Increased risk of atrial fibrillation in patients with acute exacerbation of chronic obstructive pulmonary disease and sinus rhythm

Abstract

Background: Atrial fibrillation (AF) has been suggested as a relevant comorbidity in patients with chronic obstructive pulmonary disease (COPD). The evaluation of the total atrial conduction time via tissue Doppler imaging (PA-TDI interval) can be used to identify patients with increased risk of new onset AF. The PA-TDI interval measures the duration between the beginning of the P wave by ECG and the peak of the left atrial wave A’ by tissue doppler imaging. We hypothesise that the PA-TDI interval is increased in acute exacerbated COPD (AECOPD) compared with stable COPD. Materials and Methods: 28 patients with stable COPD (n=16; 66±7 ys) or AECOPD (n=12; 66±8 ys) with sinus rhythm and no history of AF were studied. All patients received a lung function test, blood gas analysis, laboratory tests and echocardiography including the PA-TDI interval. Results: FEV1%pred was lower in AECOPD than in stable COPD (26±11 vs 42±16%; p=0.006). NT-proBNP (354±515 vs 306±198 ng/l; p=0.76), left ventricular function and atrial sizes were comparable in both groups. Patients with AECOPD had a significant longer PA-TDI interval than patients with stable COPD (137±12 vs.124±13 ms, p=0.013) indicating an increased risk of AF. No correlation was found between FEV1%pred, pO2 or pCO2 and the PA-TDI interval. Conclusion: Patients with AECOPD have an increased risk of AF in comparison with stable COPD patients as indicated by an increased PA-TDI interval. An association between an increased PA-TDI interval and lung function or blood gases was not found. Further studies are needed to identify the underlying mechanisms of an increased risk of AF in AECOPD.