Therapy of atrial fibrillation in asthma: case report and discussion of the problem
DOI: 10.32364/2587-6821-2025-9-9-17
N.Yu. Mironov1, O.Yu. Agapova2
1E.I. Chazov National Medical Research Center of Cardiology, Moscow, Russian Federation
2Russian University of Medicine, Moscow, Russian Federation
Atrial fibrillation (AF) is highly prevalent and represents a common reason for seeking medical attention, as well as for both elective and emergency hospital admissions. Chronic respiratory diseases, including asthma, are also widespread, and may contribute to a worsening course of AF. The treatment of patients with AF and concomitant asthma poses challenges due to reduced efficacy of rhythm control tactcis and the potential adverse effects of many antiarrhythmic drugs. We present a clinical case of successful pharmacological treatment of AF in a female patient with concomitant asthma, the difficulties of managing comorbid patients are discussed, as are practical aspects of monitoring antiarrhythmic therapy efficacy and safety.
Keywords: arrhythmias, atrial fibrillation, supraventricular extrasystole, asthma, treatment, antiarrhythmic drug, safety monitoring, rhythm control, comorbidity, interdisciplinary management.
For citation: Mironov N.Yu., Agapova O.Yu. Therapy of atrial fibrillation in asthma: case report and discussion of the problem. Russian Medical Inquiry. 2025;9(9):656–662 (in Russ.). DOI: 10.32364/2587-6821-2025-9-9-17
About the authors:
Nikolai Yu. Mironov — Dr. Sc. (Med.), Senior Researcher of the Department of Clinical Electrophysiology and X-ray Surgical Methods for Cardiac Arrhythmia Treatment, Acad. E.I. Chazov National Medical Research Center of Cardiology; 15A, Academician Chazov str., Moscow, 121552, Russian Federation; ORCID iD 0000-0002-6086-6784
Olga Yu. Agapova — C. Sc. (Med.), Assistant Professor of the Department of Faculty Therapy and Occupational Diseases, N.A. Semashko Scientific Educational Institute of Clinical Medicine, Russian University of Medicine; 4, Dolgorukovskaya str., Moscow, 127006, Russian Federation; ORCID iD 0000-0001-9480-8999
Contact information: Nikolai Yu. Mironov, e-mail: nikmir.7ko@gmail.com
Financial Disclosure: no authors have a financial or property interest in any material or method mentioned.
There is no conflict of interest.
Received 09.07.2025.
Revised 01.08.2025.
Accepted 26.08.2025.
References
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5. Johnson L.S., Juhlin T., Engström G. Reduced forced expiratory volume is associated with increased incidence of atrial fibrillation: the Malmo Preventive Project. Europace. 2014;16:182–188. DOI: 10.1093/europace/eut255
6. Levy M.L., Bacharier L.B., Bateman E. et al. Key recommendations for primary care from the 2022 Global Initiative for Asthma (GINA) update. NPJ Prim Care Respir Med. 2023;33(1):7. DOI: 10.1038/s41533-023-00330-1
7. Shkolnikova M.A., Jdanov D.A., Ildarova R.A. et al. Atrial fibrillation among Russian men and women aged 55 years and older: prevalence, mortality, and associations with biomarkers in a population-based study. J Geriatr Cardiol. 2020;17(2):74–84. DOI: 10.11909/j.issn.1671-5411.2020.02.002
8. Kong X., Wang M., Jiang Y. Global burden of atrial fibrillation attributable to high body mass index from 1990 to 2021: findings from the Global Burden of Disease Study 2021. BMC Cardiovasc Disord. 2024;24(1):542. DOI: 10.1186/s12872-024-04202-5
9. Чазова И.Е., Голицын С.П., Жернакова Ю.В. и др. Ведение пациентов с артериальной гипертонией и фибрилляцией предсердий. Системные гипертензии. 2021;18(3):105–128. DOI: 10.26442/2075082X.2021.3.201077Chazova I.E., Golitsyn S.P., Zhernakova J.V. et al. Management of patients with arterial hypertension and atrial fibrillation. Systemic Hypertension. 2021;18(3):105–128 (in Russ.). DOI: 10.26442/2075082X.2021.3.201077
