Chest
Volume 94, Issue 1, July 1988, Pages 44-48
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Clinical Investigations
Frequency and Significance of Cardiac Arrhythmias in Chronic Obstructive Lung Disease

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Ambulatory electrocardiograms obtained in 69 patients enrolled in the nocturnal oxygen therapy trial group were examined for frequency and significance of arrhythmias in patients with stable chronic obstructive lung disease. Ventricular premature beats occurred in 83 percent, ventricular bigeminy in 68 percent, paired ventricular premature beats in 61 percent, and nonsustained ventricular tachycardia in 22 percent of the patients. Supraventricular tachycardia occurred in 69 percent. Repetitive ventricular arrhythmia occurred in 64 percent of the patients, and was significantly more frequent in men and in patients with edema or elevated Pco2. Ventricular premature beats greater or equal to 25 per hour occurred in 35 percent of the patients. Univariate and multivariate Cox proportional hazards analysis showed that a history of coronary heart disease, increased sinus heart rate and decreased maximum work load (measured by maximal treadmill exercise test)—but not arrhythmias—were predictors of death.

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Material and Methods

Seventy-five patients were sequentially selected from three centers participating in the Nocturnal Oxygen Therapy Trial Group. Twenty-four hour ambulatory electrocardiographic monitoring was performed prior to the initiation of random intervention with oxygen therapy. In 69 patients, this recording was satisfactory for analysis; this is the group analyzed in this study. Characteristics of the original 203 patients were previously extensively described.10, 11 In brief, each patient had a

Results

Laboratory and clinical characteristics of the 69 patients in whom the 24-hour ambulatory electrocardiographic recording was satisfactory for analysis are listed in Table 1. Average age was 67 years, associated coronary heart disease was present in 15 percent; 36 percent were taking digoxin, 84 percent methylxanthines and 44 percent a diuretic. Mean arterial Po2 was 51±4 mm Hg and Pco2 45±8.

Discussion

This study supports the fact that both ventricular and supraventricular premature beats occur frequently in patients with chronic obstructive lung disease. Their frequency in this population is, in fact, similar to that observed in high risk patients with coronary heart disease who have been resuscitated after out-of-hospital cardiac arrest.12 The only significant association of other factors with these arrhythmias was the increased incidence of edema and elevated Pco2 in men with repetitive

Conclusion

This study again showed that both supraventricular and ventricular arrhythmias occur frequently in patients with stable chronic obstructive lung disease. None of the medications and concomitant medical problems were associated with the occurrence of ventricular arrhythmias. The mortality rate of our patients was high, and increased sinus heart rate, decreased maximum work load, and coronary artery disease were the only significant prognostic indicators of mortality.

ACKNOWLEDGMENTS

Participants in the Nocturnal Oxygen Therapy Trial contributing to this report were: Paul A. Kvale, M.D., and Fareed U. Khaja, M.D. Henry Ford Hospital, Detroit, Michigan; David W. Cugell, M.D., and Norman Solliday, M.D., Northwestern University, Chicago, Illinois; and Nicholas R. Anthonisen, M.D., William Corbett, M.D., and John A. Fleetham, M.D., University of Manitoba, Winnipeg, Canada; George W. Williams, Ph.D., Sandy M. Snedecor, B.S., University of Michigan, Ann Arbor; and Allyn Acheson,

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Supported by contracts N01-HR-6-2942, 2943, 2944, 2945, 2946, and 2947 from the Division of Lung Diseases, National Heart, Lung and Blood Institute, National Institutes of Health, U.S. Department of Health and Human Services

Manuscript received September 30; revision accepted December

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