the European region and globally.
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Affiliation(s)
- Eduard Shantsila
- Department of Primary Care and Mental Health, University of Liverpool, United Kingdom
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
- Brownlow Group GP Practice, Liverpool, United Kingdom
| | - Eue-Keun Choi
- Division of Cardiology, Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Republic of Korea
| | - Deirdre A. Lane
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
- Department of Cardiovascular and Metabolic Medicine, University of Liverpool, United Kingdom
- Department of Clinical Medicine, Aalborg University, Denmark
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Gregory Y.H. Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom
- Department of Cardiovascular and Metabolic Medicine, University of Liverpool, United Kingdom
- Department of Clinical Medicine, Aalborg University, Denmark
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4
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Romiti GF, Corica B, Mei DA, Frost F, Bisson A, Boriani G, Bucci T, Olshansky B, Chao TF, Huisman MV, Proietti M, Lip GYH. Impact of chronic obstructive pulmonary disease in patients with atrial fibrillation: an analysis from the GLORIA-AF registry. Europace 2023; 26:euae021. [PMID: 38266129 PMCID: PMC10825625 DOI: 10.1093/europace/euae021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/11/2024] [Indexed: 01/26/2024] Open
Abstract
AIMS Chronic obstructive pulmonary disease (COPD) may influence management and prognosis of atrial fibrillation (AF), but this relationship has been scarcely explored in contemporary global cohorts. We aimed to investigate the association between AF and COPD, in relation to treatment patterns and major outcomes. METHODS AND RESULTS From the prospective, global GLORIA-AF registry, we analysed factors associated with COPD diagnosis, as well as treatment patterns and risk of major outcomes in relation to COPD. The primary outcome was the composite of all-cause death and major adverse cardiovascular events (MACEs). A total of 36 263 patients (mean age 70.1 ± 10.5 years, 45.2% females) were included; 2,261 (6.2%) had COPD. The prevalence of COPD was lower in Asia and higher in North America. Age, female sex, smoking, body mass index, and cardiovascular comorbidities were associated with the presence of COPD. Chronic obstructive pulmonary disease was associated with higher use of oral anticoagulant (OAC) [adjusted odds ratio (aOR) and 95% confidence interval (CI): 1.29 (1.13-1.47)] and higher OAC discontinuation [adjusted hazard ratio (aHR) and 95% CI: 1.12 (1.01-1.25)]. Chronic obstructive pulmonary disease was associated with less use of beta-blocker [aOR (95% CI): 0.79 (0.72-0.87)], amiodarone and propafenone, and higher use of digoxin and verapamil/diltiazem. Patients with COPD had a higher hazard of primary composite outcome [aHR (95% CI): 1.78 (1.58-2.00)]; no interaction was observed regarding beta-blocker use. Chronic obstructive pulmonary disease was also associated with all-cause death [aHR (95% CI): 2.01 (1.77-2.28)], MACEs [aHR (95% CI): 1.41 (1.18-1.68)], and major bleeding [aHR (95% CI): 1.48 (1.16-1.88)]. CONCLUSION In AF patients, COPD was associated with differences in OAC treatment and use of other drugs; Patients with AF and COPD had worse outcomes, including higher mortality, MACE, and major bleeding.
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Affiliation(s)
- Giulio Francesco Romiti
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Translational and Precision Medicine, Sapienza – University of Rome, Rome, Italy
| | - Bernadette Corica
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of Translational and Precision Medicine, Sapienza – University of Rome, Rome, Italy
| | - Davide Antonio Mei
- Department of Translational and Precision Medicine, Sapienza – University of Rome, Rome, Italy
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Frederick Frost
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Arnaud Bisson
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Service de Cardiologie, Centre Hospitalier Régional Universitaire et Faculté de Médecine de Tours, Tours, France
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Tommaso Bucci
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Department of General Surgery and Surgical Specialties ‘Paride Stefanini’, Sapienza – University of Rome, Rome, Italy
| | - Brian Olshansky
- Division of Cardiology, Department of Medicine, University of Iowa, Iowa City, USA
| | - Tze-Fan Chao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Menno V Huisman
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Marco Proietti
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Hereijgers MJ, van der Velden RM, el Moussaoui N, Verhaert DV, Habibi Z, Luermans J, den Uijl D, Chaldoupi SM, Vernooy K, Schotten U, Baumert M, Gietema HA, Mihl C, Koltowski L, Franssen FM, Simons SO, Linz D. Repurposing catheter ablation work-up to detect expiratory airflow limitation in patients with atrial fibrillation. IJC HEART & VASCULATURE 2023; 49:101305. [PMID: 38053981 PMCID: PMC10694302 DOI: 10.1016/j.ijcha.2023.101305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/01/2023] [Accepted: 11/13/2023] [Indexed: 12/07/2023]
Abstract
Background In atrial fibrillation (AF) patients, presence of expiratory airflow limitation may negatively impact treatment outcomes. AF patients are not routinely screened for expiratory airflow limitation, but existing examinations can help identify at-risk individuals. We aimed to assess the diagnostic value of repurposing existing assessments from the pre-ablation work-up to identify and understand the characteristics of affected patients. Methods We screened 110 consecutive AF patients scheduled for catheter ablation with handheld spirometry. Routine pre-ablation work-up included cardiac computed tomographic angiography (CCTA), transthoracic echocardiography and polygraphy. CCTA was analyzed qualitatively for emphysema and airway abnormalities. Multivariate logistic regression analysis was performed to determine predictors of expiratory airflow limitation. Results We found that 25 % of patients had expiratory airflow limitation, which was undiagnosed in 86 % of these patients. These patients were more likely to have pulmonary abnormalities on CCTA, including emphysema (odds ratio [OR] 4.2, 95 % confidence interval [CI] 1.12-15.1, p < 0.05) and bronchial wall thickening (OR 2.6, 95 % CI 1.0-6.5, p < 0.05). The absence of pulmonary abnormalities on CCTA accurately distinguished patients with normal lung function from those with airflow limitation (negative predictive value: 85 %). Echocardiography and polygraphy did not contribute significantly to identifying airflow limitation. Conclusions In conclusion, routine pre-ablation CCTA can detect pulmonary abnormalities in AF patients with airflow limitation, guiding further pulmonary assessment. Future studies should investigate its impact on ablation procedure success.
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Affiliation(s)
- Maartje J.M. Hereijgers
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Rachel M.J. van der Velden
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Nora el Moussaoui
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Dominique V.M. Verhaert
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Zarina Habibi
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Justin Luermans
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Dennis den Uijl
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Sevasti-Maria Chaldoupi
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Ulrich Schotten
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
| | - Mathias Baumert
- Discipline of Biomedical Engineering, The University of Adelaide, Adelaide, Australia
| | - Hester A. Gietema
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- GROW School for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | - Casper Mihl
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Lukasz Koltowski
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Frits M.E. Franssen
- Department of Research and Development, Ciro, Horn, The Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Sami O. Simons
- Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
- NUTRIM Research Institute of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Dominik Linz
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
- CARIM Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, The Netherlands
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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6
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van der Velden RMJ, Hereijgers MJM, Arman N, van Middendorp N, Franssen FME, Gawalko M, Verhaert DVM, Habibi Z, Vernooy K, Koltowski L, Hendriks JM, Heidbuchel H, Desteghe L, Simons SO, Linz D. Implementation of a screening and management pathway for chronic obstructive pulmonary disease in patients with atrial fibrillation. Europace 2023; 25:euad193. [PMID: 37421318 PMCID: PMC10351574 DOI: 10.1093/europace/euad193] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/02/2023] [Accepted: 05/30/2023] [Indexed: 07/10/2023] Open
Abstract
AIMS Chronic obstructive pulmonary disease (COPD) negatively impacts the efficacy of heart rhythm control treatments in patients with atrial fibrillation (AF). Although COPD is recognized as a risk factor for AF, practical guidance about how and when to screen for COPD is not available. Herein, we describe the implementation of an integrated screening and management pathway for COPD into the existing pre-ablation work-up in an AF outpatient clinic infrastructure. METHODS AND RESULTS Consecutive unselected patients accepted for AF catheter ablation in the Maastricht University Medical Center+ were prospectively screened for airflow limitation using handheld (micro)spirometry at the pre-ablation outpatient clinic supervised by an AF nurse. Patients with results suggestive of airflow limitation were offered referral to the pulmonologist. Handheld (micro)spirometry was performed in 232 AF patients, which provided interpretable results in 206 (88.8%) patients. Airflow limitation was observed in 47 patients (20.3%). Out of these 47 patients, 29 (62%) opted for referral to the pulmonologist. The primary reason for non-referral was low perceived symptom burden. Using this screening strategy 17 (out of 232; 7.3%) ultimately received a diagnosis of chronic respiratory disease, either COPD or asthma. CONCLUSION A COPD care pathway can successfully be embedded in an existing AF outpatient clinic infrastructure, using (micro)spirometry and remote analysis of results. Although one out of five patients had results suggestive of an underlying chronic respiratory disease, only 62% of these patients opted for a referral. Pre-selection of patients as well as patient education might increase the diagnostic yield and requires further research.