10. Griffin M., Mills M.T. A Holistic Approach to Improving Outcomes in Atrial Fibrillation: The AF-CARE Pathway. Br J Hosp Med (Lond). 2025;86(4):1–5. DOI: 10.12968/hmed.2024.0929
11. Van Gelder I.C., Rienstra M., Bunting K.V. et al. 2024 ESC Scientific Document Group. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2024;45(36):3314–3414. DOI: 10.1093/eurheartj/ehae176
12. Kirchhof P., Camm J., Goete A. et al. Early Rhythm-Control Therapy in Patients with Atrial Fibrillation. N Engl J Med. 2020;383:1305–1316. DOI: 10.1056/NEJMoa2019422
13. Packer D.L., Mark D.B., Robb R.A. et al. CABANA Investigators. Effect of Catheter Ablation vs Antiarrhythmic Drug Therapy on Mortality, Stroke, Bleeding, and Cardiac Arrest Among Patients With Atrial Fibrillation: The CABANA Randomized Clinical Trial. JAMA. 2019;321(13):1261–1274. DOI: 10.1001/jama.2019.0693
14. Cardoso R., Justino G.B., Graffunder F.P. et al. Catheter Ablation is Superior to Antiarrhythmic Drugs as First-Line Treatment for Atrial Fibrillation: a Systematic Review and Meta-Analysis. Arq Bras Cardiol. 2022;119(1):87–94. DOI: 10.36660/abc.20210477
15. Kisling A.J., Symons J.G., Daubert J.P. Catheter ablation of atrial fibrillation: anticipating and avoiding complications. Expert Rev Med Devices. 2023;20(11):929–941. DOI: 10.1080/17434440.2023.2257131
16. Аракелян М.Г., Бокерия Л.А., Васильева Е.Ю. и др. Фибрилляция и трепетание предсердий. Клинические рекомендации 2020. Российский кардиологический журнал. 2021;26(7):4594. DOI: 10.15829/1560-4071-2021-4594Arakelyan M.G., Bockeria L.A., Vasilieva E.Yu. 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
17. Joglar J.A., Chung M.K., Armbruster A.L. et al. Peer Review Committee Members. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2024;149(1):e1–e156. DOI: 10.1161/CIR.0000000000001193
18. Hamilton D.Sr., Nandkeolyar S., Lan H. et al. Amiodarone: A Comprehensive Guide for Clinicians. Am J Cardiovasc Drugs. 2020;20(6):549–558. DOI: 10.1007/s40256-020-00401-5
19. Гаглоева Д.А., Дзаурова Х.М., Зельберг М.А. и др. Предварительные результаты проспективного рандомизированного исследования по сравнению эффективности и безопасности рефралона и амиодарона при кардиоверсии у больных пароксизмальной формой фибрилляции и трепетания предсердий. Кардиоваскулярная терапия и профилактика. 2023;22(4):3527. DOI: 10.15829/1728-8800-2023-3527Gagloeva D.A., Dzaurova Kh.M., Zelberg M.A. et al. Preliminary results of a prospective randomized study comparing the efficacy and safety of refralon and amiodarone in cardioversion in patients with paroxysmal atrial fibrillation and flutter. Cardiovascular Therapy and Prevention. 2023;22(4):3527 (in Russ.). DOI: 10.15829/1728-8800-2023-3527
20. Гаглоева Д.А., Миронов Н.Ю., Дзаурова Х.М. и др. Результаты проспективного рандомизированного исследования по сравнению эффективности и безопасности применения рефралона и амиодарона для восстановления синусового ритма у больных пароксизмальной формой фибрилляции и трепетания предсердий. Вестник аритмологии. 2024;31(1):63–70. DOI: 10.35336/VA-1289Gagloeva D.A., Mironov N.Yu., Dzaurova Kh.M. et al. Results of a prospective randomized study comparing efficacy and safety of refralon and amiodarone for cardioversion in patients with paroxysmal atrial fibrillation and flutter. Journal of Arrhythmology. 2024;31(1):63–70 (in Russ.). DOI: 10.35336/VA-1289
21. Andrade J.G., MacGillivray J., Macle L. et al. Clinical effectiveness of a systematic "pill-in-the-pocket" approach for the management of paroxysmal atrial fibrillation. Heart Rhythm. 2018;15(1):9–16. DOI: 10.1016/j.hrthm.2017.10.002
