• Seng Chan You, Min Ho An, Dukyong Yoon, Ga-Young Ban, Pil-Sung Yang, Hee Tae Yu, Rae Woong Park, and Boyoung Joung.
• Department of Biomedical Informatics, Ajou University School of Medicine, Suwon-si, Gyeonggi-do, Korea.
• Heart Rhythm. 2018 Dec 1; 15 (12): 1825-1832.

BackgroundRate-control medications are considered first-line treatment for patients with atrial fibrillation (AF). However, obstructive lung disease (OLD), a condition prevalent in those with AF, often makes it difficult to use those medications because of the lack of studies on new-onset AF in patients with OLD.ObjectiveThe purpose of this study was to investigate clinical outcomes after administration of each class of rate-control medication in patients with concomitant AF and OLD (AF-OLD).MethodsThis study used the entire database provided by the National Health Insurance Service from 2002 to 2015. Risk of all-cause mortality was compared between use of calcium channel blocker (CCB) and use of other drug classes in AF-OLD patients using Cox regression analyses after propensity score matching.ResultsAmong the 13,111 patients, the number of AF-OLD patients treated with a CCB, cardioselective β-blocker (BB), nonselective BB, and digoxin was 2482, 2379, 2255, and 5995, respectively. The risk of mortality was lower with use of selective BB (hazard ratio [HR] 0.84; 95% confidence interval [CI] 0.75-0.94; P = .002) and nonselective BB (HR 0.85; 95% CI 0.77-0.95; P = .003) compared to use of CCBs. Digoxin use was related with worse survival, with marginal statistical significance (HR 1.09; 95% CI 1.00-1.18; P = .053).ConclusionAmong patients with AF-OLD, rate-control treatment using selective and nonselective BB was associated with a significant reduction in mortality compared with CCB use. Further prospective randomized trials are required to confirm these findings.Copyright © 2018 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

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