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Affiliation(s)
- Rachel M J van der Velden
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Maartje J M Hereijgers
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Nazia Arman
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Naomi van Middendorp
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Frits M E Franssen
- Department of Research and Development, Ciro, 6085 NM Horn, the Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 6200 MD Maastricht, the Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre, 6229 HX Maastricht, the Netherlands
| | - Monika Gawalko
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
- 1st Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Dominique V M Verhaert
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
- Department of Cardiology, Radboud University Medical Centre, 6525 GA Nijmegen, the Netherlands
| | - Zarina Habibi
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
- Department of Cardiology, Radboud University Medical Centre, 6525 GA Nijmegen, the Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
- Department of Cardiology, Radboud University Medical Centre, 6525 GA Nijmegen, the Netherlands
| | - Lukasz Koltowski
- 1st Department of Cardiology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Jeroen M Hendriks
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, 5001 Adelaide, Australia
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, 5000 Adelaide, Australia
| | - Hein Heidbuchel
- Department of Cardiology, Antwerp University Hospital, 2650 Antwerp, Belgium
- Research Group Cardiovascular Diseases, University of Antwerp, 2650 Antwerp, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, 3590 Hasselt, Belgium
| | - Lien Desteghe
- Department of Cardiology, Antwerp University Hospital, 2650 Antwerp, Belgium
- Research Group Cardiovascular Diseases, University of Antwerp, 2650 Antwerp, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, 3590 Hasselt, Belgium
- Heart Center Hasselt, Jessa Hospital, 3500 Hasselt, Belgium
| | - Sami O Simons
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, 6200 MD Maastricht, the Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre, 6229 HX Maastricht, the Netherlands
| | - Dominik Linz
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
- Department of Cardiology, Radboud University Medical Centre, 6525 GA Nijmegen, the Netherlands
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, 5000 Adelaide, Australia
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
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7
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Ioannides AE, Tayal U, Quint JK. Spirometry in atrial fibrillation: what's the catch? Expert Rev Respir Med 2023; 17:937-950. [PMID: 37937396 DOI: 10.1080/17476348.2023.2279236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 10/31/2023] [Indexed: 11/09/2023]
Abstract
INTRODUCTION People with COPD rarely have COPD alone, and the commonest co-morbidities occurring with COPD are cardiovascular. Whilst multiple studies have explored the association between major cardiovascular events and COPD, less attention has been paid to arrhythmias, specifically atrial fibrillation (AF). AF and COPD frequently occur together, posing challenges in diagnosis and management. In this review, we describe the relationship between AF and COPD epidemiologically and physiologically, demonstrating the role of spirometry as a diagnostic and disease management tool. AREAS COVERED We provide epidemiological evidence that COPD and AF are independent risk factors for one another, that either disease is highly prevalent amongst people with the other, and that they have shared risk factors; all of which contribute to adverse prognostic. We elucidated common pathophysiological mechanisms implicated in AF-COPD. We ultimately present the epidemiological and physiological evidence with a view to highlight specific areas where we feel spirometry is of value in the management of AF-COPD. EXPERT OPINION AF and COPD commonly co-occur, there is often diagnostic delay, increased risk of reduced cardioversion success, and missed opportunity to intervene to reduce stroke risk. Greater awareness and timelier diagnosis and guideline directed management may improve outcomes for people with both diseases.
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Affiliation(s)
| | - Upasana Tayal
- National Heart and Lung Institute, Imperial College London, London, UK
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8
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Sun Z, Lin J, Zhang T, Sun X, Wang T, Duan J, Yao K. Combining bioinformatics and machine learning to identify common mechanisms and biomarkers of chronic obstructive pulmonary disease and atrial fibrillation. Front Cardiovasc Med 2023; 10:1121102. [PMID: 37057099 PMCID: PMC10086368 DOI: 10.3389/fcvm.2023.1121102] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 03/14/2023] [Indexed: 03/30/2023] Open
Abstract
BackgroundPatients with chronic obstructive pulmonary disease (COPD) often present with atrial fibrillation (AF), but the common pathophysiological mechanisms between the two are unclear. This study aimed to investigate the common biological mechanisms of COPD and AF and to search for important biomarkers through bioinformatic analysis of public RNA sequencing databases.MethodsFour datasets of COPD and AF were downloaded from the Gene Expression Omnibus (GEO) database. The overlapping genes common to both diseases were screened by WGCNA analysis, followed by protein-protein interaction network construction and functional enrichment analysis to elucidate the common mechanisms of COPD and AF. Machine learning algorithms were also used to identify key biomarkers. Co-expression analysis, “transcription factor (TF)-mRNA-microRNA (miRNA)” regulatory networks and drug prediction were performed for key biomarkers. Finally, immune cell infiltration analysis was performed to evaluate further the immune cell changes in the COPD dataset and the correlation between key biomarkers and immune cells.ResultsA total of 133 overlapping genes for COPD and AF were obtained, and the enrichment was mainly focused on pathways associated with the inflammatory immune response. A key biomarker, cyclin dependent kinase 8 (CDK8), was identified through screening by machine learning algorithms and validated in the validation dataset. Twenty potential drugs capable of targeting CDK8 were obtained. Immune cell infiltration analysis revealed the presence of multiple immune cell dysregulation in COPD. Correlation analysis showed that CDK8 expression was significantly associated with CD8+ T cells, resting dendritic cell, macrophage M2, and monocytes.ConclusionsThis study highlights the role of the inflammatory immune response in COPD combined with AF. The prominent link between CDK8 and the inflammatory immune response and its characteristic of not affecting the basal expression level of nuclear factor kappa B (NF-kB) make it a possible promising therapeutic target for COPD combined with AF.
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Affiliation(s)
- Ziyi Sun
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Jianguo Lin
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School, China Academy of Chinese Medical Sciences, Beijing, China
| | - Tianya Zhang
- Graduate School, Hebei University of Chinese Medicine, Shijiazhuang, China
| | - Xiaoning Sun
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School, China Academy of Chinese Medical Sciences, Beijing, China
| | - Tianlin Wang
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Jinlong Duan
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Kuiwu Yao
- Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Eye Hospital China Academy of Chinese Medical Sciences, China Academy of Chinese Medical Sciences, Beijing, China
- Correspondence: Kuiwu Yao
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9
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Levent F, Kanat S, Tutuncu A. Predictive Value of C2HEST Score for Atrial Fibrillation Recurrence Following Successful Cryoballoon Pulmonary Vein Isolation in Paroxysmal Atrial Fibrillation. Angiology 2023; 74:273-281. [PMID: 35583221 DOI: 10.1177/00033197221102230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The C2HEST score ((coronary artery disease (CAD) or chronic obstructive pulmonary disease (COPD) [C2, 1 point each]; hypertension [H, 1 point]; elderly [E, age ≥75 years, 2 points]; systolic heart failure [S, 2 points]; thyroid disease [T, hyperthyroidism, 1 point]) has been validated for predicting incidental atrial fibrillation (AF) in both the general population and patients with ischemic stroke. The present study evaluated the performance of this score in predicting AF recurrence in 252 patients following cryoballoon ablation (CRYO) for paroxysmal AF. The AF recurrence rate in 3-12 months following CRYO was 20,2%. The predictive value of the C2HEST score was significantly better than that of the CHA2DS2-VASc score ((congestive heart failure, hypertension, age (>65 = 1 point, >75 = 2 points), diabetes, previous stroke/transient ischemic attack (2 points), vascular disease, age 65-74 years, and sex category)) (area under curve [AUC]: .881 vs .741; P = .0017). C2HEST score of ≥2, increased atrial diameter, and E/e' ratio as well as, the presence of COPD and systolic heart failure (SHF) were independent predictors for AF recurrence (P < .05). In patients undergoing CRYO for paroxysmal AF, the C2HEST, a simple clinical score, could be useful to assess the risk of AF recurrence.