22. Cruickshank J.M., Prichard B.N.C. Beta-blockers in clinical practice, 2nd ed Churchill Livingstone, New York; 1994.
23. Кейко О.И., Регушевская Д.В., Благова О.В. и др. Возможности применения этацизина в лечении пациентов с фибрилляцией предсердий. Кардиология и сердечно-сосудистая хирургия. 2011;4(6):53–56.Keĭko O.I., Regushevskaia D.V., Blagova O.V. et al. Possibilities of ethacyzin application in treatment of patients with atrial fibrillation. Russian Journal of Cardiology and Cardiovascular Surgery. 2011;4(6):53–56 (in Russ.).
24. Kokina B., Strēlnieks A., Pupkeviča I. et al. Sinus rhythm maintenance after electrical cardioversion for atrial fibrillation in high-risk patients — comparative efficacy of antiarrhythmic medications. Proceedings of the Latvian Academy of Sciences Section B Natural Exact and Applied Sciences. 2021;75(1):32–39. DOI: 10.2478/prolas-2021-0006
25. Канорский С.Г., Шубик Ю.В. Антиаритмические препараты IC класса в кардиологической практике. Врач. 2025;36(3):32–39. DOI: 10.29296/25877305-2025-03-06Kanorskiy S., Shubik Y.U. Antiarrhythmic drugs of class ic in cardiology practice. Vrach (The Doctor). 2025;36(3):32–39 (in Russ.). DOI: 10.29296/25877305-2025-03-06
26. Merino J.L., Tamargo J., Blomström-Lundqvist C. et al. Practical Compendium of Antiarrhythmic Drugs: A Clinical Consensus Statement of the European Heart Rhythm Association of the ESC. Europace. 2025;27(8):euaf076. DOI: 10.1093/europace/euaf076
27. Хамитова Р.Я., Лоскутов Д.В., Акрамова Э.Г. Сравнительный анализ взаимосвязей кардиологической заболеваемости взрослого населения и социально-экономических показателей в регионах России. Социальные аспекты здоровья населения. 2022;68(3):5. DOI: 10.21045/2071-5021-2022-68-3-5Khamitova R.Ya., Loskutov D.V., Akramova E.G. Comparative analysis of the relationship between cardiovascular morbidity in the adult population and socio-economic indicators in the regions of Russia. Social'nye aspekty zdorov'a naselenia [serial online]. 2022;68(3):5 (in Russ.). DOI: 10.21045/2071-5021-2022-68-3-5.
