Quantification of atrial fibrillation in copd and its occurrence relative to exacerbation

SESSION TITLE: Obstructive Lung Disease Posters 4 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/10/2023 12:00 pm - 12:45 pm PURPOSE: Atrial fibrillation (AF) is a well-known comorbidity of COPD, shares common risk factors, and increases morbidity and mortality. However, the reported rates of concurrence are varied. In addition, there has been a suggested chronological relationship between acute exacerbations of COPD (AECOPD) and AF events, due to hypoxia, inflammation, use of beta-2 agonists, and autonomic changes. We sought to characterize the AF burden in subjects with COPD at high risk of exacerbation and the relationship between exacerbation and AF events. METHODS: Subjects were enrolled in the Reveal LINQ for COPD trial, the purpose of which was to characterize the relationship between changes in Reveal LINQ implantable cardiac monitor (ICM) derived data with AECOPD events. All subjects were implanted with a Reveal LINQ enabled with specialized software to facilitate data recording and followed for up to 2 years. In addition to cardiac monitoring, LINQ can capture and record arrhythmic events and cumulative AF burden. All AECOPD were adjudicated by committee and day 1 of AECOPD was defined as the onset of symptoms. All subject data was reviewed for the maximum daily AF burden and AF relative to the onset of the AECOPD, including AF episodes occurring within a day of AECOPD. RESULTS: Of the 40 subjects enrolled in the study with ICM, 13 had a reported history of atrial arrhythmia (AF, atrial flutter, or atrial tachycardia). In total, 25 (62.5%) of all subjects had detected AF with daily burden of at least 2 minutes, 20 (50%) with at least 10 minutes, and 15 (37.5%) with at least 1 hour. Twenty-three subjects had paroxysmal, 1 had persistent, and 1 had permanent AF. The subject with permanent AF underwent AV nodal ablation and pacemaker placement and was without recurrence of AF. Two subjects with history of atrial arrhythmia did not have any detected AF episodes. Of the subjects with at least 1 hour of daily AF burden, 7 (46.7%) did not report a history of atrial arrhythmia. Thirty-nine AECOPD were reported in all subjects with AF, and 17 (43.6%) were associated with episodes of AF within 1 day of AECOPD onset, having a median 88 minutes of daily burden. In subjects with at least 1 hour of daily AF during the study, 15 of 25 (60%) AECOPD were associated with AF episodes, and with median daily burden of 102 minutes. CONCLUSIONS: Atrial fibrillation is a common comorbidity of COPD, occurring in more than half of subjects in this cohort. In the subjects with at least an hour of daily AF, nearly half had no reported history of atrial arrhythmia. The vast majority of AF was paroxysmal, which may contribute to the difficulty in diagnosing AF in patients with COPD. In addition, a significant number of COPD exacerbations occurred concurrently with episodes of AF. CLINICAL IMPLICATIONS: This degree of AF concurrent with COPD and the finding of AF in subjects without a history of atrial arrhythmia suggests the need for increased surveillance of AF in patients with COPD, and with greater vigilance around the time of exacerbations. DISCLOSURES: No relevant relationships by Shakeel Amanullah No relevant relationships by Philip Diaz No relevant relationships by Jose Diaz Employee relationship with Medtronic, Inc. Please note: 3/1/2004 - present Added 03/30/2023 by Trent Fischer, source=Web Response, value=Salary No relevant relationships by David MacDonald No relevant relationships by Christine Wendt