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Affiliation(s)
- Fatih Levent
- Department of Cardiology, 147003Bursa Yüksek İhtisas Training and Research Hospital, İzmir, Turkey
| | - Selçuk Kanat
- Department of Cardiology, 147003Bursa Yüksek İhtisas Training and Research Hospital, İzmir, Turkey
| | - Ahmet Tutuncu
- Department of Cardiology, 147003Bursa Yüksek İhtisas Training and Research Hospital, İzmir, Turkey
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10
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A new scoring system: PAT 2C 2H score. Its clinical use and comparison with HATCH and CHA 2DS 2-VASc scores in predicting arrhythmia recurrence after cryoballoon ablation of paroxysmal atrial fibrillation. J Interv Card Electrophysiol 2022; 65:701-710. [PMID: 35927600 DOI: 10.1007/s10840-022-01328-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 07/28/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Several clinical risk factors and scoring systems have been proposed to predict arrhythmia recurrence after atrial fibrillation (AF) ablation. We sought to determine the ability of a new score to predict atrial arrhythmia recurrence after cryoballoon (CB) ablation of AF and whether the new score shows superior efficiency compared to previously offered scores. METHODS A total of 419 patients with paroxysmal AF who underwent their first CB ablation were included. Baseline clinical variables were analyzed, and independent predictors of recurrence at 12 months were used to develop the PAT2C2H score. The predictive capability of the new score was calculated and compared with the currently available risk scores. RESULTS Chronic obstructive pulmonary disease, left atrial dilatation, transient ischemic attack or stroke, congestive heart failure, and hypertension were independent predictors of recurrence. The PAT2C2H score which was developed from these variables had a better clinical predictive capability of arrhythmia recurrence compared to HATCH and CHA2DS2-VASc scores. With increasing PAT2C2H score and score severity (low, score of 0; moderate, score of 1-2; and high, score of ≥ 3), the proportion of patients with recurrence was increased from 7% (score = 0, severity = low) to 59% (score ≥ 3, severity = high). CONCLUSIONS The PAT2C2H score may help to identify patients who are likely benefited most from CB ablation of paroxysmal AF and who should be monitored more closely for arrhythmia recurrence at 12 months.
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11
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Lang RM, Cameli M, Sade LE, Faletra FF, Fortuni F, Rossi A, Soulat-Dufour L. Imaging assessment of the right atrium: anatomy and function. Eur Heart J Cardiovasc Imaging 2022; 23:867-884. [PMID: 35079782 DOI: 10.1093/ehjci/jeac011] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 01/12/2022] [Indexed: 01/07/2023] Open
Abstract
The right atrium (RA) is the cardiac chamber that has been least well studied. Due to recent advances in interventional cardiology, the need for greater understanding of the RA anatomy and physiology has garnered significant attention. In this article, we review how a comprehensive assessment of RA dimensions and function using either echocardiography, cardiac computed tomography, and magnetic resonance imaging may be used as a first step towards a better understanding of RA pathophysiology. The recently published normative data on RA size and function will likely shed light on RA atrial remodelling in atrial fibrillation (AF), which is a complex phenomenon that occurs in both atria but has only been studied in depth in the left atrium. Changes in RA structure and function have prognostic implications in pulmonary hypertension (PH), where the increased right ventricular (RV) afterload first induces RV remodelling, predominantly characterized by hypertrophy. As PH progresses, RV dysfunction and dilatation may begin and eventually lead to RV failure. Thereafter, RV overload and increased RV stiffness may lead to a proportional increase in RA pressure. This manuscript provides an in-depth review of RA anatomy, function, and haemodynamics with particular emphasis on the changes in structure and function that occur in AF, tricuspid regurgitation, and PH.
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Affiliation(s)
- Roberto M Lang
- Heart and Vascular Center, University of Chicago, 5758 S Maryland Avenue, MC 9067, DCAM 5509, Chicago, IL 60637, USA
| | - Matteo Cameli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Leila E Sade
- University of Pittsburgh Medical Center, Heart and Vascular Institute, Pittsburgh, PA, USA.,Department of Cardiology, University of Baskent, Ankara, Turkey
| | | | - Federico Fortuni
- Department of Cardiology, San Giovanni Battista Hospital, Foligno, Italy.,Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Alexia Rossi
- Department of Nuclear Medicine, Zurich University Hospital, Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Schlieren, Zurich, Switzerland
| | - Laurie Soulat-Dufour
- Saint Antoine and Tenon Hospital, AP-HP, Pr Ariel Cohen, Sorbonne Université, INSERM, Unité de recherche sur les maladies cardiovasculaires, le métabolisme et la nutrition, ICAN, Paris F-75013, France
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12
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Management of atrial fibrillation: two decades of progress - a scientific statement from the European Cardiac Arrhythmia Society. J Interv Card Electrophysiol 2022; 65:287-326. [PMID: 35419669 DOI: 10.1007/s10840-022-01195-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 03/21/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common sustained arrhythmia encountered in clinical practice. The aim of this review was to evaluate the progress made in the management of AF over the two last decades. RESULTS Clinical classification of AF is usually based on the presence of symptoms, the duration of AF episodes and their possible recurrence over time, although incidental diagnosis is not uncommon. The majority of patients with AF have associated cardiovascular diseases and more recently the recognition of modifiable risk factors both cardiovascular and non-cardiovascular which should be considered in its management. Among AF-related complications, stroke and transient ischaemic accidents (TIAs) carry considerable morbidity and mortality risk. The use of implantable devices such as pacemakers and defibrillators, wearable garments and subcutaneous cardiac monitors with recording capabilities has enabled to access the burden of "subclinical AF". The recent introduction of non-vitamin K antagonists has led to improve the prevention of stroke and peripheral embolism. Agents capable of reversing non-vitamin K antagonists have also become available in case of clinically relevant major bleeding. Transcatheter closure of left atrial appendage represents an option for patients unable to take oral anticoagulation. When treating patients with AF, clinicians need to select the most suitable strategy, i.e. control of heart rate and/or restoration and maintenance of sinus rhythm. The studies comparing these two strategies have not shown differences in terms of mortality. If an AF episode is poorly tolerated from a haemodynamic standpoint, electrical cardioversion is indicated. Otherwise, restoration of sinus rhythm can be obtained using intravenous pharmacological cardioversion and oral class I or class III antiarrhythmic is used to prevent recurrences. During the last two decades after its introduction in daily practice, catheter ablation has gained considerable escalation in popularity. Progress has also been made in AF associated with heart failure with reduced or preserved ejection fraction. CONCLUSIONS Significant progress has been made within the past 2 decades both in the pharmacological and non-pharmacological managements of this cardiac arrhythmia.
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13
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Numminen A, Penttilä T, Arola O, Inkovaara J, Oksala N, Mäkynen H, Hernesniemi J. Treatment success and its predictors as well as the complications of catheter ablation for atrial fibrillation in a high-volume centre. J Interv Card Electrophysiol 2021; 63:357-367. [PMID: 34060008 PMCID: PMC8983498 DOI: 10.1007/s10840-021-01011-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 05/12/2021] [Indexed: 11/29/2022]
Abstract
Purpose Catheter ablation for atrial fibrillation (AF) is a standard procedure for maintaining sinus rhythm. The aim of this study was to evaluate treatment success and its predictors and to provide quality control data on complications and redo operations in a centre with an initially a low but currently high annual volume. Methods Data on patients (n = 1,253) treated with catheter ablation for AF in Tays Heart Hospital between January 2010 and May 2018 was evaluated (n = 1178 ablation-naïve patients and n = 1514 AF ablations). Comprehensive data on patient characteristics, treatment results, redo operations and complications were collected. Treatment success (maintenance of sinus rhythm at 1 year) was evaluated among patients residing within the hospital district (45% of the entire study population). Results Treatment success was observed in approximately 62.9% of the ablation-naïve patients. Preoperative predictors of treatment success were paroxysmal AF type, previous use of antiarrhythmic drugs, left atrium diameter and age. The experience at the centre did not associate with the 1-year outcome. A relapse during the first 3-month blanking period was associated with a nine-fold risk of failure at 1 year (unadjusted OR 9.1, 95% CI 5.5–15.1, p < 0.001). The major complication rate was 4.5% (68/1514) with no deaths. Ten percent of the patients needed a redo procedure within the first year. Conclusions Patient-related factors are the most significant predictors of treatment success. A relapse during a 3-month blanking period is associated with a very high risk of failure at 1 year.
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Affiliation(s)
- Anna Numminen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | - Tero Penttilä
- Tays Heart Hospital, Tampere University Hospital, Tampere, Finland
| | - Olli Arola
- Tays Heart Hospital, Tampere University Hospital, Tampere, Finland
| | - Jaakko Inkovaara
- Tays Heart Hospital, Tampere University Hospital, Tampere, Finland
| | - Niku Oksala
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Vascular Centre, Tampere University Hospital, Tampere, Finland
| | - Heikki Mäkynen
- Tays Heart Hospital, Tampere University Hospital, Tampere, Finland
| | - Jussi Hernesniemi
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Tays Heart Hospital, Tampere University Hospital, Tampere, Finland
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14
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Simons SO, Elliott A, Sastry M, Hendriks JM, Arzt M, Rienstra M, Kalman JM, Heidbuchel H, Nattel S, Wesseling G, Schotten U, van Gelder IC, Franssen FME, Sanders P, Crijns HJGM, Linz D. Chronic obstructive pulmonary disease and atrial fibrillation: an interdisciplinary perspective. Eur Heart J 2021; 42:532-540. [PMID: 33206945 DOI: 10.1093/eurheartj/ehaa822] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 06/12/2020] [Accepted: 09/11/2020] [Indexed: 02/06/2023] Open
Abstract
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.