28. Xue Z., Guo S., Liu X. et al. Impact of COPD or Asthma on the Risk of Atrial Fibrillation: A Systematic Review and Meta-Analysis. Front Cardiovasc Med. 2022;9:872446. DOI: 10.3389/fcvm.2022.872446
29. Graul E.L., Nordon C., Rhodes K. et al. Factors associated with non-fatal heart failure and atrial fibrillation or flutter within the first 30 days post COPD exacerbation: a nested case-control study. BMC Pulm Med. 2024;24(1):221. DOI: 10.1186/s12890-024-03035-4
30. Chen W., Li S., Huang D., Su Y. Drugs associated with a risk of supraventricular tachycardia: analysis using the OpenVigil database. J Int Med Res. 2024;52(3):3000605241238993. DOI: 10.1177/03000605241238077
31. Skoll D., Lu R., Gasmelseed A.Y. et al. Asthma is associated with higher recurrence rates of atrial fibrillation after catheter ablation. Heart Rhythm. 2024;S1547-5271(24)03656-7. Online ahead of print. DOI: 10.1016/j.hrthm.2024.12.011.28
2. Шапкина М.Ю., Маздорова Е.В., Авдеева Е.М. и др. Динамика частоты фибрилляции предсердий в российской популяционной выборке за 13 лет наблюдения. Кардиоваскулярная терапия и профилактика. 2022;21(8):3108. DOI: 10.15829/1728-8800-2022-3108Shapkina M.Yu., Mazdorova E.V., Avdeeva E.M. et al. Changes in the prevalence of atrial fibrillation in the Russian population over a 13-year follow-up. Cardiovascular Therapy and Prevention. 2022;21(8):3108 (in Russ.). DOI: 10.15829/1728-8800-2022-3108
3. Быстрицкая Е.В., Биличенко Т.Н. Обзор общей заболеваемости населения Российской Федерации бронхиальной астмой. Пульмонология. 2022;32(5):651–660. DOI: 10.18093/0869-0189-2022-32-5-651-660Bystritskaya E.V., Bilichenko T.N. The review of the bronchial asthma morbidity in the population of the Russian Federation. Pulmonologiya. 2022;32(5):651–660 (in Russ.). DOI: 10.18093/0869-0189-2022-32-5-651-660
4. Cepelis A., Brumpton B.M., Malmo V. et al. Associations of Asthma and Asthma Control With Atrial Fibrillation Risk: Results From the Nord-Trøndelag Health Study (HUNT). JAMA Cardiol. 2018;3(8):721–728. DOI: 10.1001/jamacardio.2018.1901
5. Johnson L.S., Juhlin T., Engström G. Reduced forced expiratory volume is associated with increased incidence of atrial fibrillation: the Malmo Preventive Project. Europace. 2014;16:182–188. DOI: 10.1093/europace/eut255
6. Levy M.L., Bacharier L.B., Bateman E. et al. Key recommendations for primary care from the 2022 Global Initiative for Asthma (GINA) update. NPJ Prim Care Respir Med. 2023;33(1):7. DOI: 10.1038/s41533-023-00330-1
7. Shkolnikova M.A., Jdanov D.A., Ildarova R.A. et al. Atrial fibrillation among Russian men and women aged 55 years and older: prevalence, mortality, and associations with biomarkers in a population-based study. J Geriatr Cardiol. 2020;17(2):74–84. DOI: 10.11909/j.issn.1671-5411.2020.02.002
8. Kong X., Wang M., Jiang Y. Global burden of atrial fibrillation attributable to high body mass index from 1990 to 2021: findings from the Global Burden of Disease Study 2021. BMC Cardiovasc Disord. 2024;24(1):542. DOI: 10.1186/s12872-024-04202-5
9. Чазова И.Е., Голицын С.П., Жернакова Ю.В. и др. Ведение пациентов с артериальной гипертонией и фибрилляцией предсердий. Системные гипертензии. 2021;18(3):105–128. DOI: 10.26442/2075082X.2021.3.201077Chazova I.E., Golitsyn S.P., Zhernakova J.V. et al. Management of patients with arterial hypertension and atrial fibrillation. Systemic Hypertension. 2021;18(3):105–128 (in Russ.). DOI: 10.26442/2075082X.2021.3.201077
