Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Arrhythmias in COPD

Omar A Minai, MD
Section Editors
James K Stoller, MD, MS
Leonard I Ganz, MD, FHRS, FACC
Deputy Editors
Helen Hollingsworth, MD
Brian C Downey, MD, FACC


The natural history of chronic obstructive pulmonary disease (COPD) includes gradually worsening shortness of breath and functional limitation, caused by a progressive decline in lung function and the development of co-morbid illnesses [1]. Multifocal atrial tachycardia, atrial fibrillation, and ventricular arrhythmias are common co-morbidities among patients with COPD [2].

The potential contributing factors, occurrence rates, and management of arrhythmias in patients with COPD will be discussed here. The management of stable COPD and atrial and ventricular arrhythmia is reviewed separately. (See "Management of stable chronic obstructive pulmonary disease" and "Clinical manifestations, diagnosis, and evaluation of narrow QRS complex tachycardias" and "Multifocal atrial tachycardia" and "Management of new onset atrial fibrillation" and "Rhythm control versus rate control in atrial fibrillation" and "Approach to the diagnosis of wide QRS complex tachycardias" and "Approach to the management of wide QRS complex tachycardias".)


Multiple factors have been evaluated as possible contributors to the development of arrhythmias in patients with COPD [3,4]. Some are related to comorbid disease processes with shared risk factors and others are more specifically related to COPD. Factors related to COPD that have been studied regarding their potential role in arrhythmia development are discussed in greater detail below.

Comorbid disease processes — COPD shares risk factors (eg, age, smoking) with a number of disease processes and related treatments that are also associated with cardiac arrhythmias, including [3,4]:

Coronary heart disease

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Oct 2017. | This topic last updated: Sep 22, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Minai OA, Benditt J, Martinez FJ. Natural history of emphysema. Proc Am Thorac Soc 2008; 5:468.
  2. Sode BF, Dahl M, Nordestgaard BG. Myocardial infarction and other co-morbidities in patients with chronic obstructive pulmonary disease: a Danish nationwide study of 7.4 million individuals. Eur Heart J 2011; 32:2365.
  3. Shih HT, Webb CR, Conway WA, et al. Frequency and significance of cardiac arrhythmias in chronic obstructive lung disease. Chest 1988; 94:44.
  4. Górecka D. Cardiac arrhythmias in chronic obstructive pulmonary disease. Monaldi Arch Chest Dis 1997; 52:278.
  5. Anand IS, Chandrashekhar Y, Ferrari R, et al. Pathogenesis of congestive state in chronic obstructive pulmonary disease. Studies of body water and sodium, renal function, hemodynamics, and plasma hormones during edema and after recovery. Circulation 1992; 86:12.
  6. Bittar G, Friedman HS. The arrhythmogenicity of theophylline. A multivariate analysis of clinical determinants. Chest 1991; 99:1415.
  7. Sessler CN, Cohen MD. Cardiac arrhythmias during theophylline toxicity. A prospective continuous electrocardiographic study. Chest 1990; 98:672.
  8. Huerta C, Lanes SF, García Rodríguez LA. Respiratory medications and the risk of cardiac arrhythmias. Epidemiology 2005; 16:360.
  9. Global Strategy for the Diagnosis, Management and Prevention of COPD, Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2016. www.goldcopd.org (Accessed on March 17, 2016).
  10. Kallergis EM, Manios EG, Kanoupakis EM, et al. Acute electrophysiologic effects of inhaled salbutamol in humans. Chest 2005; 127:2057.
  11. Salpeter SR, Ormiston TM, Salpeter EE. Cardiovascular effects of beta-agonists in patients with asthma and COPD: a meta-analysis. Chest 2004; 125:2309.
  12. Hanrahan JP, Grogan DR, Baumgartner RA, et al. Arrhythmias in patients with chronic obstructive pulmonary disease (COPD): occurrence frequency and the effect of treatment with the inhaled long-acting beta2-agonists arformoterol and salmeterol. Medicine (Baltimore) 2008; 87:319.
  13. Donohue JF, Hanania NA, Fogarty C, et al. Long-term safety of nebulized formoterol: results of a twelve-month open-label clinical trial. Ther Adv Respir Dis 2008; 2:199.
  14. D'Alessandro A, Boeckelmann I, Hammwhöner M, Goette A. Nicotine, cigarette smoking and cardiac arrhythmia: an overview. Eur J Prev Cardiol 2012; 19:297.
  15. Tükek T, Yildiz P, Atilgan D, et al. Effect of diurnal variability of heart rate on development of arrhythmia in patients with chronic obstructive pulmonary disease. Int J Cardiol 2003; 88:199.
  16. Stewart AG, Waterhouse JC, Howard P. The QTc interval, autonomic neuropathy and mortality in hypoxaemic COPD. Respir Med 1995; 89:79.
  17. Yildiz P, Tükek T, Akkaya V, et al. Ventricular arrhythmias in patients with COPD are associated with QT dispersion. Chest 2002; 122:2055.
  18. Zulli R, Donati P, Nicosia F, et al. Increased QT dispersion: a negative prognostic finding in chronic obstructive pulmonary disease. Intern Emerg Med 2006; 1:279.
  19. Dilaveris PE, Gialafos JE. P-wave dispersion: a novel predictor of paroxysmal atrial fibrillation. Ann Noninvasive Electrocardiol 2001; 6:159.
  20. Magnani JW, Williamson MA, Ellinor PT, et al. P wave indices: current status and future directions in epidemiology, clinical, and research applications. Circ Arrhythm Electrophysiol 2009; 2:72.
  21. Tükek T, Yildiz P, Akkaya V, et al. Factors associated with the development of atrial fibrillation in COPD patients: the role of P-wave dispersion. Ann Noninvasive Electrocardiol 2002; 7:222.
  22. Incalzi RA, Pistelli R, Fuso L, et al. Cardiac arrhythmias and left ventricular function in respiratory failure from chronic obstructive pulmonary disease. Chest 1990; 97:1092.
  23. Celli BR. Pulmonary rehabilitation in patients with COPD. Am J Respir Crit Care Med 1995; 152:861.
  24. Cheong TH, Magder S, Shapiro S, et al. Cardiac arrhythmias during exercise in severe chronic obstructive pulmonary disease. Chest 1990; 97:793.
  25. Buch P, Friberg J, Scharling H, et al. Reduced lung function and risk of atrial fibrillation in the Copenhagen City Heart Study. Eur Respir J 2003; 21:1012.
  26. Fuso L, Incalzi RA, Pistelli R, et al. Predicting mortality of patients hospitalized for acutely exacerbated chronic obstructive pulmonary disease. Am J Med 1995; 98:272.
  27. Konecny T, Park JY, Somers KR, et al. Relation of chronic obstructive pulmonary disease to atrial and ventricular arrhythmias. Am J Cardiol 2014; 114:272.
  28. Payne, RM. Management of arrhythmias in patients with severe lung disease. Clin Pulm Med 1994; 1:232.
  29. McCord J, Borzak S. Multifocal atrial tachycardia. Chest 1998; 113:203.
  30. Hudson LD, Kurt TL, Petty TL, Genton E. Arrhythmias associated with acute respiratory failure in patients with chronic airway obstruction. Chest 1973; 63:661.
  31. Engel TR, Radhagopalan S. Treatment of multifocal atrial tachycardia by treatment of pulmonary insufficiency: or is it vice versa? Chest 2000; 117:7.
  32. Holtzman D, Aronow WS, Mellana WM, et al. Electrocardiographic abnormalities in patients with severe versus mild or moderate chronic obstructive pulmonary disease followed in an academic outpatient pulmonary clinic. Ann Noninvasive Electrocardiol 2011; 16:30.
  33. Shibata Y, Watanabe T, Osaka D, et al. Impairment of pulmonary function is an independent risk factor for atrial fibrillation: the Takahata study. Int J Med Sci 2011; 8:514.
  34. Greenberg, YJ, Rosenfeld, LE. Evaluating and managing arrhythmias in COPD. J Respir Dis 1995; 16:1099.
  35. Rogers RM, Owens GR, Pennock BE. The pendulum swings again. Toward a rational use of theophylline. Chest 1985; 87:280.
  36. Kastor JA. Multifocal atrial tachycardia. N Engl J Med 1990; 322:1713.
  37. Salpeter S, Ormiston T, Salpeter E. Cardioselective beta-blockers for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2005; :CD003566.
  38. January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2014; 64:e1.
  39. Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 2016; 37:2893.
  40. Barranco F, Sanchez M, Rodriguez J, Guerrero M. Efficacy of flecainide in patients with supraventricular arrhythmias and respiratory insufficiency. Intensive Care Med 1994; 20:42.
  41. Ganz LI, Friedman PL. Supraventricular tachycardia. N Engl J Med 1995; 332:162.
  42. Fuster V, Rydén LE, Cannom DS, et al. ACC/AHA/ESC 2006 Guidelines for the Management of Patients with Atrial Fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation): developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Circulation 2006; 114:e257.
  43. Kennedy JI Jr. Clinical aspects of amiodarone pulmonary toxicity. Clin Chest Med 1990; 11:119.
  44. Razak E, Kamireddy S, Saba S. Implantable cardioverter-defibrillators confer survival benefit in patients with chronic obstructive pulmonary disease. Pacing Clin Electrophysiol 2010; 33:1125.
  45. McGarvey LP, Magder S, Burkhart D, et al. Cause-specific mortality adjudication in the UPLIFT® COPD trial: findings and recommendations. Respir Med 2012; 106:515.
  46. Pratt CM. Asymptomatic ventricular arrhythmias in patients with obstructive lung disease. Should they be treated? Chest 1988; 94:2.
  47. Steer J, Gibson GJ, Bourke SC. Predicting outcomes following hospitalization for acute exacerbations of COPD. QJM 2010; 103:817.
  48. Kleiger RE, Senior RM. Longterm electrocardiographic monitoring of ambulatory patients with chronic airway obstruction. Chest 1974; 65:483.
  49. Roberts CM, Stone RA, Lowe D, et al. Co-morbidities and 90-day outcomes in hospitalized COPD exacerbations. COPD 2011; 8:354.