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Affiliation(s)
- Sami O Simons
- 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
| | - Adrian Elliott
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, 1 Port Road, SA 5000 Adelaide, Australia
| | - Manuel Sastry
- Academic Sleep Centre CIRO, Hornerheide 1, 6085 NM Horn, the Netherlands
| | - Jeroen M Hendriks
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, 1 Port Road, SA 5000 Adelaide, Australia.,Institute of Health, Medicine and Caring Sciences, Linköping University, Campus US, SE 581 83 Linköping, Sweden.,Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, SA 5001 Adelaide, Australia
| | - Michael Arzt
- Department of Internal Medicine II, Centre of Sleep Medicine, University Hospital Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Germany
| | - Michiel Rienstra
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, the Netherlands
| | - Jonathan M Kalman
- Department of Cardiology, Royal Melbourne Hospital and Department of Medicine, University of Melbourne, Grattan St Parkville, 3050 Melbourne, Australia
| | - Hein Heidbuchel
- University of Antwerp and Antwerp University Hospital, Drie Eikenstraat 655, 2650 Antwerp, Belgium.,Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium
| | - Stanley Nattel
- Department of Medicine, Montreal Heart Institute and Université de Montréal, 5000 Rue Bélanger, QC H1T 1C8, Montréal, Canada.,Department of Pharmacology and Therapeutics, McGill University, 3649 Promenade Sir-William-Osler, QC H3A 1A3, Canada.,Institute of Pharmacology, West German Heart and Vascular Center, Faculty of Medicine, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Geertjan Wesseling
- Department of Respiratory Medicine, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Ulrich Schotten
- University Maastricht, Cardiovascular Research Institute Maastricht (CARIM), Universiteitssingel 50, 6229 ER Maastricht, the Netherlands
| | - Isabelle C van Gelder
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9700 RB, Groningen, the Netherlands
| | - Frits M E Franssen
- 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.,Academic Sleep Centre CIRO, Hornerheide 1, 6085 NM Horn, the Netherlands
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, 1 Port Road, SA 5000 Adelaide, Australia
| | - Harry J G M Crijns
- University Maastricht, Cardiovascular Research Institute Maastricht (CARIM), Universiteitssingel 50, 6229 ER Maastricht, the Netherlands.,Department of Cardiology, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands
| | - Dominik Linz
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, 1 Port Road, SA 5000 Adelaide, Australia.,University Maastricht, Cardiovascular Research Institute Maastricht (CARIM), Universiteitssingel 50, 6229 ER Maastricht, the Netherlands.,Department of Cardiology, Maastricht University Medical Centre, P. Debyelaan 25, 6229 HX Maastricht, the Netherlands.,Department of Cardiology, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands.,Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200 København N, Denmark
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15
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Influence of Chronic Obstructive Pulmonary Disease on Atrial Mechanics by Speckle Tracking Echocardiography in Patients With Atrial Fibrillation. Am J Cardiol 2021; 143:60-66. [PMID: 33359195 DOI: 10.1016/j.amjcard.2020.12.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/05/2020] [Accepted: 12/08/2020] [Indexed: 01/01/2023]
Abstract
The present study aimed to examine differences in left- and right atrial characteristics between atrial fibrillation (AF) patients with and without chronic obstructive pulmonary disease (COPD). For this, 420 patients (mean age 68 ± 10 years, 73% female) with first diagnosis of AF and baseline echocardiography were included. Of these, 143 COPD patients were compared with 277 patients without COPD matched by age, gender and body surface area. Additionally 38 healthy controls without cardiovascular risk factors, matched for age, were included. For all 3 groups, left atrial (LA) volumes and diameter, LA reservoir strain (LASr), left ventricular ejection fraction (LVEF), right atrial (RA) area and diameter, RA reservoir strain (RASr) and tricuspid annular plane systolic excursion were evaluated on transthoracic echocardiography. Baseline characteristics were similar in patients with and without COPD except for smoking and a history of heart failure (42% vs 11%, p < 0.001 and 48% vs 37%, p = 0.036 for COPD and non-COPD patients, respectively). Also, COPD patients less often used β-blockers (63% vs 75%, p = 0.017). There were no significant differences in LVEF, LA volume and RA area between COPD and non-COPD patients. Compared to the controls, AF patients had impaired LVEF, LASr and RASr. Only RASr was significantly worse in COPD patients as compared to non-COPD patients (15.3% [9.0 to 25.1] vs 19.6% [11.8 to 28.5], p = 0.013). Additionally, a trend towards worse RASr was observed with increasing COPD severity. In conclusion, AF patients with concomitant COPD have more impaired RA function compared to patients without COPD but with similar atrial size and LA function.
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Yilmaz M, Candemir B. Approach to recurrence of atrial fibrillation after catheter ablation. Minerva Cardiol Angiol 2021; 69:81-93. [PMID: 33691388 DOI: 10.23736/s2724-5683.20.05173-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Atrial fibrillation (AF) is the most commonly observed sustained rhythm disorder during adult ages. Since it has been shown that the ectopic beat initiating AF is usually caused by pulmonary veins, AF ablation has become the mainstay of therapy worldwide. Cryoballoon and radiofrequency ablation are the most commonly used methods in today's technologies. However, despite technological advances, the success of a single procedure in AF ablation is still limited and multiple procedures may be required for the majority of patients. In cases in which a redo ablation is required, pulmonary vein isolation is still the main target, but non-pulmonary vein targets should also be considered in AF episodes that continue despite multiple ablations. Many issues are still unclear as to which energy to choose in the first procedure, and what ablation strategy will be utilized when a redo ablation is required. The studies on this subject are very limited but, it still seems feasible and a rational approach to utilize a customized treatment strategy in each specific patient subgroup.
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Affiliation(s)
- Mustafa Yilmaz
- Department of Cardiology, Faculty of Medicine, Baskent University, Adana, Turkey -
| | - Basar Candemir
- Department of Cardiology, Faculty of Medicine, Ankara University, Ankara, Turkey
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17
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Huang Q, Xiong H, Shuai T, Zhang M, Zhang C, Wang Y, Zhu L, Lu J, Liu J. Risk factors for new-onset atrial fibrillation in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. PeerJ 2020; 8:e10376. [PMID: 33344074 PMCID: PMC7718784 DOI: 10.7717/peerj.10376] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 10/26/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND New-onset atrial fibrillation (AF) in patients with chronic obstructive pulmonary disease (COPD) is associated with an accelerated decline in lung function, and a significant increase in mortality rate. A deeper understanding of the risk factors for new-onset AF during COPD will provide insights into the relationship between COPD and AF and guide clinical practice. This systematic review and meta-analysis is designed to identify risk factors for new-onset AF in patients with COPD, and to formulate recommendations for preventing AF in COPD patients that will assist clinical decision making. METHODS PubMed, Embase, Web of Science and Cochrane Library databases were searched for studies, which reported the results of potential risk factors for new-onset AF in COPD patients. RESULTS Twenty studies involving 8,072,043 participants were included. Fifty factors were examined as potential risk factors for new-onset AF during COPD. Risk factors were grouped according to demographics, comorbid conditions, and COPD- and cardiovascular-related factors. In quantitative analysis, cardiovascular- and demographic-related factors with a greater than 50% increase in the odds of new-onset AF included age (over 65 years and over 75 years), acute care encounter, coronary artery disease, heart failure and congestive heart failure. Only one factor is related to the reduction of odds by more than 33.3%, which is black race (vs white). In qualitative analysis, the comparison of the risk factors was conducted between COPD-associated AF and non-COPD-associated AF. Cardiovascular-related factors for non-COPD-associated AF were also considered as risk factors for new-onset AF during COPD; however, the influence tended to be stronger during COPD. In addition, comorbid factors identified in non-COPD-associated AF were not associated with an increased risk of AF during COPD. CONCLUSIONS New-onset AF in COPD has significant demographic characteristics. Older age (over 65 years), males and white race are at higher risk of developing AF. COPD patients with a history of cardiovascular disease should be carefully monitored for new-onset of AF, and appropriate preventive measures should be implemented. Even patients with mild COPD are at high risk of new-onset AF. This study shows that risk factors for new-onset AF during COPD are mainly those associated with the cardiovascular-related event and are not synonymous with comorbid factors for non-COPD-associated AF. The pathogenesis of COPD-associated AF may be predominantly related to the cardiac dysfunction caused by the chronic duration of COPD, which increases the risk of cardiovascular-related factors and further increases the risk of AF during COPD. PROSPERO REGISTRATION NUMBER CRD42019137758.