10. Griffin M., Mills M.T. A Holistic Approach to Improving Outcomes in Atrial Fibrillation: The AF-CARE Pathway. Br J Hosp Med (Lond). 2025;86(4):1–5. DOI: 10.12968/hmed.2024.0929
11. Van Gelder I.C., Rienstra M., Bunting K.V. et al. 2024 ESC Scientific Document Group. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2024;45(36):3314–3414. DOI: 10.1093/eurheartj/ehae176
12. Kirchhof P., Camm J., Goete A. et al. Early Rhythm-Control Therapy in Patients with Atrial Fibrillation. N Engl J Med. 2020;383:1305–1316. DOI: 10.1056/NEJMoa2019422
13. Packer D.L., Mark D.B., Robb R.A. et al. CABANA Investigators. Effect of Catheter Ablation vs Antiarrhythmic Drug Therapy on Mortality, Stroke, Bleeding, and Cardiac Arrest Among Patients With Atrial Fibrillation: The CABANA Randomized Clinical Trial. JAMA. 2019;321(13):1261–1274. DOI: 10.1001/jama.2019.0693
14. Cardoso R., Justino G.B., Graffunder F.P. et al. Catheter Ablation is Superior to Antiarrhythmic Drugs as First-Line Treatment for Atrial Fibrillation: a Systematic Review and Meta-Analysis. Arq Bras Cardiol. 2022;119(1):87–94. DOI: 10.36660/abc.20210477
15. Kisling A.J., Symons J.G., Daubert J.P. Catheter ablation of atrial fibrillation: anticipating and avoiding complications. Expert Rev Med Devices. 2023;20(11):929–941. DOI: 10.1080/17434440.2023.2257131
16. Аракелян М.Г., Бокерия Л.А., Васильева Е.Ю. и др. Фибрилляция и трепетание предсердий. Клинические рекомендации 2020. Российский кардиологический журнал. 2021;26(7):4594. DOI: 10.15829/1560-4071-2021-4594Arakelyan M.G., Bockeria L.A., Vasilieva E.Yu. 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
17. Joglar J.A., Chung M.K., Armbruster A.L. et al. Peer Review Committee Members. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2024;149(1):e1–e156. DOI: 10.1161/CIR.0000000000001193
18. Hamilton D.Sr., Nandkeolyar S., Lan H. et al. Amiodarone: A Comprehensive Guide for Clinicians. Am J Cardiovasc Drugs. 2020;20(6):549–558. DOI: 10.1007/s40256-020-00401-5
19. Гаглоева Д.А., Дзаурова Х.М., Зельберг М.А. и др. Предварительные результаты проспективного рандомизированного исследования по сравнению эффективности и безопасности рефралона и амиодарона при кардиоверсии у больных пароксизмальной формой фибрилляции и трепетания предсердий. Кардиоваскулярная терапия и профилактика. 2023;22(4):3527. DOI: 10.15829/1728-8800-2023-3527Gagloeva D.A., Dzaurova Kh.M., Zelberg M.A. et al. Preliminary results of a prospective randomized study comparing the efficacy and safety of refralon and amiodarone in cardioversion in patients with paroxysmal atrial fibrillation and flutter. Cardiovascular Therapy and Prevention. 2023;22(4):3527 (in Russ.). DOI: 10.15829/1728-8800-2023-3527
20. Гаглоева Д.А., Миронов Н.Ю., Дзаурова Х.М. и др. Результаты проспективного рандомизированного исследования по сравнению эффективности и безопасности применения рефралона и амиодарона для восстановления синусового ритма у больных пароксизмальной формой фибрилляции и трепетания предсердий. Вестник аритмологии. 2024;31(1):63–70. DOI: 10.35336/VA-1289Gagloeva D.A., Mironov N.Yu., Dzaurova Kh.M. et al. Results of a prospective randomized study comparing efficacy and safety of refralon and amiodarone for cardioversion in patients with paroxysmal atrial fibrillation and flutter. Journal of Arrhythmology. 2024;31(1):63–70 (in Russ.). DOI: 10.35336/VA-1289
21. Andrade J.G., MacGillivray J., Macle L. et al. Clinical effectiveness of a systematic "pill-in-the-pocket" approach for the management of paroxysmal atrial fibrillation. Heart Rhythm. 2018;15(1):9–16. DOI: 10.1016/j.hrthm.2017.10.002
