most common arrhythmia in copd

Drs. Anesthesia is associated with cardiac arrhythmias for several reasons, including : 22. Consequently, a high mortality rate (ie, up to 45%) is associated with this arrhythmia, although it is not a direct consequence of the rhythm abnormality. Patients treated with placebo used more rescue drugs during the 24-hour Holter period than those treated with LABAs, although overall beta-agonist exposure was likely greater in patients in the active treatment groups. Abstract. Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study. These trials consisted of more than 1400 patients who had more than 5000 24-hour Holter recordings. Baumgartner RA, Hanania NA, Calhoun WJ, Sahn SA, Sciarappa K, Hanrahan JP. We use cookies to help provide and enhance our service and tailor content and ads. 1, 2 Globally, COPD is projected to rise from the sixth leading cause of death in 1990 to the third most common cause of death in 2020. Chronic obstructive pulmonary disease (COPD) is one of the most important comorbidities of CVD, which causes serious consequences in patients with ischemic heart disease, stroke, arrhythmia, and heart failure. Severe exacerbations are related to a significantly worse survival outcome. Hanrahan, John P. MD, MPH; Grogan, Donna R. MD; Baumgartner, Rudolf A. MD; Wilson, Amy PhD; Cheng, Hailong MS; Zimetbaum, Peter J. MD; Morganroth, Joel MD. 3–6 CVD comorbidity is not limited to … The institutional review boards at each study site approved each protocol, and written informed consent was obtained from all participants. Nevertheless, use of inhaled short-acting beta2-agonists may have affected the occurrence of arrhythmias observed in all groups, especially the placebo group. 14. MacNee W, Calverley PM. People who have all stages of … Both were assessed by the investigator as unrelated to treatment. The commonest arrhythmia was ventricular premature beats (VPB) – 88.8%, followed by supraventricular premature beats (SPB) – 56.5%. Dr. Morganroth is a consultant for many pharmaceutical companies, including Sepracor Inc., and is an employee and officer of eResearch Technology Inc., Philadelphia, PA. Trial registration numbers: NCT00064402 and NCT00064415. For information on cookies and how you can disable them visit our Privacy and Cookie Policy. Wolters Kluwer Health However, as noted above, patients who were not randomized in these clinical trials may not have had the same degree of preexisting arrhythmia risk as those who were randomized and received study drug. Dr. Hanrahan is currently at Pulmatrix, Lexington, MA. Sin DD, Man SF. Several limitations of these trials should be considered in the interpretation of these results. Modest but consistent mean decreases in heart rate over baseline (both on a 24-hour basis and that associated with the individual patient's maximum single hourly mean heart rate) were observed in both the LABA and placebo groups. Patients were required to meet several inclusion criteria, including the following: aged 35 years or older; primary clinical COPD diagnosis; baseline FEV1 of ≤65% of predicted and >0.70 L; FEV1/forced vital capacity (FVC) ratio ≤70%; ≥15 pack-year smoking history; and breathlessness severity from the Medical Research Council dyspnea scale of ≥23. [email protected]. In this study, we attempted to non-invasively verify these hypotheses in hypoxaemic COPD patients that are not in respiratory failure by examining how PaO2, PaCO2, pH and HCO3 correlate with QTd in those patients. Based on these interpretations, 2 board-certified internal medicine physicians at Sepracor Inc. retrospectively, but independently and blinded to treatment, categorized each overread Holter into 4 major arrhythmia categories: atrial tachycardia (≥4 beat run), atrial fibrillation/flutter, "nonsustained"; ventricular tachycardia (4-10 beat run), and "sustained"; ventricular tachycardia (>10 beat run). Ventricular tachycardia occurs when the ventricles start pounding away at up to 200 bpm—a disruption that can cause dizziness and breathlessness. When asked specifically, she says her dyspnea gets worse with exertion, but she feels “almost normal” when sitting down. 9. Few studies have had an adequate number of patients and sufficient duration of monitoring to characterize the occurrence of transient and infrequent arrhythmias such as atrial fibrillation and ventricular tachycardia. Mortality in COPD: role of comorbidities. Inhaled beta-agonists are among the first treatment options for the management of COPD. Chronic obstructive pulmonary disease (COPD) is a progressive condition that makes it hard to breathe. Albuterol metered dose inhaler (Ventolin inhalation aerosol, GlaxoSmithKline, Research Triangle Park, NC) and ipratropium metered dose inhaler (Atrovent inhalation aerosol, Boehringer Ingelheim, Ridgefield, CT) were provided as rescue and supplemental medications for COPD, respectively. The availability of arrhythmia prevalence data derived from ambulatory heart rate monitoring in a large cohort of healthy elderly patients is surprisingly sparse, although several smaller studies have been published11,13,17. Mannino DM, Homa DM, Akinbami LJ, Ford ES, Redd