Cardiac arrhythmias in patients with chronic obstructive pulmonary disease (COPD)

Abstract

Background. Cardiovascular comorbidities, especially arrhythmias burden COPD patients by exceeding the pulmonary pathology and worsening the outcomes of the disease leading to increased morbidity and higher mortality rates. Recognition of these cardiovascular complications is crucial for the overall prognosis of COPD. Objective(s). Evaluation of the incidence and mechanisms of arrhythmias to optimize the management of cardiovascular complications associated with chronic obstructive pulmonary disease. Materials and methods. The results were collected by conducting a literature and clinical review of articles, clinical observations and data, and meta-analyses published from 2013 to 2024. Clinical databases like PubMed, GOLD COPD document 2023, and medRvix were incorporated into the research process. The mentioned articles were then chosen and reviewed. Results. Arrhythmogenicity in COPD arises from multifactorial processes that lead to structural and electrical myocardial changes and remodeling. The integrated analysis shows an incidence of arrhythmias in 48% of patients with moderate and severe COPD, with atrial fibrillation (11%), premature atrial contraction (4%) and sinus tachycardia (6%) predominating. Shortened P-wave duration, a prolonged PR interval and an increase in NTpro-BNP might predict the occurrence of atrial fibrillation. The presence of persistent inflammation, chronic hypoxia and pulmonary hypertension eventually lead to myocardial remodeling and endothelial dysfunction. Conclusion(s). The link between COPD and arrhythmia requires clinical vigilance especially during exacerbations. Atrial fibrillation was found to be the most common arrhythmia. Optimal management includes arrhythmia screening, avoidance of pro-arrhythmic drugs in high-risk patients and follow-up.