The Association between Chronic Obstructive Pulmonary Disease (COPD) and Atrial Fibrillation: A Review

Abstract

COPD is one of the leading causes of Mortality & Morbidity in the US and is associated with a wide variety of cardiovascular diseases especially arrhythmias, angina, myocardial infarction and congestive heart failure and is directly associated with the severity of COPD described in the GOLD initiative. COPD is an independent risk factor for AF/AFL. Smoking, hypoxia and inflammation all contribute to AF in COPD patients mainly via atrial remodeling while hypercapnia contributes to it via increasing refractoriness of the atrial musculature and a delay in the return of the refractoriness to normal after resolution of the hypercapnia. The most common EKG abnormality found in patients with COPD is P pulmonale and the PQ interval is the strongest predictor of developing AF. The P wave Dispersion (PwD) was also an independent risk factor for the development of AF and was found to be more in the acute phase than in the stable phase.The BODE index, an important prognostic score among patients hospitalized with a COPD exacerbation has a direct co relation with the prevalence of AF/AFL while the DECAF score, which was found to be superior to the CURB 65 score as a mortality predictor for hospitalized patients, includes AF as one of the criteria. Chronic hypoxemia is one of the main reasons for altered pulmonary vein anatomy and hence the presence of COPD was identified as an independent risk factor for the recurrence of atrial tachyarrhythmias after catheter ablation in patients with COPD and the absence of COPD was also found to be an independent predictor for a successful electrocardioversion. These patients were also found to have an increased incidence of non-PV foci for the arrhythmias. Oral glucocorticoids were associated with an increased risk of developing AF especially high dose steroids. It is recommended to correct the underlying respiratory decompensation while treating patients with AF as they render the treatment of AF ineffective. Nondihydropyridine calcium channel blockers should be used as first line rate control agents for AF in patients with concomitant COPD while the β-blockers, sotalol, propafenone can be used in patients with obstructive lung disease who do not have bronchospasm.

Changes on Electrocardiographic Patterns and Associated Factors among Chronic Obstructive Pulmonary Disease Patients

“…This is in line with study conducted by Shah V et al as the hypoxia is the independent risk factor in inducing abnormal ECG especially atrial fibrillation with [AOR 1.76(1.64-1.89)]. 33 2. Severity of COPD: by making the mild stage of COPD reference, other stages are 3.2 more likely to develop abnormal ECG/AOR 3.…”

“…Smoking [AOR 2.2(1.5-8.6)] as a mutual risk factor for COPD and CVDs also in harmony with study conducted by Shah V et al as one of the determined risk factor [AOR 2.2(1.5-3.1)] for the development of abnormal ECG indicating CVDs due to COPD systemic comorbidity. 33 4. Gender male [AOR 3.1(1.5-23)] is another identified risk factor for development abnormal ECG among COPD patients because all the male patients were exposed to smoking and they were relatively elders (the two mutual risk factors (smoking and aging)).…”

“…The identified factors for ECG changes were amount of systemic C-reactive proteins (CRP) as markers of inflammation, hypoxia, duration and severity of COPD which was exacerbated by mutual risk factors smoking and aging. [26][27][28][29][30][31][32][33] Thus, the current study aimed to explore and detect changes of ECG pattern by using the 12 lead ECG which is not routinely performed especially in developing countries including Ethiopia and the study area due to economic constraints and determine the associated risk factors among COPD patients.…”

ECG-Derived Respiratory Rate in Atrial Fibrillation

“…The f-wave variance σ 2 f is estimated from the observed signal by computing the sample variance of the concatenated TQ intervals of all beats, following bandpass filtering in the band [0. 5,30] Hz to preserve f-wave related frequency components and reduce the influence of noise [27]. The QRS variance σ 2 QRS (n) is estimated bŷ…”

“…R ESPIRATORY dysfunction is associated with atrial fibrillation (AF) since reduced lung function, decreased oxygenation, hypercapnia, pulmonary hypertension, chronic obstructive pulmonary disease, and sleep-disordered breathing (SDB) have been identified as independent predictors of AF [1]- [4]. Alterations in respiratory physiology due to a progressive decline in lung function may provoke alterations in cardiac structure and function through changes in atrial electrophysiology, leading to increased incidence of cardiac arrhythmia [5].…”