Atrial and Ventricular Arrhythmia-Associated Factors in Stable Patients with Chronic Obstructive Pulmonary Disease

Abstract

Background: Supraventricular and ventricular premature complexes (SVPC and VPC, respectively) are associated with chronic obstructive pulmonary disease (COPD) and with increased mortality in COPD patients. However, there are few reports on the causes of arrhythmia in COPD patients. Objectives: This study explores the associations between cardiopulmonary dysfunction and COPD by comparing patients with defined arrhythmias (>100 beats per 24 h) and those without, based on 24-hour electrocardiogram (ECG) recordings. Methods: Patients with arrhythmia underwent a 24-hour ECG and subsequent pulmonary function tests, computed tomography, ECG, 6-min walk test (6MWT), and BODE (body mass index, airflow obstruction, modified Medical Research Council Dyspnoea Scale, exercise capacity) index calculation. Results: Of 103 study patients (71 COPD patients and 32 at-risk patients), 36 had VPC, 45 had SVPC, 20 had both, and 42 had neither. The predicted post-bronchodilator forced expiratory volume in 1 s, the proportion of low-attenuation area on computed tomography, and BODE index values were significantly worse in the SVPC and VPC groups compared with the corresponding reference groups. Patients in the VPC group showed significantly increased right ventricular pressure and increased desaturation in the 6MWT compared with the reference group. In the multivariate analyses, bronchodilator use was a significant risk factor in the SVPC group, whereas in the VPC group, all parameters of the BODE index except for the dyspnoea score were identified as risk factors. Conclusions: Increased SVPC might be caused by bronchodilator use, whereas increased VPC is likely related to the peculiar pathophysiology of COPD.

Chronic obstructive pulmonary disease as a risk factor for ventricular arrhythmias independent of left ventricular function

“…While a potential selection bias could have been introduced, the demographic and comorbid characteristics of our cohort are similar to those of previously published in large unselected registries of COPD patients, 29 and our results are consistent with the growing body of evidence implicating COPD in arrhythmogenesis. 4, 10, 30 The timing and sequence of the LVEF assessment, Holter monitoring, and PFT can lead to a possible indication bias. The sub-analysis focusing on this issue supports the notion that the conclusions of this study remain similar in patients with echocardiogram performed prior to the Holter monitoring as in those with echocardiogram performed after Holter monitoring, but future prospectively designed studies are needed to fully elucidate this issue.…”

The Toxicological Mechanisms of Environmental Soot (Black Carbon) and Carbon Black: Focus on Oxidative Stress and Inflammatory Pathways

“…It has been already reported that cytochalasin B is able to inhibit the cytotoxic response of sensitized lymphoid cells and thus may attenuate mast cells responses (Figure 7) (272). The activation of transmembrane adaptor protein PAG/CBP, which is associated with the both positive and negative regulation cell signaling of mast cells, may also be used as a noble target against mast cells activation (273). …”

Higher premature atrial complex burden from the Holter examination predicts poor cardiovascular outcome

“…Dr. Kusunoki et al studied atrial and ventricular arrhythmia in stable chronic obstructive lung disease and used > 100 beats per 24 h as a specific cut-off. They concluded that increased supraventricular premature complexes, or PACs, might be strongly associated with the use of bronchodilator 19 . However, another group studied the combination of theophylline and salbutamol, and also concluded that oral theophylline added to a regimen of salbutamol does not seem to affect the occurrence or severity of arrhythmias 20 .…”