Arrhythmias and Conduction Disturbances
Relation of Chronic Obstructive Pulmonary Disease to Atrial and Ventricular Arrhythmias

https://doi.org/10.1016/j.amjcard.2014.04.030Get rights and content

Chronic obstructive pulmonary disease (COPD) is associated with increased cardiovascular morbidity and mortality, yet the exact pathophysiological links remain unclear. Whether the presence and severity of COPD are associated with atrial or ventricular arrhythmias recorded on continuous electrocardiographic monitoring is unknown. We identified consecutive adult patients who underwent clinically indicated pulmonary function testing as well as 24-hour Holter monitoring at the Mayo Clinic, Rochester, from 2000 to 2009. Demographic data and relevant co-morbidities were gathered from the electronic medical record; severity of COPD was classified according to the GOLD classification, and arrhythmias were classified in concordance with the current clinical guidelines. From 7,441 patients who were included (age 64 ± 16 years, 49% woman, 92% Caucasian), COPD was diagnosed in 3,121 (41.9%). Compared with those without COPD, the presence and severity of COPD were associated with increased likelihood of atrial fibrillation/atrial flutter (AF/AFL; 23.3% vs 11.0%, respectively, p <0.0001), nonsustained ventricular tachycardia (NSVT; 13.0% vs 5.9%, respectively, p <0.0001), and sustained ventricular tachycardia (0.9% vs 1.6%, respectively, p <0.0001). COPD remained a significant predictor of AF/AFL and NSVT (p <0.0001 and p <0.0001, respectively) after adjusting for age, gender, tobacco use, obesity, hypertension, coronary artery disease, heart failure, diabetes, anemia, cancer, chronic kidney disease, and rate/rhythm control medications. In conclusion, the independent association between the presence and severity of COPD and arrhythmias (AF/AFL and NSVT) provides further insight into the markedly increased cardiovascular mortality of patients with COPD. Further studies should explore which anti-arrhythmic strategies would best apply to the patients with COPD.

Section snippets

Methods

This study protocol was approved by the Mayo Clinic Institutional Review Board. We retrospectively identified and searched the medical records at our institution for all unique adult patients who underwent clinically indicated 24-hour ECG Holter monitoring between the years 2000 and 2009. From this cohort, we identified those patients who performed pulmonary function testing (PFT) in our laboratory (spirometry variables necessary for inclusion: FEV1 and FVC). Relevant demographic variables,

Results

We included 7,441 patients in this study (age 64 ± 16 years, 49% woman, 92% Caucasian) of whom 3,121 (41.9%) were diagnosed with COPD based on the PFT results. Characteristics of the study cohort stratified according to the presence and severity of COPD are listed in Table 1. The Holter monitoring results (listed in Table 2) revealed that patients with COPD experienced significantly greater number of atrial premature complex (APC) and ventricular premature complex (VPC); this difference

Discussion

The novel findings of this study were as follows: (1) COPD and its severity were independently associated with the occurrence of AF on a 24-hour Holter monitor, (2) COPD presence and severity were independently associated with NSVT as recorded by a 24-hour Holter monitor; and (3) COPD served as a univariate risk factor for SustVT, but this association did not remain independent in a multivariate analysis. These findings suggest that COPD poses an important and previously underappreciated risk

Disclosures

Dr. Scanlon has been an investigator for clinical trials sponsored by the National Heart Lung and Blood Institute, Bethesda, Maryland, Department of Energy, Atlanta, Georgia, Boehringer Ingelheim, Ridgefield, Connecticut, Dey L.P. Pharmaceutical, Napa, California, Forest, New York, New York, GlaxoSmithKline, Philadelphia, Pennsylvania, Novartis AG, Cambridge, Massachusetts, and Pfizer Inc., New York, New York. All other authors do not report any conflicts of interest.

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    This study was supported in part by European Regional Development Fund—Project FNUSA-ICRC CARDIO 3 and 5—No. CZ.1.05/1.1.00/02.0123.

    See page 276 for disclosure information.

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