Atrial fibrillation pulmonary diseases


 * Associate Editor(s)-In-Chief: ; Varun Kumar, M.B.B.S.

Synonyms and related keywords: AF, Afib, fib

Overview
In patients with COPD, supraventricular arrhythmias, including atrial fibrillation are common. In patients with acute exacerbations of COPD, the presence of AF has shown to have worst prognosis. The first step in the management is to treat the underlying lung disease and correct hypoxia and acid-base imbalance. Theophylline and beta adrenergic agonists, which are commonly used to relieve bronchospasm, may precipitate atrial fibrillation. In patients with bronchospasm, beta blockers, sotalol, propafenone, and adenosine are contraindicated. Non-dihydropyridine calcium channel blocker and intravenous flecainide may be used to restore sinus rhythm. However, in hemodynamically unstable patients direct-current cardioversion may be attempted. In patients refractory to drug therapy, AV nodal ablation and ventricular pacing may be necessary to control the ventricular rate.

==ACCF/AHA/HRS 2011 Guidelines- Pulmonary Diseases (DO NOT EDIT) == {{cquote|

Class I
1. Correction of hypoxemia and acidosis is the recommended primary therapeutic measure for patients who develop AF during an acute pulmonary illness or exacerbation of chronic pulmonary disease. (Level of Evidence: C)

2. A non dihydropyridine calcium channel antagonist (diltiazem or verapamil) is recommended to control the ventricular rate in patients with obstructive pulmonary disease who develop AF. (Level of Evidence: C)

3. Direct-current cardioversion should be attempted in patients with pulmonary disease who become hemodynamically unstable as a consequence of AF. (Level of Evidence: C)

Class III
1. Theophylline and beta-adrenergic agonist agents are not recommended in patients with bronchospastic lung disease who develop AF. (Level of Evidence: C)

2. Beta blockers, sotalol, propafenone, and adenosine are not recommended in patients with obstructive lung disease who develop AF. (Level of Evidence: C)}}

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Guideline Resources

 * ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation


 * 2011 ACCF/AHA/HRS Focused Updates Incorporated Into the ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation


 * ACC/AHA/Physician Consortium 2008 clinical performance measures for adults with nonvalvular atrial fibrillation or atrial flutter