Atrial Fibrillation and Non-cardiovascular Diseases: A Systematic Review

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.

Mid‐regional pro‐adrenomedullin outperforms N‐terminal pro‐B‐type natriuretic peptide for the diagnosis of acute heart failure in the presence of atrial fibrillation

“…The general work‐up of the dyspnoeic patient in the ED may include the use of laboratory tests and imaging modalities, such as chest radiography and lung ultrasonography. Besides ADHF, respiratory and other non‐cardiovascular conditions may give rise to the symptom of dyspnoea in a patient with pre‐existing AF . Natriuretic peptides, such as NT‐proBNP are recommended in the hospital to aid clinicians in assessing the probability of heart failure .…”

“…Many studies have attempted to identify novel biomarkers in heart failure, but little data are available on their performance in detection of ADHF in the presence of AF . Diagnosing ADHF in dyspnoeic patients presenting to the emergency department (ED) with pre‐existing AF may not always be straightforward clinically due to coexisting non‐cardiovascular conditions such as chronic obstructive pulmonary disease, obstructive sleep apnoea, sepsis, and cancer . Importantly, AF has been shown to markedly impair the diagnostic performance of natriuretic peptides in ADHF …”

Pathophysiology of cancer therapy-provoked atrial fibrillation

“…Elevated levels of proinflammatory cytokines, including Creactive protein (CRP), tumor necrosis factor (TNF)-α, interleukins (e.g., IL-6), and MIF, were discovered during AF and cancer progression [47,[120][121][122][123][124]. Inflammation plays an important role in cancer progression, and AF may represent an inflammatory complication of cancer [125]. Anti-inflammatory effects of statin treatment could significantly contribute to the prevention of AF [126].…”

Approaches to Antithrombotic Therapy in Elderly Patients With Atrial Fibrillation

“…К факторам риска, требующим дальнейшей вали-дизации, относятся ожирение, синдром обструктивного апноэ сна, субклинический гипертиреоз, хроническое обструктивное заболевание легких, хроническая болезнь почек, воспаление, повышенное потребление алкого-ля и некоторые другие [12,18].…”