Presented by : Ima Sulistiyo R.

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is associated

with increased cardio-vascular morbidity and mortality

In the United States, chronic obstructive pulmonary disease

(COPD) ranks as the fourth leading cause of mortality, second
leading cause of morbidity, and it remains the only common
mortality etiology that continues to rise (COPD deaths
increased by 58% from 1990 to 2010)
 Hypothesis

Most clinically significant arrhythmias would be more

commonly seen on 24-hour ECG Holter monitors of patients
with COPD compared with patients without COPD

The severity of COPD would correlate with the prevalence of

these arrhythmias
 AIM OF STUDY

Whether the presence and severity of COPD are associated

with atrial or ventricular arrhythmias
 Methods
Retrospectively identified and searched the medical records for
all unique adult patients who underwent clinically indicated
24-hour ECG Holter monitoring between the years 2000 and
2009

Pulmonary function testing (PFT) in our laboratory (spirometry

variables necessary for inclusion: FEV1 and FVC
 Methods

Exclusion criteria :
(1) incomplete medical record
(2) restrictive or nonspecific pulmonary disease identified on
PFT
(3) patient’s preference not to participate in research studies
 Classification of COPD
Absence mild-to- severe very severe
moderate

FEV1/FVC ≥ 0,7 < 0,7 < 0,7 < 0,7

FEV1 percent ≥ 0,8 ≥ 0,5 0,3 – 0,5 < 0,3
predicted
Ventricular tachycardia (VT) was defined as a sequence of ≥3
beats at a rate of>100 beats/min, which were ventricular in
origin

VT that lasted <30 consecutive beats was termed NSVT, and

VT lasting 30 consecutive beats was termed SustVT
 Results

3,121
7,441 patients (41.9%) were diagnosed with COPD
Results
Results
 Discussion
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
3. COPD served as a univariate risk factor for
SustVT
 Discussion
Patients with COPD experienced significantly greater number of
atrial premature complex (APC) and ventricular premature
complex (VPC)

Prolonged and inhomogeneous propagation of depolarization

could be present in the atria of patients with COPD

Our finding that AF is independently associated with COPD

hypercapnia, pulmonary hypertension, b agonistic effect,
diastolic dysfunction, changes in atrial size and increased
arrhythmogenicity
 Discussion
The ventricular arrhythmogenic substrate in COPD is increased
at least in part due to the high prevalence of coronary artery
disease in this population

Implantation of a defibrillator for primary prevention was

shown to carry a survival benefit in patients with COPD with
reduced left ventricular ejection fraction of 35%
 conclusion

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 medication
THANK YOU