22. Cruickshank J.M., Prichard B.N.C. Beta-blockers in clinical practice, 2nd ed Churchill Livingstone, New York; 1994.
23. Кейко О.И., Регушевская Д.В., Благова О.В. и др. Возможности применения этацизина в лечении пациентов с фибрилляцией предсердий. Кардиология и сердечно-сосудистая хирургия. 2011;4(6):53–56.Keĭko O.I., Regushevskaia D.V., Blagova O.V. et al. Possibilities of ethacyzin application in treatment of patients with atrial fibrillation. Russian Journal of Cardiology and Cardiovascular Surgery. 2011;4(6):53–56 (in Russ.).
24. Kokina B., Strēlnieks A., Pupkeviča I. et al. Sinus rhythm maintenance after electrical cardioversion for atrial fibrillation in high-risk patients — comparative efficacy of antiarrhythmic medications. Proceedings of the Latvian Academy of Sciences Section B Natural Exact and Applied Sciences. 2021;75(1):32–39. DOI: 10.2478/prolas-2021-0006
25. Канорский С.Г., Шубик Ю.В. Антиаритмические препараты IC класса в кардиологической практике. Врач. 2025;36(3):32–39. DOI: 10.29296/25877305-2025-03-06Kanorskiy S., Shubik Y.U. Antiarrhythmic drugs of class ic in cardiology practice. Vrach (The Doctor). 2025;36(3):32–39 (in Russ.). DOI: 10.29296/25877305-2025-03-06
26. Merino J.L., Tamargo J., Blomström-Lundqvist C. et al. Practical Compendium of Antiarrhythmic Drugs: A Clinical Consensus Statement of the European Heart Rhythm Association of the ESC. Europace. 2025;27(8):euaf076. DOI: 10.1093/europace/euaf076
27. Хамитова Р.Я., Лоскутов Д.В., Акрамова Э.Г. Сравнительный анализ взаимосвязей кардиологической заболеваемости взрослого населения и социально-экономических показателей в регионах России. Социальные аспекты здоровья населения. 2022;68(3):5. DOI: 10.21045/2071-5021-2022-68-3-5Khamitova R.Ya., Loskutov D.V., Akramova E.G. Comparative analysis of the relationship between cardiovascular morbidity in the adult population and socio-economic indicators in the regions of Russia. Social'nye aspekty zdorov'a naselenia [serial online]. 2022;68(3):5 (in Russ.). DOI: 10.21045/2071-5021-2022-68-3-5.
28. Xue Z., Guo S., Liu X. et al. Impact of COPD or Asthma on the Risk of Atrial Fibrillation: A Systematic Review and Meta-Analysis. Front Cardiovasc Med. 2022;9:872446. DOI: 10.3389/fcvm.2022.872446
29. Graul E.L., Nordon C., Rhodes K. et al. Factors associated with non-fatal heart failure and atrial fibrillation or flutter within the first 30 days post COPD exacerbation: a nested case-control study. BMC Pulm Med. 2024;24(1):221. DOI: 10.1186/s12890-024-03035-4
30. Chen W., Li S., Huang D., Su Y. Drugs associated with a risk of supraventricular tachycardia: analysis using the OpenVigil database. J Int Med Res. 2024;52(3):3000605241238993. DOI: 10.1177/03000605241238077
31. Skoll D., Lu R., Gasmelseed A.Y. et al. Asthma is associated with higher recurrence rates of atrial fibrillation after catheter ablation. Heart Rhythm. 2024;S1547-5271(24)03656-7. Online ahead of print. DOI: 10.1016/j.hrthm.2024.12.011.28
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