SC. Sin DD, Anthonisen NR, Soriano JB, Agusti AG. The purpose of this investigation was to 1) describe the background occurrence frequency of 4 arrhythmias (atrial tachycardia, atrial fibrillation/flutter, "nonsustained"; ventricular tachycardia, and "sustained"; ventricular tachycardia) in these trials; and 2) assess whether LABA treatment resulted in any change in heart rate or in the occurrence of these arrhythmias. Medical history conditions were coded using terms from the Medical Dictionary for Regulatory Activities version 9.1 (MedDRA) summarized by system organ class, high level group term, high level term, and preferred term. Cardiac arrhythmias are quite common in people who are undergoing general anesthesia. The prevalence of these arrhythmias was similar to that previously reported in healthy elderly populations, with the possible exception of atrial fibrillation, which was less frequently observed than in prior reports. Patterns of comorbidities in newly diagnosed COPD and asthma in primary care. More serious arrhythmias were infrequent and did not increase with inhaled LABA therapy. Patients taking beta-blockers were also excluded. 18. Atrial fibrillation, also known as AFib, is the most common heart rhythm disorder (arrhythmia). Abbreviations: bpm = beats per minute, CI = confidence interval, COPD = chronic obstructive pulmonary disease, FEV1 = forced expiratory volume in 1 second, FVC = forced vital capacity, ITT = intent-to-treat, LABA = long-acting beta2-agonist, MedDRA = Medical Dictionary for Regulatory Activities. 1 This can lead to blood clots and stroke. 26. 1-2 It occurs when the atria, the two upper chambers of the heart, beat very fast in a disorganized way. The 2 trials were identically designed Phase III multicenter randomized trials. In terms of diagnosed cases, this makes COPD the second most common lung disease in the UK, after asthma. Because the study designs, patient populations, safety, and efficacy endpoints in each trial were identical, the data were combined to provide more stable estimates of infrequent arrhythmia events, such as atrial fibrillation and ventricular tachycardia, than either trial analyzed separately. Atrial fibrillation (AF) is one of the most common arrhythmias and causes substantial morbidity and mortality. Some error has occurred while processing your request. Hanrahan, Grogan, Baumgartner, Wilson, and Mr. Cheng were full-time employees of Sepracor Inc. when the study was conducted. It is important to note that patients with COPD who participated in the current trials may have been less prone to arrhythmia than COPD patients in general, with similar arrhythmia risk as "healthy"; elderly individuals. 25 COPD patients were subjected for Standard 12-lead ECG for arrhythmia detection and the measurement of QT intervals, chest X-ray, two dimensional echocardiography and myocardial nuclear imaging to exclude IHD. 30. Baseline was calculated from the 24-hour Holter records obtained at the start of the placebo run-in period 2 weeks before study drug administration. A total of 1829 patients met eligibility at the screening visit and received single-blind placebo; 364 patients were not randomized, 329 of whom had a baseline Holter assessment (nonrandomized patients). The rates of serious cardiovascular events (0.7%-1.4%) were similar in the LABA and placebo groups, but the proportion of patients who discontinued due to cardiovascular adverse events was slightly higher in those with LABA treatment (3.8%) compared to those with placebo (1.7%; p = 0.101). 800-638-3030 (within USA), 301-223-2300 (international). to maintaining your privacy and will not share your personal information without Of the 1465 randomized patients, 1456 took at least 1 dose of double-blind study medication (ITT patients) and 1429 had a baseline Holter assessment. 11. Data is temporarily unavailable. In conclusion, the current study describes the occurrence frequency of 24-hour Holter-assessed arrhythmias in a large cohort of patients with moderate to severe COPD with no or stable cardiac comorbidities and the impact of LABA treatment on these arrhythmias. 7. With respect to more serious arrhythmias, the proportion of patients with nonsustained ventricular tachycardia was small, with no evidence of a dose response for arformoterol. Published by Wolters Kluwer Health, Inc. Exacerbation of COPD was diagnosed in 152 patients and the prevalence of arrhythmias in this group of patients was 97%. The first relates to the composition of the COPD study cohort. In stable COPD patients enrolled in our study, new cutoff levels for predicting arrhythmic fatality were proposed for the QTc parameter (395 ms with a sensitivity of 92% and a specificity of 83%) and the QTd parameter (58 ms with a sensitivity of 100% and a specificity of 92%). Inhaled formoterol dry powder versus ipratropium bromide in chronic obstructive pulmonary disease. Registered users can save articles, searches, and manage email alerts. They also observed that nonsustained ventricular tachycardia among these healthy elderly was associated with a higher relative risk of subsequent death (RR, 2.8; 95% CI, 1.2-6.4). The potential contributing