Prevalence and Affecting Factors of Arrhythmias in Stable Chronic Obstructive Pulmonary Disease at a Tertiary Hospital in Indonesia
Downloads
Introduction: Chronic obstructive pulmonary disease (COPD) represents an increasing global health burden. Among its significant comorbidities, cardiovascular complications, particularly arrhythmias, are of significant concern. Chronic obstructive pulmonary disease and arrhythmias share common risk factors, including advanced age and smoking. This study investigated the prevalence and contributing factors of arrhythmias in stable COPD patients.
Methods: This cross-sectional study was conducted among stable COPD patients attending the Asthma-COPD Clinic at Persahabatan National Respiratory Referral Hospital, Jakarta, Indonesia, from January to April 2018. The inclusion criteria encompassed a clinical diagnosis of COPD and voluntary participation with written informed consent. Each participant underwent laboratory evaluation, electrocardiography (ECG), blood pressure measurement, and a structured interview. Patients were excluded if they had experienced acute COPD exacerbations during the assessment, had a history of other chronic lung diseases, suffered a recent myocardial infarction, had structural heart disease, were diagnosed with fibrillation, or declined to participate.
Results: The prevalence of arrhythmias in stable COPD patients was 24.1%. The types included sinus bradycardia (2.41%), premature atrial contractions/PACs (3.61%), premature ventricular contractions/PVCs (8.43%), and sinus tachycardia (9.64%). The majority of arrhythmic patients were males, with an average age of 68 years old. These patients also had a history of heart disease, exhibited severe COPD symptoms, and demonstrated significant airflow obstruction (average pCO₂ of 36 mmHg).
Conclusion: Decreased chloride levels were associated with an increased incidence of arrhythmias. However, no significant associations were observed with airflow limitation, sex, age, bronchodilator use, or arterial blood gas parameters.
Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (2024 Report), https://goldcopd.org/2024-gold-report/ (2024).
Liu X, Chen Z, Li S, et al. Association of Chronic Obstructive Pulmonary Disease With Arrhythmia Risks: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2021; 8: 732349. [PubMed]
Papaporfyriou A, Bartziokas K, Gompelmann D, et al. Cardiovascular Diseases in COPD: From Diagnosis and Prevalence to Therapy. Life (Basel, Switzerland); 13. Epub ahead of print May 2023. [PubMed]
Hazarapetyan LG, Zelveian PH, Grigoryan SV. Features of Atrial Fibrillation Pathogenesis and Prognosis in Chronic Obstructive Pulmonary Patients during the COVID-19 Pandemic. Rev Cardiovasc Med 2023; 24: 51. [PubMed]
Konecny T, Park JY, Somers KR, et al. Relation of Chronic Obstructive Pulmonary Disease to Atrial and Ventricular Arrhythmias. Am J Cardiol 2014; 114: 272–277. [PubMed]
Dewantoro L, Wiyono W, Yunus F, et al. Proportions of Hypertension in Stable COPD Patients at the National Respiratory Center Persahabatan Hospital. J Respirologi Indones 2024; 44: 187–195. [Journal]
Choudhury G, Rabinovich R, MacNee W. Comorbidities and Systemic Effects of Chronic Obstructive Pulmonary Disease. Clin Chest Med 2014; 35: 101–130. [PubMed]
Curkendall SM, DeLuise C, Jones JK, et al. Cardiovascular Disease in Patients with Chronic Obstructive Pulmonary Disease, Saskatchewan Canada Cardiovascular Disease in COPD Patients. Ann Epidemiol 2006; 16: 63–70. [PubMed]
Cazzola M, Bettoncelli G, Sessa E, et al. Prevalence of Comorbidities in Patients with Chronic Obstructive Pulmonary Disease. Respiration 2010; 80: 112–119. [PubMed]
Cui H, Miao DM, Wei ZM, et al. Prevalence of Cardiovascular Disease in Subjects Hospitalized due to Chronic Obstructive Pulmonary Disease in Beijing from 2000 to 2010. J Geriatr Cardiol 2012; 9: 5–10. [PubMed]
Aprilen N, Indratama IMB. Profile of Chronic Obstructive Pulmonary Disease (COPD) Patients in Oksibil Regional Public Hospital at 2020. J Penyakit Dalam Udayana 2022; 6: 10–14. [Journal]
