Relationship between right atrial dilation and paroxysmal atrial fibrillation in patients with hypertension and chronic obstructive pulmonary disease

Aim. To assess the relationship between right atrial (RA) dilation and paroxysmal atrial fibrillation (AF) in patients with hypertension (HTN) and chronic obstructive pulmonary disease (COPD).

Material and methods. This retrospective cross-sectional study included 369 patients with HTN and COPD, who were divided into 2 following groups: group I — 68 (18,42%) hypertensive patients with COPD and paroxysmal AF; group II (comparison group) — 301 (81,57%) patients with HTN and COPD without arrhythmia.

Results. Patients in group I had significantly higher RA area and left atrial (LA) volume index (LAVI) than patients in group II. Multivariate regression analysis revealed that the RA area and LAVI were associated with paroxysmal AF in comorbid patients with HTN and COPD. To assess the relationship between atrial size and paroxysmal AF in patients with HTN and COPD, we developed a mathematical model with the following equation: р=1/(1+e^-z)*100%, z=-12,51+0,130*LAVI+0,408*RAA, where p is the probability of having paroxysmal AF (%), RAA — RA area (cm²); LAVI — left atrial volume index (ml/m²). The p-value ≥24% indicates a high probability of paroxysmal AF (area under the ROC curve (AUC) =0,89, sensitivity — 80%, specificity — 77%).

Conclusion. RA dilation is associated with paroxysmal AF in patients with HTN and COPD — odds ratio (OR) 1,50; 95% confidence interval: 1,27-1,79.

1. Arakelyan MG, Bockeria LA, Vasilieva EYu, et al. 2020 Clinical guidelines for Atrial fibrillation and atrial flutter. Russian Journal of Cardiology. 2021;26(7):4594. (In Russ.. doi:10.15829/1560-4071-2021-4594.

2. Chazova IE, Golitsyn SP, Zhernakova JuV, et al. Management of patients with arterial hypertension and atrial fibrillation. Systemic Hypertension. 2021;18(3):105-28. (In Russ.). doi:10.26442/2075082X. 2021.3.201077.

3. Hansson L, Lindholm LH, Niskanen L, et al. Effect of angiotensin-converting-enzyme inhibition compared with conventional therapy on cardiovascular morbidity and mortality in hypertension: the Captopril Prevention Project (CAPPP) randomised trial. Lancet. 1999;353(9153):611-6. doi:10.1016/S0140-6736(98)05012-0.

4. Dahlöf B, Devereux RB, Kjeldsen SE, et al. Cardiovascular morbidity and mortality in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE): A randomised trial against atenolol. Lancet. 2002;359(9311):995-1003. doi:10.1016/S0140-6736(02)08089-3.

5. Buch P, Friberg J, Scharling H, et al. Reduced lung function and risk of atrial fibrillation in the Copenhagen City Heart Study. Eur Respir J. 2003;21(6):1012-6. doi:10.1183/09031936.03.00051502.

6. Shibata Y, Watanabe T, Osaka D, et al. Impairment of pulmonary function is an independent risk factor for atrial fibrillation: the Takahata study. Int J Med Sci. 2011;8(7):514-22. doi:10.7150/ijms.8.514.

7. Khidirova LD, Yakhontov DA, Zenin SA, et al. The impact of chronic obstructive pulmonary disease and hypertension on the development and progression of atrial fibrillation. Cardiovascular Therapy and Prevention. 2019;18(5):138-44. (In Russ.). doi:10.15829/1728-8800-2019-5-138-144.

8. Kobalava ZhD, Konradi AO, Nedogoda SV, et al. 2024 Clinical practice guidelines for Hypertension in adults. Russian Journal of Cardiology. 2024;29(9):6117. (In Russ.). doi:10.15829/1560-4071-2024-6117.

9. Chuchalin AG, Avdeev SN, Aisanov ZR, et al. Federal guidelines on diagnosis and treatment of chronic obstructive pulmonary disease. Pulmonologiya. 2022;32(3):356-92. (In Russ.). doi:10.18093/0869-0189-2022-32-3-356-392.

10. Podzolkov VI, Tarzimanova AI. Current Predictors of Atrial Fibrillation Progression. Rational Pharmacotherapy in Cardiology. 2019;15(2):149-58. (In Russ.). doi:10.20996/1819-6446-2019-15-2-149-158.

11. Glova SE, Razumovsky IV. Chronic obstructive pulmonary disease and atrial fibrillation. South Russian Journal of Therapeutic Practice. 2021;2(4):22-9. (In Russ.). doi:10.21886/2712-8156-2021-2-4-22-29.

12. Xie E, Yu R, Ambale-Venkatesh B, et al. Association of right atrial structure with incident atrial fibrillation: a longitudinal cohort cardiovascular magnetic resonance study from the Multi-Ethnic Study of Atherosclerosis (MESA). J Cardiovasc Magn Reson. 2020;22(1):36. doi:10.1186/s12968-020-00631-1.

13. Bai Y, Zhao Y, Li J, et al. Association of peak atrial longitudinal strain with atrial fibrillation recurrence in patients with chronic lung diseases following radiofrequency ablation. Intern Med J. 2018;48:851-9. doi:10.1111/imj.13768.

14. Mourik MJW, Artola Arita V, Lyon A, et al. Association between comorbidities and left and right atrial dysfunction in patients with paroxysmal atrial fibrillation: Analysis of AF-RISK. Int J Cardiol. 2022;360:29-35. doi:10.1016/j.ijcard.2022.05.044.