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• W2017050667 abstract "We thank Dr Kumar et al for their comment on our article and for sharing with us their experience in managing atrial fibrillation (AF) in patients with chronic obstructive pulmonary disease (COPD). Indeed, COPD is not only an important underlying disease of AF, but also an independent risk factor of long-term outcome in patients with AF confirmed by our and late studies. 1 Lip G.Y. Laroche C. Ioachim P.M. et al. Prognosis and treatment of atrial fibrillation patients by European cardiologists: One year follow-up of the EURObservational Research Programme-Atrial Fibrillation General Registry Pilot Phase (EORP-AF Pilot registry). Eur Heart J. August 31, 2014; (pii: ehu374. [Epub ahead of print]) Google Scholar , 2 Huang B. Yang Y. Zhu J. et al. Clinical characteristics and prognostic significance of chronic obstructive pulmonary disease in patients with atrial fibrillation: Results from a multicenter atrial fibrillation registry study. J Am Med Dir Assoc. 2014; 15: 576-581 Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar Clinically, the treatment becomes thorny when COPD accompanies AF. On one hand, some agents, such as β-adrenergic agonists and theophyllines, which are often used in patients with COPD to alleviate bronchospasm, have the potential to cause tachyarrhythmia; on the other hand, agents used to control AF, such as nonselective β-blockers, sotalol, and propafenone, have the potential to provoke bronchialspasm. 3 Hayashi T. Fukamizu S. Hojo R. et al. Prevalence and electrophysiological characteristics of typical atrial flutter in patients with atrial fibrillation and chronic obstructive pulmonary disease. Europace. 2013; 15: 1777-1783 Crossref PubMed Scopus (16) Google Scholar In recent years, several studies evaluated the efficacy and safety of managing AF with radiofrequency catheter ablation (RCA) with small sample size in patients with COPD. Roh et al 4 Roh S.Y. Choi J.I. Lee J.Y. et al. Catheter ablation of atrial fibrillation in patients with chronic lung disease. Circ Arrhythm Electrophysiol. 2011; 4: 815-822 Crossref PubMed Scopus (29) Google Scholar first investigated the electroanatomic alterations in pulmonary vein (PV) in 15 patients with AF and chronic lung disease (CLD), including 8 with COPD, and assessed the outcomes of RCA in these patients. The results showed PV anatomy that was significantly altered was related to arrhythmogenicity, and non-PV foci from the right atrium were common in patients with CLD. Nevertheless, RCA could be performed safely for AF in patients with CLD with a success rate comparable to that in patients with normal lungs. During the subsequent follow-up period, however, a relatively higher recurrence rate was observed in patients with CLD than in patients with normal lungs, although the difference did not reach statistical significance. Similarly, in the study by Gu et al 5 Gu J. Liu X. Tan H. et al. Impact of chronic obstructive pulmonary disease on procedural outcomes and quality of life in patients with atrial fibrillation undergoing catheter ablation. J Cardiovasc Electrophysiol. 2013; 24: 148-154 Crossref PubMed Scopus (28) Google Scholar (54 patients with COPD and AF), patients with COPD had a higher AF recurrence after RCA compared with patients without COPD; however, significant improvements in quality of life were observed after RCA in patients with COPD. Recently, Kumar et al 6 Kumar N. Pison L. La Meir M. et al. Hybrid approach to atrial fibrillation ablation using bipolar radiofrequency devices epicardially and cryoballoon endocardially. Interact Cardiovasc Thorac Surg. 2014; 19: 590-594 Crossref PubMed Scopus (16) Google Scholar adopted a unique approach of endocardial cryoballoon and epicardial bipolar radiofrequency devices to treat AF in patients with COPD. After 3-year follow-up, 8 of 10 were in sinus rhythm without any antiarrythmic drug therapy, with an overall efficacy of index procedure at 80%. Re: Clinical Characteristics and Prognostic Significance of Chronic Obstructive Pulmonary Disease in Patients With Atrial Fibrillation: Results From a Multicenter Atrial Fibrillation Registry StudyJournal of the American Medical Directors AssociationVol. 16Issue 1PreviewHuang et al1 elegantly describe the clinical characteristics and prognostic significance of 2 common morbidities: atrial fibrillation (AF) and chronic obstructive pulmonary disease (COPD). Their statistical analysis revealed higher all-cause mortality and major adverse event rate among patients with COPD. COPD is an independent risk factor not only for cardiovascular mortality, but also for 1-year all-cause mortality. Further, “AF and COPD usually aggravate each other, making the treatment complicated.” Full-Text PDF" @default.
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• W2017050667 title "Radiofrequency Catheter Ablation of Atrial Fibrillation in Patients With Chronic Obstructive Pulmonary Disease: Opportunity and Challenge: Response to Dr Kumar's Comment" @default.
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• W2017050667 doi "https://doi.org/10.1016/j.jamda.2014.09.014" @default.
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