Al Wachami N, Guennouni M, Iderdar Y, et al. Estimating the Global Prevalence of Chronic Obstructive Pulmonary Disease (COPD): A Systematic Review and Meta-Analysis. BMC Public Health 2024; 24: 297. [PubMed]
Shih HT, Webb CR, Conway WA, et al. Frequency and Significance of Cardiac Arrhythmias in Chronic Obstructive Lung Disease. Chest 1988; 94: 44–48. [PubMed]
Jacques MR, Kuhn BT, Albertson TE. Update on the Pharmacological Treatment of Chronic Obstructive Pulmonary Disease. Expert Opin Pharmacother 2024; 25: 1903–1922. [PubMed]
Andreas S. Effects of LAMA/LABA Alone and in Combination on Cardiac Safety. International Journal of Chronic Obstructive Pulmonary Disease 2020; 15: 1931–1933. [PubMed]
Goudis CA, Konstantinidis AK, Ntalas IV, et al. Electrocardiographic Abnormalities and Cardiac Arrhythmias in Chronic Obstructive Pulmonary Disease. Int J Cardiol 2015; 199: 264–273. [PubMed]
Mittal S, Bhushan R, Jhajhria N, et al. The Significance of Systemic Inflammatory Markers in ‘New-Onset Atrial Fibrillation’ Following Cardiac Surgeries. Cureus 2024; 16: e59869. [PubMed]
Zhang J, Wang J, Ma X, et al. Rapid FEV1 Decline and the Effects of Both FEV1 and FVC on Cardiovascular Disease: A UK Biobank Cohort Analysis. BMC Public Health 2024; 24: 3214. [PubMed]
Dabadghao VS, Patil R, Sharma SK, et al. A Clinical Study of Cardiac Rhythm Disturbance in Patients with Chronic Obstructive Pulmonary Disease Using 24 Hour Holter Monitoring. Int J Res Med Sci 2016; 4: 702–705. [Journal]
Mehra R, Chung MK, Olshansky B, et al. Sleep-Disordered Breathing and Cardiac Arrhythmias in Adults: Mechanistic Insights and Clinical Implications: A Scientific Statement from the American Heart Association. Circulation 2022; 146: e119–e136. [PubMed]
Park JH, Jegal Y, Shim TS, et al. Hypoxemia and Arrhythmia during Daily Activities and Six-Minute Walk Test in Fibrotic Interstitial Lung Diseases. J Korean Med Sci 2011; 26: 372–378. [PubMed]
Xu X, Wang Z, Yang J, et al. Burden of Cardiac Arrhythmias in Patients with Acute Myocardial Infarction and Their Impact on Hospitalization Outcomes: Insights from China Acute Myocardial Infarction (CAMI) Registry. BMC Cardiovasc Disord 2024; 24: 218. [PubMed]
Verma P, Jain M, Sharma A, et al. Electrolyte Disturbances in Acute Exacerbation of Chronic Obstructive Pulmonary Disease at SMS Medical College, Jaipur. Glob J Res Anal 2023; 31–33. [Journal]
Can Ç, Gulacti U, Kurtoglu E, et al. The Relationship between Serum Sodium Concentration and Atrial Fibrillation among Adult Patients in Emergency Department Settings. EurAsian J Biosci 2014; 13: 131–134. [Journal]
Mandai S, Kanda E, Iimori S, et al. Association of Serum Chloride Level with Mortality and Cardiovascular Events in Chronic Kidney Disease: The CKD-ROUTE Study. Clin Exp Nephrol 2017; 21: 104–111. [PubMed]
Xu J, Zeng Q, Li S, et al. Inflammation Mechanism and Research Progress of COPD. Front Immunol 2024; 15: 1404615. [PubMed]
Turner D, Kang C, Mesirca P, et al. Electrophysiological and Molecular Mechanisms of Sinoatrial Node Mechanosensitivity. Front Cardiovasc Med 2021; 8: 662410. [PubMed]
Copyright (c) 2025 Achmad Gozali, Muhammad Bimo Adi Wicaksono, Faisal Yunus, Ratnawati Ratnawati, Muhammad Abbas Basalamah, Bagus Radityo Amien

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
1. The journal allows the author to hold the copyright of the article without restrictions.
2. The journal allows the author(s) to retain publishing rights without restrictions.
3. The legal formal aspect of journal publication accessibility refers to Creative Commons Attribution Share-Alike (CC BY-SA).
4. The Creative Commons Attribution Share-Alike (CC BY-SA) license allows re-distribution and re-use of a licensed work on the conditions that the creator is appropriately credited and that any derivative work is made available under "the same, similar or a compatible license”. Other than the conditions mentioned above, the editorial board is not responsible for copyright violation.