Int J Chron Obstruct Pulmon Dis. 2026 Oct 21;21:642161. doi: 10.2147/COPD.S642161. eCollection 2026.
ABSTRACT
BACKGROUND: Cardiac arrhythmias are increasingly recognized during acute exacerbations of chronic obstructive pulmonary disease (AECOPD), but their full spectrum and prognostic significance detected by continuous Holter monitoring remain insufficiently characterized.
METHODS: We conducted a single-center retrospective cohort study of patients hospitalized for AECOPD between April 2022 and January 2025 who underwent continuous Holter monitoring. Arrhythmias were classified as atrial arrhythmias (AA), atrial fibrillation/flutter (AF/AFL), ventricular arrhythmias (VA), or coexistence of ≥2 arrhythmia types. Multivariable regression models were used to identify factors associated with arrhythmias and clinical outcomes. COPD-related readmission was assessed using Kaplan-Meier and Cox regression analyses.
RESULTS: Among 548 patients, 60.4% experienced at least one arrhythmia during hospitalization. AA (37.6%) was the most frequent subtype, followed by VA (31.0%) and AF/AFL (12.2%), while 21.5% exhibited multiple arrhythmia types. Older age, male sex, higher heart rate, elevated NT-proBNP, and larger left atrial diameter were independently associated with in-hospital arrhythmias. NT-proBNP was consistently associated with all arrhythmia phenotypes and demonstrated moderate discrimination for arrhythmia identification (AUC=0.730; cutoff, 131.5 pg/mL). AF/AFL was independently associated with prolonged hospitalization (adjusted ratio=1.26, P=0.010). After accounting for the time-dependent effect of age, hypercapnia (PaCO ≥45 mmHg) remained associated with a higher risk of COPD-related readmission (adjusted HR=1.85, 95% CI 1.19-2.88; P=0.007).
CONCLUSION: In-hospital arrhythmias are highly prevalent among patients hospitalized for AECOPD. NT-proBNP is consistently associated with multiple arrhythmia phenotypes and may aid arrhythmic risk stratification. Hypercapnia, but not arrhythmia status, remained independently associated with COPD-related readmission despite the limited sample and observational design.
PMID:42928902 | PMC:PMC13695928 | DOI:10.2147/COPD.S642161