0
Correspondence |

Arrhythmias in COPDArrhythmias in COPD: Consider P-Wave Dispersion and Pulmonary Hypertension, Too FREE TO VIEW

Andrew R. L. Medford, MBChB, MD, FCCP
Author and Funding Information

From the North Bristol NHS Trust Lung Centre, Southmead Hospital.

Correspondence to: Andrew R. L. Medford, MBChB, MD, FCCP, North Bristol NHS Trust Lung Centre, Southmead Hospital, Southmead Rd, Westbury-on-Trym, Bristol, BS10 5NB, England; e-mail: andrewmedford@hotmail.com


Financial/nonfinancial disclosures: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(2):579. doi:10.1378/chest.12-2199
Text Size: A A A
Published online
To the Editor:

In a recent issue of CHEST (August 2012), Wilchesky et al1 noted an increase in cardiac arrhythmias in patients with COPD and concluded that these were due to long-acting bronchodilator therapy after adjusting for known confounding factors. However, two other potential contributory factors should be considered before attributing the observations to bronchodilators alone.

First, secondary pulmonary hypertension attributable to COPD or other lung disease can affect right atrial function without causing gross enlargement in the early stages leading to secondary atrial dysfunction and consequent atrial arrhythmias. Indeed, recent data suggest that pulmonary hypertension alone in COPD is associated with increased COPD exacerbations, and one wonders whether this is partly explained by an increase in cardiac arrhythmias.2 Was secondary pulmonary hypertension (without necessarily right atrial or ventricular enlargement) included in the comorbidity criteria of congestive heart failure and cardiac enlargement and, hence, adjusted for in the analysis?

Second, P-wave dispersion (reflecting heterogeneous atrial depolarization) has been reported to predispose to the development of atrial arrhythmias (especially atrial fibrillation) in COPD (as well as in other scenarios, eg, hypertension or postoperatively after coronary artery bypass graft) independent of lung function, blood gas and electrolyte levels, and atrial function.3 Was this variable measured and accounted for in the study?

References

Wilchesky M, Ernst P, Brophy JM, Platt RW, Suissa S Bronchodilator use and the risk of arrhythmia in COPD: part 1: Saskatchewan Cohort Study. Chest. 2012;142(2):298-304. [CrossRef] [PubMed]
 
Wells JM, Washko GR, Han MK, et al; COPDGene Investigators; ECLIPSE Study Investigators. Pulmonary arterial enlargement and acute exacerbations of COPD. N Engl J Med. 2012;367(10):913-921. [CrossRef] [PubMed]
 
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(3):222-227. [CrossRef] [PubMed]
 

Figures

Tables

References

Wilchesky M, Ernst P, Brophy JM, Platt RW, Suissa S Bronchodilator use and the risk of arrhythmia in COPD: part 1: Saskatchewan Cohort Study. Chest. 2012;142(2):298-304. [CrossRef] [PubMed]
 
Wells JM, Washko GR, Han MK, et al; COPDGene Investigators; ECLIPSE Study Investigators. Pulmonary arterial enlargement and acute exacerbations of COPD. N Engl J Med. 2012;367(10):913-921. [CrossRef] [PubMed]
 
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(3):222-227. [CrossRef] [PubMed]
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543