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Affiliation(s)
- Qiangru Huang
- Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, China
- The First Clinical Medical College of the First Hospital of Lanzhou University, LanZhou, China
| | - Huaiyu Xiong
- Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, China
- The First Clinical Medical College of the First Hospital of Lanzhou University, LanZhou, China
| | - Tiankui Shuai
- Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, China
- The First Clinical Medical College of the First Hospital of Lanzhou University, LanZhou, China
| | - Meng Zhang
- Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, China
- The First Clinical Medical College of the First Hospital of Lanzhou University, LanZhou, China
| | - Chuchu Zhang
- Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, China
- The First Clinical Medical College of the First Hospital of Lanzhou University, LanZhou, China
| | - Yalei Wang
- Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, China
- The First Clinical Medical College of the First Hospital of Lanzhou University, LanZhou, China
| | - Lei Zhu
- Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, China
- The First Clinical Medical College of the First Hospital of Lanzhou University, LanZhou, China
| | - Jiaju Lu
- Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, China
- The First Clinical Medical College of the First Hospital of Lanzhou University, LanZhou, China
| | - Jian Liu
- Department of Intensive Care Unit, The First Hospital of Lanzhou University, Lanzhou, China
- The First Clinical Medical College of the First Hospital of Lanzhou University, LanZhou, China
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Hirayama A, Goto T, Shimada YJ, Faridi MK, Camargo CA, Hasegawa K. Acute Exacerbation of Chronic Obstructive Pulmonary Disease and Subsequent Risk of Emergency Department Visits and Hospitalizations for Atrial Fibrillation. Circ Arrhythm Electrophysiol 2019; 11:e006322. [PMID: 30354294 DOI: 10.1161/circep.118.006322] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background Although emerging evidence has suggested the relationship of chronic obstructive pulmonary disease with atrial fibrillation (AF), little is known about whether acute exacerbation of chronic obstructive pulmonary disease (AECOPD) increases the risk of repeated AF-related healthcare utilization. Methods This is a self-controlled case series study using the population-based emergency department (ED) and inpatient databases of 5 US states from 2007 through 2012. Among patients with existing AF, we identified patients with an AECOPD hospitalization and at least 1 ED visit or hospitalization for AF during the observation period. We constructed conditional Poisson regression models to compare the rate of AF-related ED visits or hospitalizations during sequential 90-day periods after the AECOPD hospitalization, with pre-AECOPD days 1 to 90 as the reference. Results We analyzed 944 patients who were hospitalized for AECOPD and had an ED visit or hospitalization for AF during a 450-day period. The median age was 77 years, and 41% were men. Compared with the reference period, the rate of AF-related ED visits or hospitalizations significantly increased in the post-AECOPD days 1 to 90 (7.3 versus 14.1 per 100 person-months; rate ratio, 1.93; 95% CI, 1.63-2.29; P<0.001). Then, the rate decreased to the reference level in the post-AECOPD days 91 to 180 (7.5 per 100 person-months; rate ratio, 1.03; 95% CI, 0.85-1.25; P=0.77) and remained at the reference level during post-AECOPD days 181 to 270 (rate ratio, 0.84; 95% CI, 0.68-1.03; P=0.09) and days 271 to 360 (rate ratio, 0.90; 95% CI, 0.73-1.10; P=0.29). These temporal associations persisted with stratification by age, sex, and season. Conclusions Among patients with existing AF, AECOPD was associated with a higher risk of AF-related ED visit or hospitalization in the first 90-day post-AECOPD period.
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Affiliation(s)
- Atsushi Hirayama
- Department of Emergency Medicine, Massachusetts General Hospital, Boston (A.H., T.G., M.K.F., C.A.C., K.H.)
| | - Tadahiro Goto
- Department of Emergency Medicine, Massachusetts General Hospital, Boston (A.H., T.G., M.K.F., C.A.C., K.H.)
| | - Yuichi J Shimada
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY (Y.J.S.)
| | - Mohammad Kamal Faridi
- Department of Emergency Medicine, Massachusetts General Hospital, Boston (A.H., T.G., M.K.F., C.A.C., K.H.)
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, Boston (A.H., T.G., M.K.F., C.A.C., K.H.).,Harvard T.H. Chan School of Public Health, Boston, MA (C.A.C.).,Harvard Medical School, Boston, MA (C.A.C., K.H.)
| | - Kohei Hasegawa
- Department of Emergency Medicine, Massachusetts General Hospital, Boston (A.H., T.G., M.K.F., C.A.C., K.H.).,Harvard Medical School, Boston, MA (C.A.C., K.H.)
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19
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Ghandi Y, Habibi D, Abasi M. The Effect of Bronchial Asthma on Interatrial Electromechanical Delay Coupling Obtained Using Tissue Doppler Imaging. IRANIAN JOURNAL OF MEDICAL SCIENCES 2019; 44:196-203. [PMID: 31182885 PMCID: PMC6525734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND Asthma is a predisposing factor for the development of atrial fibrillation. Asthma disturbs the electrophysiology in the right and left atrium. The aim of this study was to evaluate atrial electromechanical delay by coupling obtained from tissue Doppler imaging (TDI) in children. METHODS A cross-sectional study was conducted on 50 patients with Bronchial Asthma, compared with 50 healthy children. The intra-right atrial conduction time (IRCT), intra-left atrial conduction time (ILCT), and interatrial conduction time (IACT) were calculated. The function of systolic and diastolic right ventricular (RV) was assessed by TDI, conventional echocardiography, and pulse Doppler wave. The pulmonary function test was carried out for all the subjects by spirometry. We used an independent Student's t test and Pearson's correlation test for analyzing the data. RESULTS The findings revealed normal shape in both atrial between the two groups. The diastolic RV function was not significantly different between the subjects as measured by the pulse wave Doppler in the tricuspid flow. Patients in the experimental group had significantly higher intra and interatrial electromechanical delays (P=0.007) than the control group. This difference was statistically significant with regard to IRCT (P=0.0001) and IACT (P=0.005). IRCT/IACT and myocardia performance index (r=0.35, P=0.004; and r=0.52, P=0.008) correlated with isovolumetric relaxation time (r=0.46, P=0.003; and r=0.58, P=0.008). CONCLUSION We found that IRCT and IACT prolonged in pediatrics with asthma. Also, it was found that there was a correlation between IRCT and IACT, on one hand, and RV myocardial performance index, on the other hand, but they were not related to TDI diastolic parameters.
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Affiliation(s)
- Yazdan Ghandi
- Department of Pediatric Cardiology, Faculty of Medicine, Arak University of Medical Sciences, Arak, Iran;
| | - Danial Habibi
- Department of Biostatistics, Faculty of Medicine, Arak University of Medical Sciences, Arak, Iran;
| | - Mohammad Abasi
- Medical Science, School of Medicine, Arak University of Medical Sciences, Arak, Iran
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20
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Cardiovascular Comorbidities in Chronic Obstructive Pulmonary Disease (COPD)-Current Considerations for Clinical Practice. J Clin Med 2019; 8:jcm8010069. [PMID: 30634565 PMCID: PMC6352261 DOI: 10.3390/jcm8010069] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 01/07/2019] [Indexed: 12/14/2022] Open
Abstract
In patients with chronic obstructive pulmonary disease (COPD), cardiovascular comorbidities are highly prevalent and associated with considerable morbidity and mortality. This coincidence is increasingly seen in context of a “cardiopulmonary continuum” rather than being simply attributed to shared risk factors such as cigarette smoking. Overlapping symptoms such as dyspnea or chest pain lead to a worse prognosis due to missed concomitant diagnoses. Moreover, medication is often withheld as a result of unfounded concerns about side effects. Despite the frequent coincidence, current guidelines are still mostly restricted to the management of the individual disease. Future diagnostic and therapeutic strategies should therefore be guided by an integrative perspective as well as a refined phenotyping of disease entities.
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21
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Bai Y, Zhao Y, Li J, Zhang Y, Bai R, Du X, Dong JZ, He YH, Ma CS. Association of peak atrial longitudinal strain with atrial fibrillation recurrence in patients with chronic lung diseases following radiofrequency ablation. Intern Med J 2018; 48:851-859. [PMID: 29460463 DOI: 10.1111/imj.13768] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 02/07/2018] [Accepted: 02/08/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Strain was shown associated with atrial fibrillation (AF) recurrence after radiofrequency ablation (RFA), but data on AF patients complicated with chronic lung diseases (CLD) were rare. AIM This study was designed to evaluate the relationship of baseline atrial function with AF recurrence in these patients using speckle-tracking echocardiography. METHODS Average strain values (median: 2 days before RFA) were calculated for 87 AF patients (Mean age: 61.91 years, male: 71.26%) with CLD undergoing RFA from 2013 to 2014. Of these patients, 25 (28.74%) experienced AF recurrence during a mean follow up of 10.3 months. RESULTS Peak right atrial longitudinal strain (R-PALS) was associated with peak left atrial longitudinal strain (L-PALS, Standardised β = 0.45, P < 0.001) in multivariate linear regression. Multivariate Cox regression analysis showed R-PALS was associated with AF recurrence (hazard ratio, 0.86; 95% confidence interval (CI), 0.78-0.96, P = 0.005) in CLD. Patients with R-PALS ≥14.69% had higher AF free rate compared with R-PALS<14.69% using Kaplan-Meier analysis (log-rank, P < 0.001). R-PALS had similar C-index compared to L-PALS (difference: 0.03, 95%CI: -0.06-0.12, P = 0.53) and combined R-PALS and L-PALS (difference: 0.005, 95%CI: -0.04-0.05, P = 0.84) associated with AF recurrence in CLD. CONCLUSION R-PALS, L-PALS and combined R-PALS and L-PALS are important factors associated with AF recurrence following RFA in patients with CLD.