factors, occurrence rates, and management … Recent estimates are that more than 12 million adults are currently diagnosed with COPD, and that the actual prevalence may be more than double that number23. The only cardiac exclusions were patients with clinically significant abnormal electrocardiograms at screening, or clinically significant cardiac disorders that in the opinion of the investigator would have interfered with the patient's ability to complete the study. While increases in the number of patients with atrial fibrillation/flutter were observed with increasing doses of arformoterol, only a small proportion of patients was affected in each treatment group (0.3%-1.4%). Nebulized arformoterol in patients with COPD: a 12-week, multicenter, randomized, double-blind, double-dummy, placebo- and active-controlled trial. Ferguson GT, Funck-Brentano C, Fischer T, Darken P, Reisner C. Cardiovascular safety of salmeterol in COPD. While most of these arrhythmias are benign and easily managed, some can become dangerous and difficult to treat. 4. Unexpectedly, that study also reported a similar proportion of patients with comorbidities as those in the current COPD cohort. Inhaled bronchodilators are an essential element of the pharmacologic management of COPD. The effect of inhaled long-acting beta2-agonists (LABAs) on these outcomes was evaluated in patients with chronic obstructive pulmonary disease (COPD) in 2 double-blind randomized clinical trials. Huiart L, Ernst P, Suissa S. Cardiovascular morbidity and mortality in COPD. While no statistically significant differences were observed (p > 0.71), the proportion of patients with episodes of atrial tachycardia not present at baseline was slightly higher in the LABA groups than in the placebo group (by ∼2%-5%). Each Holter record was interpreted in a blinded fashion by cardiologists at a central electrocardiogram laboratory (SpaceLabs Medical Data, Issaquah, WA). The 24-hour Holter monitoring was performed pretreatment and at Weeks 0 (first day of dosing), 6, and 12. Atrial tachycardia was present in a large proportion of these patients, but the cumulative frequency of more serious arrhythmias was low. 3. The primary cause of COPD is tobacco smoke (including second­hand or passive exposure). Patients may have had more than 1 of these abnormalities during any 24-hour Holter monitoring period. 2. These arrhythmias are not responsible for dramatic events such as sudden cardiac death, but the most common arrhythmia, atrial fibrillation, is supraventricular and … 29. Exacerbation of COPD was diagnosed in 152 patients and the prevalence of arrhythmias in this group of patients was 97%. By continuing to use this website you are giving consent to cookies being used. COPD is associated with many comorbidities [ 2 , 3 ] ( figure 1 ) and can be one of multiple chronic or acute diseases and medical conditions present within one person [ 4 ]. Chronic obstructive pulmonary disease. Whether these results imply that arrhythmia risk is related more to underlying comorbidities than to airway function compromise is not known. From Sepracor Inc. (JPH, DRG, RAB, AW, HC), Marlborough, Massachusetts; Beth Israel Deaconess Medical Center (PJZ), Harvard Medical School, Boston, Massachusetts; University of Pennsylvania School of Medicine (JM) and eResearch Technology, Inc. (JM), Philadelphia, Pennsylvania. By continuing you agree to the use of cookies. Finally, the initial Holter interpretations did not a priori place arrhythmias into the categories described in this report. While COPD is a mainly chronic disease, a substantial number of patients suffer from exacerbations. In fact, the 3 more serious arrhythmia categories (afibrillation/flutter, nonsustained ventricular tachycardia, and >10 beat ventricular tachycardia) did occur in a significantly greater proportion of patients who did not receive study drug when compared to those who did. It is unclear whether these comorbidities are due to the disease itself27,28, its associated risk factors8,26,31, or its treatment24. Heeringa J, van der Kuip DA, Hofman A, Kors JA, van HG, Stricker BH, Stijnen T, Lip GY, Witteman JC. We assessed the proportion of patients with each of 4 arrhythmias: atrial tachycardia, atrial fibrillation/flutter, and "nonsustained"; (4-10 beats) and "sustained"; (>10 beats) ventricular tachycardia. The observation that more patients who discontinued participation before being randomized had arrhythmias than those who were given study drug may support this interpretation. 21 However, neither the … Mahler DA, Donohue JF, Barbee RA, Goldman MD, Gross NJ, Wisniewski ME, Yancey SW, Zakes BA, Rickard KA, Anderson WH. Rabe KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P, Fukuchi Y, Jenkins C, Rodriguez-Roisin R, van WC, Zielinski J. They were double-blind, double-dummy, placebo- and active-controlled, parallel-group, 12-week multiple-dose clinical trials. It's caused by long-term exposure to irritating gases or particulate matter, most often from cigarette smoke. Cardiac contractions protocol, and written informed consent was obtained from all participants the groups... 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