A deep dive into atrial fibrillation in chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a prevalent respiratory condition and a major cause of morbidity and mortality. Atrial fibrillation (AF) is the most common chronic arrhythmia in patients with and without COPD, with numerous factors contributing to its development. These include hypoxemia, hypercapnia, hyperinflammation and changes in cardiac geometry and autonomic function. The presence of COPD is associated with an elevated risk of thromboembolic events, recurrence of atrial fibrillation after cardioversion, and increased all-cause mortality. Conversely, AF itself further increases the risk of mortality in patients with COPD. Medications employed in the COPD treatment may have deleterious effects on AF, while medications used to treat AF have the potential to exacerbate COPD. The majority of bronchodilator agents have been observed to increase heart rate and induce AF episodes. However, antimuscarinic agents appear to be better tolerated than β-receptor agonists in COPD. It is imperative that the AF treatment be tailored to the individual needs of patients with COPD. The efficacy and safety of AF catheter ablation in cases with COPD appears to be well-established. Further research is warranted to develop appropriate AF screening protocols in COPD patients, incorporating artificial intelligence and telemonitoring, as well as to establish COPD-specific tools for estimating thromboembolic risk. This narrative review comprehensively explores the complex relationship between COPD and AF, incorporating the latest evidence and offering novel insights and updated perspectives.