Cardiovascular complications are common in patients with chronic obstructive pulmonary disease (COPD), and arrhythmias contribute substantially to morbidity. A cross-sectional observational study published in the Journal of Electrocardiology evaluated the relationship between electrocardiographic markers of right heart strain and arrhythmias in patients with COPD.

COPD severity was classified according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. Patients were divided into groups with and without arrhythmias. Multivariable logistic regression analysis adjusted for age, sex, forced expiratory volume in 1 second (FEV₁), hypertension, diabetes, and cardiovascular risk factors. The analysis included 80 consecutive patients with confirmed COPD. 

Findings

• P pulmonale was more frequently observed in patients with arrhythmias than in those without arrhythmias (55% vs 20%; p=0.002), although this analysis was restricted to patients in sinus rhythm.
• Right axis deviation was significantly more common among patients with arrhythmias (62.5% vs 20%; p<0.001).
• Right ventricular hypertrophy was more common in patients with arrhythmias (45% vs 15%; p=0.007), while T-wave inversion in leads V1–V3 (65% vs 30%; p=0.003) and right bundle branch block (60% vs 20%; p<0.001) were also observed more frequently.
• Low QRS voltage did not differ significantly between patients with and without arrhythmias (70% vs 55%; p=0.20).
• On multivariable analysis, P pulmonale (OR, 3.2; 95% CI, 1.3-7.8; p=0.01) and right ventricular hypertrophy (OR, 2.9; 95% CI, 1.1-7.2; p=0.03) remained independent predictors of arrhythmias.

The findings suggest that ECG markers of right heart strain, particularly P pulmonale and right ventricular hypertrophy, may help identify patients with COPD at increased arrhythmic risk.