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Affiliation(s)
- Ying Bai
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ying Zhao
- Ultrasound Department, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jie Li
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Ying Zhang
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Rong Bai
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Jian-Zeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Yi-Hua He
- Ultrasound Department, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Chang-Sheng Ma
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
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22
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Grymonprez M, Vakaet V, Kavousi M, Stricker BH, Ikram MA, Heeringa J, Franco OH, Brusselle GG, Lahousse L. Chronic obstructive pulmonary disease and the development of atrial fibrillation. Int J Cardiol 2018; 276:118-124. [PMID: 30268382 DOI: 10.1016/j.ijcard.2018.09.056] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 09/11/2018] [Accepted: 09/14/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) has been associated with atrial fibrillation (AF). More insight into the epidemiology and underlying mechanisms is required to optimize management. METHODS The Rotterdam Study is a large, population-based cohort study with long-term follow-up. Time dependent Cox proportional hazard models were constructed to study the effect of COPD on incident AF, adjusted for age, sex and pack years of cigarette smoking, and additionally stratified according to exacerbation frequency, left atrial size and baseline systemic inflammatory levels. RESULTS 1369 of 10,943 subjects had COPD, of whom 804 developed AF. The AF incidence rate was 14 per 1000 person years in COPD and 8 per 1000 person years in subjects without COPD. The adjusted hazard ratio (HR) for COPD subjects to develop AF as compared to subjects without COPD was 1.28 (95%CI [1.04, 1.57]). COPD subjects with frequent exacerbations had a twofold increased AF risk (HR 1.99 [1.42, 2.79]) and COPD subjects with a left atrial size ≥40 mm also had an elevated AF risk (HR 1.77 [1.07, 2.94]). COPD subjects with baseline systemic inflammatory levels above the median had significantly increased AF risks (hsCRP≥1.83 mg/L: HR 1.51 [1.13, 2.03] and IL6 ≥ 1.91 ng/L: HR 2.49 [1.18, 5.28]), whereas COPD subjects below the median had in both analyses no significantly increased AF risk. CONCLUSIONS COPD subjects had a 28% increased AF risk, which further increased with frequent exacerbations and an enlarged left atrium. The risk was driven by COPD subjects having elevated systemic inflammatory levels.
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Affiliation(s)
- Maxim Grymonprez
- Department of Respiratory Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; Department of Epidemiology, Erasmus Medical Center, PO Box 2040, Rotterdam 3000, CA, the Netherlands
| | - Vincent Vakaet
- Department of Respiratory Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; Department of Epidemiology, Erasmus Medical Center, PO Box 2040, Rotterdam 3000, CA, the Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, Rotterdam 3000, CA, the Netherlands
| | - Bruno H Stricker
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, Rotterdam 3000, CA, the Netherlands; Department of Internal Medicine, Erasmus Medical Center, PO Box 2040, Rotterdam 3000, CA, the Netherlands; Inspectorate of Healthcare, The Hague, the Netherlands.
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, Rotterdam 3000, CA, the Netherlands
| | - Jan Heeringa
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, Rotterdam 3000, CA, the Netherlands
| | - Oscar H Franco
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, Rotterdam 3000, CA, the Netherlands
| | - Guy G Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, Corneel Heymanslaan 10, 9000 Ghent, Belgium; Department of Epidemiology, Erasmus Medical Center, PO Box 2040, Rotterdam 3000, CA, the Netherlands; Department of Respiratory Medicine, Erasmus Medical Center, PO Box 2040, Rotterdam 3000, CA, the Netherlands
| | - Lies Lahousse
- Department of Epidemiology, Erasmus Medical Center, PO Box 2040, Rotterdam 3000, CA, the Netherlands; Department of Bioanalysis, FFW, Ghent University, Ottergemsesteenweg 460, 9000 Ghent, Belgium
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23
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Chen X, Lin M, Wang W. The progression in atrial fibrillation patients with COPD: a systematic review and meta-analysis. Oncotarget 2017; 8:102420-102427. [PMID: 29254257 PMCID: PMC5731967 DOI: 10.18632/oncotarget.22092] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 09/22/2017] [Indexed: 02/05/2023] Open
Abstract
AIM Chronic Obstructive Pulmonary Disease (COPD) and atrial fibrillation (AF) share pathophysiological links, as supported by the high prevalence of AF within COPD patients. AF progression and recurrence can increase the risks of mortality, morbidity and adverse cardiovascular events. The present systematic review and meta-analysis aims to assess the risk for AF progression and recurrence for COPD patients, to further demonstrate the risk of COPD in AF patients. METHODS AND RESULTS A systematic review was conducted in MEDLINE / PubMed and Cochrane Library and Embase, Web of science. Prospective studies including AF patients with COPD were screened and included if matching inclusion and exclusion criteria. 7 studies were included, adding up to 10761 AF patients (1556 with AF and COPD, 9205 without COPD). Mean age from each study ranged from 51 to 81 years, and 57.2% were male. Hypertension accounted for 75.5% of the population, and 20.7% had the comorbidity of diabetes mellitus. The pool analysis showed that COPD could promote AF progression (OR = 1.90; 95% CI, 1.34-2.68, I2 = 77%, p = 0.0003). For subgroup analysis, we found that COPD could increase the risk of AF recurrence (OR = 2.35; 95% CI, 1.86-2.97, I2 = 0%, p = 0.39). Besides, in the younger group, at the median age of 64, COPD was still a risk factor for AF progression (OR = 2.22; 95% CI, 1.80-2.74, I2 = 0%, p = 0.69). CONCLUSIONS COPD is an independent risk for AF progression and recurrence, COPD patients with AF carry a worse prognosis than those in sinus rhythm (SR).
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Affiliation(s)
- Xiaoying Chen
- Department of Cardiology, The Second Affiliate Hospital of Shantou University Medical College, Guangdong, 515000, China
| | - Meiling Lin
- Department of Cardiology, The Second Affiliate Hospital of Shantou University Medical College, Guangdong, 515000, China
- Department of Cardiology, The First Affiliate Hospital of Shantou University Medical College, Guangdong, 515000, China
| | - Wei Wang
- Department of Cardiology, The Second Affiliate Hospital of Shantou University Medical College, Guangdong, 515000, China
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24
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Deng H, Bai Y, Shantsila A, Fauchier L, Potpara TS, Lip GYH. Clinical scores for outcomes of rhythm control or arrhythmia progression in patients with atrial fibrillation: a systematic review. Clin Res Cardiol 2017; 106:813-823. [PMID: 28560516 PMCID: PMC5613037 DOI: 10.1007/s00392-017-1123-0] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 05/22/2017] [Indexed: 11/01/2022]
Abstract
Patients with atrial fibrillation (AF) are commonly managed with rhythm control strategy, but the natural history of this common arrhythmia leads itself to progression from paroxysmal to persistent or permanent AF, and recurrences are evident despite rhythm control treatments using cardioversion or catheter ablation. Numerous clinical factors have been associated with outcomes of rhythm control or arrhythmia progression in patients with AF. The more common factors have been used to formulate risk stratification scores, to help predict the outcomes of rhythm control treatments or AF progression. This review article provides an overview on the published clinical risk scores related to outcomes of rhythm control strategy or AF progression.
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Affiliation(s)
- Hai Deng
- Institute of Cardiovascular Sciences, University of Birmingham, City Hospital, Birmingham, B18 7QH, UK
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Science, Guangzhou, China
| | - Ying Bai
- Institute of Cardiovascular Sciences, University of Birmingham, City Hospital, Birmingham, B18 7QH, UK
- Beijing Tongren Hospital, Capital University, Beijing, China
| | - Alena Shantsila
- Institute of Cardiovascular Sciences, University of Birmingham, City Hospital, Birmingham, B18 7QH, UK
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France
| | - Tatjana S Potpara
- School of Medicine, Belgrade University, Belgrade, Serbia
- Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | - Gregory Y H Lip
- Institute of Cardiovascular Sciences, University of Birmingham, City Hospital, Birmingham, B18 7QH, UK.
- School of Medicine, Belgrade University, Belgrade, Serbia.
