High Prevalence of Unrecognized Actionable Cardiac Arrhythmias in Patients with Moderate to Severe Chronic Obstructive Pulmonary Disease

BackgroundPatients with chronic obstructive pulmonary disease (COPD) are at high risk for developing arrhythmias due to hypoxemia, right heart failure, and the use of beta-agonist inhalers. Symptoms related to arrhythmias can often be masked or confounded by symptoms related to COPD exacerbation and remain undiagnosed. With this study, we identify the incidence of actionable arrhythmias in patients with no prior cardiology follow-up and moderate-severe COPD with continuous monitoring. MethodsAn automatic referral for electrophysiology (EP) consult was generated in patients with moderate-severe COPD if they endorsed one of the following: palpitations, dizziness, abnormal ECG, or near syncope. Eligible patients underwent ILR implantation after evaluation with an EP specialist and were followed via remote monitoring for 12 months. A control group of patients without COPD matched for age, sex, and implant indication were randomly selected in a 3:1 ratio. Actionable arrhythmias, defined as arrhythmias that correlated with symptoms triggered by the patient, necessitating EP intervention, were recorded for both groups. ResultsIn this prospective cohort study, 21 patients with COPD were enrolled and compared to 63 controls. COPD patients experienced a significantly higher rate of actionable arrhythmias compared to the controls (48% vs 11%, p<0.001). EP interventions in response to actionable arrhythmias included eight patients initiated on anticoagulation, three catheter ablations, one implantable cardiac defibrillator, and one permanent pacemaker implanted. In multivariate analysis, COPD was an independent predictor of actionable arrhythmias (aOR 4.3, 95% CI 1.2-15.2, p=0.02) when adjusting for chronic kidney disease and all-cause readmissions. ConclusionContinuous monitoring was highly effective in diagnosing significant arrhythmic events in patients with moderate-severe COPD. Awareness should be raised about the high arrhythmic risk in this population and the role of continuous monitoring should be evaluated in larger studies. O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=113 SRC="FIGDIR/small/24315304v1_ufig1.gif" ALT="Figure 1"> View larger version (54K): org.highwire.dtl.DTLVardef@1ca2d5forg.highwire.dtl.DTLVardef@68d6a3org.highwire.dtl.DTLVardef@e393a6org.highwire.dtl.DTLVardef@f2b758_HPS_FORMAT_FIGEXP M_FIG C_FIG WHAT IS KNOWN?O_LIPatients with COPD are at greater risk for developing cardiac arrhythmias, which may propagate COPD exacerbations. C_LI WHAT THE STUDY ADDSO_LIQuantification of incidence of actionable arrhythmias in patients with moderate to severe COPD using continuous monitoring for the 1st time. C_LIO_LIMultivariate analysis which determines whether this phenomenon is due to demographic confounders, comorbidities, treatment modalities or an independent association. C_LIO_LIDetailed presentation of the type or arrhythmias, COPD exacerbations and healthcare utilization, emphasizing the need for arrhytmia surveillance in this vulnerable patient population. C_LI