Chronic obstructive pulmonary disease and the development of atrial fibrillation

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.

Objectives, design and main findings until 2020 from the Rotterdam Study

“…We have shown that COPD is associated with an increased risk of peripheral artery disease [332], sudden cardiac death [333] and the development of atrial fibrillation [334]. COPD subjects with frequent exacerbations, with an enlarged left atrium on echocardiography or increased systemic inflammation had a significantly increased risk to develop atrial fibrillation [334]. Since atrial fibrillation is often asymptomatic and is an important cause of (embolic) stroke, this association between COPD-especially during or following acute exacerbations-and atrial fibrillation has implications for clinical practice.…”

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“…In line with this, diabetes has been shown to be associated with an increased risk of stroke, even in younger patients . Other less well‐studied risk factors, such as chronic obstructive pulmonary disease, are also linked to AF, which is probably driven by systemic inflammation …”

“…9 Other less well-studied risk factors, such as chronic obstructive pulmonary disease, are also linked to AF, 10 which is probably driven by systemic inflammation. 11…”

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