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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Roversi S, Fabbri LM, Sin DD, Hawkins NM, Agustí A. Chronic Obstructive Pulmonary Disease and Cardiac Diseases. An Urgent Need for Integrated Care. Am J Respir Crit Care Med 2017; 194:1319-1336. [PMID: 27589227 DOI: 10.1164/rccm.201604-0690so] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a global health issue with high social and economic costs. Concomitant chronic cardiac disorders are frequent in patients with COPD, likely owing to shared risk factors (e.g., aging, cigarette smoke, inactivity, persistent low-grade pulmonary and systemic inflammation) and add to the overall morbidity and mortality of patients with COPD. The prevalence and incidence of cardiac comorbidities are higher in patients with COPD than in matched control subjects, although estimates of prevalence vary widely. Furthermore, cardiac diseases contribute to disease severity in patients with COPD, being a common cause of hospitalization and a frequent cause of death. The differential diagnosis may be challenging, especially in older and smoking subjects complaining of unspecific symptoms, such as dyspnea and fatigue. The therapeutic management of patients with cardiac and pulmonary comorbidities may be similarly challenging: bronchodilators may have cardiac side effects, and, vice versa, some cardiac medications should be used with caution in patients with lung disease. The aim of this review is to summarize the evidence of the relationship between COPD and the three most frequent and important cardiac comorbidities in patients with COPD: ischemic heart disease, heart failure, and atrial fibrillation. We have chosen a practical approach, first summarizing relevant epidemiological and clinical data, then discussing the diagnostic and screening procedures, and finally evaluating the impact of lung-heart comorbidities on the therapeutic management of patients with COPD and heart diseases.
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Affiliation(s)
- Sara Roversi
- 1 Department of Metabolic Medicine, University of Modena and Reggio Emilia and Sant'Agostino Estense Hospital, Modena, Italy
| | - Leonardo M Fabbri
- 1 Department of Metabolic Medicine, University of Modena and Reggio Emilia and Sant'Agostino Estense Hospital, Modena, Italy
| | | | - Nathaniel M Hawkins
- 3 Division of Cardiology, Department of Medicine, Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada; and
| | - Alvar Agustí
- 4 Thorax Institute, Hospital Clinic in Barcelona, University of Barcelona, Barcelona, Spain
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26
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Goudis CA. Chronic obstructive pulmonary disease and atrial fibrillation: An unknown relationship. J Cardiol 2017; 69:699-705. [PMID: 28188041 DOI: 10.1016/j.jjcc.2016.12.013] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Accepted: 12/21/2016] [Indexed: 11/28/2022]
Abstract
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.
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Proietti M, Laroche C, Drozd M, Vijgen J, Cozma DC, Drozdz J, Maggioni AP, Boriani G, Lip GYH. Impact of chronic obstructive pulmonary disease on prognosis in atrial fibrillation: A report from the EURObservational Research Programme Pilot Survey on Atrial Fibrillation (EORP-AF) General Registry. Am Heart J 2016; 181:83-91. [PMID: 27823697 DOI: 10.1016/j.ahj.2016.08.011] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 08/23/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a common chronic disease, being associated with both high rates of morbidity and mortality. Similarly, atrial fibrillation (AF) is associated with a higher risk of both cardiovascular (CV) events and overall mortality. The AF and COPD often coexist, but the impact of COPD on prognosis in European AF patients is unknown. METHODS We evaluated COPD prevalence in patients enrolled in the EURObservational Research Programme Pilot Survey on Atrial Fibrillation Registry Pilot Phase. Clinical factors associated with COPD and adverse outcomes at 1-year follow-up were determined. RESULTS In the overall cohort, a diagnosis of COPD was recorded in 339 (11.0%) of AF patients. The AF patients with COPD were more burdened with risk factors and comorbidities, including diabetes mellitus (P < .0001) and chronic heart failure (P < .0001). β-Blockers were less likely to be prescribed to patients with COPD (P = .0007). On follow-up, AF patients with COPD had a higher risk of both CV death and all-cause death (both P < .0001), as well as for the composite outcome of any thromboembolic event/bleeding /CV death (P = .0003). Cox regression analysis found that COPD was independently associated with an increase in all-cause death (hazard ratio, 1.55; 95% CI 1.05-2.28; P = .0269). CONCLUSIONS Chronic obstructive pulmonary disease is highly prevalent in European AF patients, and is associated with higher rates of CV death, all-cause death, and the composite outcome of any thromboembolic event/bleeding/CV death. The presence of COPD in AF patients was independently associated with all-cause death in AF patients.
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Affiliation(s)
- Marco Proietti
- University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom
| | - Cécile Laroche
- EURObservational Research Programme Department, European Society of Cardiology, Sophia Antipolis, France
| | - Marcin Drozd
- Department of Cardiology, Center for Heart Diseases, Military Hospital, Wroclaw, Poland; Laboratory for Applied Research on Cardiovascular System, Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Johan Vijgen
- Department of Cardiology, Jessa Hospitlas, Hasselt, Belgium
| | - Dragos C Cozma
- Institute of Cardiovascular Medicine, Timisoara, Victor Babes University of Medicine and Pharmacy of Timisoara, Timisoara, Romania
| | | | - Aldo P Maggioni
- EURObservational Research Programme Department, European Society of Cardiology, Sophia Antipolis, France; ANMCO Research Center, Firenze, Italy
| | - Giuseppe Boriani
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, University of Bologna, S. Orsola-Malpighi University Hospital, Bologna, Italy; Cardiology Department, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Gregory Y H Lip
- University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Birmingham, United Kingdom; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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28
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Outcomes of surgery for lung cancer in patients with atrial fibrillation as a preoperative comorbidity: a decade of experience at a single institution in Japan. Surg Today 2016; 47:795-801. [DOI: 10.1007/s00595-016-1436-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 10/10/2016] [Indexed: 12/30/2022]
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29
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Kim YG, Shim J, Choi JI, Kim YH. Radiofrequency Catheter Ablation Improves the Quality of Life Measured with a Short Form-36 Questionnaire in Atrial Fibrillation Patients: A Systematic Review and Meta-Analysis. PLoS One 2016; 11:e0163755. [PMID: 27681507 PMCID: PMC5040266 DOI: 10.1371/journal.pone.0163755] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 09/13/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The main purpose of performing radiofrequency catheter ablation (RFCA) in atrial fibrillation (AF) patients is to improve the quality of life (QoL) and alleviate AF-related symptoms. We aimed to determine the qualitative and quantitative effects of RFCA on the QoL in AF patients. METHODS We performed a systemic review and meta-analysis using a random effects model. We searched for the studies that reported the physical component summary score (PCS) and mental component summary score (MCS) of the short form-36, a validated system to assess and quantify the QoL, before and after RFCA in AF patients. PCS and MCS are T-scores with a mean of 50 and standard deviation of 10. RESULTS Of the 470 studies identified through systematic search, we included 13 studies for pre-RFCA vs. the post-RFCA analysis and 5 studies for treatment success vs. AF recurrence analyses. In the pre-RFCA vs. post-RFCA analysis, RFCA was associated with a significant increase in both the PCS (weighted mean difference [WMD] = 6.33 [4.81-7.84]; p < 0.001) and MCS (WMD = 7.80 [6.15-9.44]; p < 0.001). The ΔPCS (post-RFCA PCS-pre-RFCA PCS) and ΔMCS values were used for the treatment success vs. AF recurrence analysis. Patients with successful ablation had a higher ΔPCS (WMD = 7.46 [4.44-10.49]; p < 0.001) and ΔMCS (WMD = 7.59 [4.94-10.24]; p < 0.001). CONCLUSIONS RFCA is associated with a significant increase in the PCS and MCS in AF patients. Patients without AF recurrence after RFCA had a better improvement in the PCS and MCS than patients who had AF recurrence.
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Affiliation(s)
- Yun Gi Kim
- From the Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
| | - Jaemin Shim
- From the Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
| | - Jong-Il Choi
- From the Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
| | - Young-Hoon Kim
- From the Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
- * E-mail:
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Ferreira C, Providência R, Ferreira MJ, Gonçalves LM. Atrial Fibrillation and Non-cardiovascular Diseases: A Systematic Review. Arq Bras Cardiol 2015; 105:519-26. [PMID: 26577719 PMCID: PMC4651411 DOI: 10.5935/abc.20150142] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Revised: 05/31/2015] [Accepted: 06/15/2015] [Indexed: 01/26/2023] Open
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with an unfavorable prognosis, increasing the risk of stroke and death. Although traditionally associated with cardiovascular diseases, there is increasing evidence of high incidence of AF in patients with highly prevalent noncardiovascular diseases, such as cancer, sepsis, chronic obstructive pulmonary disease, obstructive sleep apnea and chronic kidney disease. Therefore, considerable number of patients has been affected by these comorbidities, leading to an increased risk of adverse outcomes.The authors performed a systematic review of the literature aiming to better elucidate the interaction between these conditions.Several mechanisms seem to contribute to the concomitant presence of AF and noncardiovascular diseases. Comorbidities, advanced age, autonomic dysfunction, electrolyte disturbance and inflammation are common to these conditions and may predispose to AF.The treatment of AF in these patients represents a clinical challenge, especially in terms of antithrombotic therapy, since the scores for stratification of thromboembolic risk, such as the CHADS2 and CHA2DS2VASc scores, and the scores for hemorrhagic risk, like the HAS-BLED score have limitations when applied in these conditions.The evidence in this area is still scarce and further investigations to elucidate aspects like epidemiology, pathogenesis, prevention and treatment of AF in noncardiovascular diseases are still needed.
