title: Atrial fibrillation in the acute, hypercapnic exacerbations of COPD.
abstract: OBJECTIVE
  Chronic obstructive pulmonary disease (COPD) has been associated with a high frequency of arrhythmias. Atrial fibrillation (AF) is one of the most common arrhythmias and causes substantial morbidity and mortality. Emerging risk factors for the development of AF include a variety of breathing disorders like COPD. Few studies have analyzed the role of reduced lung function and respiratory acidosis in predicting AF. Aim of the current study was to investigate the role of hypercapnia, pulmonary systolic hypertension and lung function impairment in COPD patients, as risk factors for atrial fibrillation development.
  We evaluated a population of individuals consecutively hospitalized for COPD exacerbation and hypercapnic respiratory failure between January 2012 and January 2013; among them we selected a subgroup of patients presenting a paroxysmal episode of atrial fibrillation. All patients underwent pulmonary function tests, haemogasanalysis, electrocardiogram and transthoracic echocardiography.
  
  
  RESULTS
  Among the 193 subjects evaluated, 35 individuals with AF and COPD were enrolled in the study. Risk of new AF was higher in those subjects with lower FEV1 and higher PaCO2 values, also there was a significantly increased prevalence of AF in patients with higher value of Pulmonary Artery Systolic Pressure (PASP), obtained by transthoracic echocardiography. Linear correlation between variables revealed a direct relationships between hypercapnia and PASP and left and right atrial areas.
  
  
  CONCLUSIONS
  Impaired pulmonary function, hypercapnia and high values of PASP are independent predictors of incident AF.
authors.affiliation: Respiratory Diseases Unit, School of Specialization in Respiratory Diseases, University of Rome "Sapienza", Policlinico Umberto I, Rome, Italy. cterzano@tin.it.
authors.forename: C
authors.initials: C
authors.lastname: Terzano
authors.forename: S
authors.initials: S
authors.lastname: Romani
authors.forename: V
authors.initials: V
authors.lastname: Conti
authors.forename: G
authors.initials: G
authors.lastname: Paone
authors.forename: F
authors.initials: F
authors.lastname: Oriolo
authors.forename: A
authors.initials: A
authors.lastname: Vitarelli
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000378:metabolism; D001784:Blood Gas Analysis / Q000639:trends; D004562:Electrocardiography / Q000639:trends; D005260:Female; D006760:Hospitalization / Q000639:trends; D006801:Humans; D006935:Hypercapnia / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000378:metabolism; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000378:metabolism; D008297:Male; D029424:Pulmonary Disease, Chronic Obstructive / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000378:metabolism; D012129:Respiratory Function Tests / Q000639:trends; D012131:Respiratory Insufficiency / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000378:metabolism; D012307:Risk Factors; D014463:Ultrasonography