Chronic obstructive pulmonary disease (
COPD) is highly prevalent among patients with
atrial fibrillation (AF), shares common risk factors, and adds to the overall morbidity and mortality in this population. Additionally, it may promote AF and impair treatment efficacy. The prevalence of
COPD in AF patients is high and is estimated to be ∼25%. Diagnosis and treatment of
COPD in AF patients requires a close interdisciplinary collaboration between the electrophysiologist/cardiologist and pulmonologist. Differential diagnosis may be challenging, especially in elderly and smoking patients complaining of unspecific symptoms such as dyspnoea and
fatigue. Routine evaluation of lung function and determination of
natriuretic peptides and echocardiography may be reasonable to detect
COPD and
heart failure as contributing causes of dyspnoea. Acute exacerbation of
COPD transiently increases AF risk due to
hypoxia-mediated mechanisms,
inflammation, increased use of beta-2 agonists, and autonomic changes. Observational data suggest that
COPD promotes AF progression, increases AF recurrence after
cardioversion, and reduces the efficacy of
catheter-based antiarrhythmic
therapy. However, it remains unclear whether treatment of
COPD improves AF outcomes and which metric should be used to determine
COPD severity and guide treatment in AF patients. Data from non-randomized studies suggest that
COPD is associated with increased AF recurrence after
electrical cardioversion and
catheter ablation. Future prospective cohort studies in AF patients are needed to confirm the relationship between
COPD and AF, the benefits of treatment of either
COPD or AF in this population, and to clarify the need and cost-effectiveness of routine
COPD screening.