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Affiliation(s)
- Cátia Ferreira
- Faculdade de Medicina da Universidade de Coimbra, Coimbra,
Portugal
- Serviço de Cardiologia – Centro Hospitalar e Universitário
de Coimbra, Coimbra, Portugal
| | - Rui Providência
- Faculdade de Medicina da Universidade de Coimbra, Coimbra,
Portugal
- Serviço de Cardiologia – Centro Hospitalar e Universitário
de Coimbra, Coimbra, Portugal
| | - Maria João Ferreira
- Faculdade de Medicina da Universidade de Coimbra, Coimbra,
Portugal
- Serviço de Cardiologia – Centro Hospitalar e Universitário
de Coimbra, Coimbra, Portugal
| | - Lino Manuel Gonçalves
- Faculdade de Medicina da Universidade de Coimbra, Coimbra,
Portugal
- Serviço de Cardiologia – Centro Hospitalar e Universitário
de Coimbra, Coimbra, Portugal
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Goudis CA, Konstantinidis AK, Ntalas IV, Korantzopoulos P. Electrocardiographic abnormalities and cardiac arrhythmias in chronic obstructive pulmonary disease. Int J Cardiol 2015. [DOI: 10.1016/j.ijcard.2015.06.096] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Huang B, Yang Y. Radiofrequency catheter ablation of atrial fibrillation in patients with chronic obstructive pulmonary disease: opportunity and challenge: response to Dr. Kumar's comment. J Am Med Dir Assoc 2014; 16:83-4. [PMID: 25444574 DOI: 10.1016/j.jamda.2014.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 09/23/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Bi Huang
- State Key Laboratory of Cardiovascular Disease, Emergency and Critical Care Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yanmin Yang
- State Key Laboratory of Cardiovascular Disease, Emergency and Critical Care Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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Kumar N, Pison L, La Meir M, Maessen J, Crijns HJ. Hybrid approach to atrial fibrillation ablation using bipolar radiofrequency devices epicardially and cryoballoon endocardially. Interact Cardiovasc Thorac Surg 2014; 19:590-4. [PMID: 24981108 DOI: 10.1093/icvts/ivu189] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES Bipolar radiofrequency (RF) devices are used epicardially by cardiac surgeons and cryoballoon endocardially by cardiac electrophysiologists for atrial fibrillation (AF) ablation, but in separate entities. The study's objective was to evaluate the feasibility and safety of combining an endocardial cryoballoon with epicardial bipolar RF ablation for the treatment of AF. METHODS A cohort of 7 patients with AF underwent a hybrid thoracoscopic surgical and endocardial ablation. To prevent bilateral sequential lung deflation in these patients with severe chronic obstructive pulmonary disease, the right pulmonary veins (PVs) were isolated using an epicardial bipolar RF clamp and the contralateral veins with an endocardial cryoballoon. A box lesion set was made epicardially using a bipolar RF pen. RESULTS Acutely, pacing manoeuvres proved a bidirectional block in all PVs in all patients. No complications were seen. A box lesion was made in 5 patients. During follow-up, 2 of them had AF recurrence: 1 was treated successfully with sotalol and another underwent redo RF catheter ablation with reisolation of the right inferior PV. At present, 6 of 7 patients are in sinus rhythm without any anti-arrythmic drugs during a follow-up of more than 40 ± 3 months. CONCLUSIONS A hybrid approach to AF ablation using a cryoballoon endocardially and a bipolar RF device epicardially is feasible and safe.
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Affiliation(s)
- Narendra Kumar
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands
| | - Laurent Pison
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands
| | - Mark La Meir
- Department of Cardiac Surgery, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands
| | - Jos Maessen
- Department of Cardiac Surgery, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands
| | - Harry J Crijns
- Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands
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Ciftel M, Yılmaz O, Kardelen F, Kahveci H. Assessment of atrial electromechanical delay using tissue Doppler echocardiography in children with asthma. Pediatr Cardiol 2014; 35:857-62. [PMID: 24419398 DOI: 10.1007/s00246-014-0867-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Accepted: 01/03/2014] [Indexed: 11/26/2022]
Abstract
Right ventricular (RV) dysfunction, pulmonary hypertension, atrial enlargement, and cor pulmonale may be associated with asthma. These pathological conditions may disturb the electrophysiological properties of the right atrium. This study investigated the atrial electromechanical delay and P-wave dispersion (PWD) in patients with asthma. Thirty-four children aged 8-16 years who were being followed up for asthma constituted the patient group, and 34 age- and body mass index-matched patients constituted the control group. Both groups underwent RV tissue Doppler measurements, intra-right atrial conduction time (IRCT-echo) determination, intra-left atrial conduction time (ILCT-echo) determination, inter-atrial conduction time (IACT-echo) determination, and PWD measurement. The IRCT-echo (14.38 ± 5.46 and 8.20 ± 3.90 ms; p < 0.001) and IACT-echo (28.97 ± 6.58 and 22.79 ± 6.28 ms; p < 0.001) were higher in patients with asthma than in the control group. The PWD (44.58 ± 17.51 and 38.11 ± 13.50 ms; p = 0.09), maximum P-wave duration (87.94 ± 18.20 and 82.44 ± 16.36 ms, p = 0.19), minimum P-wave duration (43.58 ± 9.95 and 44.79 ± 9.13 ms; p = 0.60), and ILCT-echo (15.88 ± 5.40 and 14.58 ± 4.94 ms; p = 0.30) were similar between the two groups. The IRCT-echo was positively correlated with the isovolumetric relaxation time of the lateral tricuspid annulus (r = 0.60; p < 0.001) and with the myocardial performance index of the lateral tricuspid annulus (r = 0.59; p < 0.001) in patients with asthma. The IRCT-echo and IACT-echo were higher in patients with asthma than in the control group. The deterioration of the electrophysiological properties of the right atrium may result in a risk of atrial fibrillation in patients with asthma.
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Affiliation(s)
- Murat Ciftel
- Department of Pediatric Cardiology, Erzurum Region Training and Research Hospital, Erzurum, Turkey,
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Suzuki S, Sagara K, Otsuka T, Kano H, Matsuno S, Takai H, Uejima T, Oikawa Y, Koike A, Nagashima K, Kirigaya H, Yajima J, Tanabe H, Sawada H, Aizawa T, Yamashita T. Effects of smoking habit on the prevalence of atrial fibrillation in Japanese patients with special reference to sex differences. Circ J 2013; 77:2948-53. [PMID: 24065034 DOI: 10.1253/circj.cj-13-0446] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Tobacco smoking is a well-known risk factor for cardiovascular disease, but controversial results have been reported regarding its relationship with atrial fibrillation (AF). Moreover, no study on the relationship between smoking and AF has yet been undertaken in a Japanese context. METHODS AND RESULTS We used data from the Shinken Database 2004-2011 (men/women, n=10,714/6,803, respectively), which included all new patients attending the Cardiovascular Institute between June 2004 and March 2012. AF was diagnosed in 1,698 and 598 men and women, respectively. In men, smokers were more prevalent in the AF than in the non-AF group (54.5% vs. 44.7%), whereas in women the prevalence of smokers was similar between AF and non-AF groups (14.4% vs. 15.4%). This discrepancy between the sexes seems to derive from a characteristic distribution pattern of smoking habit in women. After adjustment for various cofactors, smoking was independently associated with AF (odds ratio 1.54; 95% confidence interval 1.35-1.75; P<0.001) without a significant interaction between sex categories (P=0.195). CONCLUSIONS Smoking was independently associated with AF without a significant interaction between sex categories among Japanese patients visiting a cardiovascular hospital. Further studies using a prospective cohort design are required to confirm a causal link between smoking and AF in Japanese patients.
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Affiliation(s)
- Shinya Suzuki
- Departments of Cardiovascular Medicine, The Cardiovascular Institute
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Hayashi T, Fukamizu S, Hojo R, Komiyama K, Tanabe Y, Tejima T, Nishizaki M, Hiraoka M, Ako J, Momomura SI, Sakurada H. Prevalence and electrophysiological characteristics of typical atrial flutter in patients with atrial fibrillation and chronic obstructive pulmonary disease. Europace 2013; 15:1777-83. [DOI: 10.1093/europace/eut158] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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