Electrocardiographic markers of right heart strain and their association with arrhythmias in patients with COPD.

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is frequently associated with cardiovascular complications, including right heart dysfunction and cardiac arrhythmias. Chronic hypoxia and pulmonary vascular remodeling may lead to structural and electrical cardiac changes. Electrocardiography (ECG) may provide simple markers of right heart strain that could help identify COPD patients at increased arrhythmic risk.

OBJECTIVE

To evaluate the association between ECG markers of right heart strain and arrhythmias and to identify independent predictors using multivariable analysis.

METHODS

This cross-sectional observational study included 80 consecutive patients with confirmed COPD treated in a secondary healthcare center. All patients underwent standard 12‑lead ECG and 24-h Holter monitoring. COPD diagnosis and severity were defined according to GOLD criteria. Arrhythmias included atrial fibrillation, supraventricular tachycardia, premature ventricular contractions, and other clinically relevant rhythm disturbances. Patients were divided into two groups: with arrhythmias (n = 40) and without arrhythmias (n = 40). ECG parameters included P pulmonale, right axis deviation (RAD), right ventricular hypertrophy (RVH), T-wave inversion in V1-V3, low QRS voltage and right bundle branch block (RBBB). Multivariable logistic regression analysis was performed adjusting for age, sex, FEV₁, hypertension, diabetes, and cardiovascular risk factors.

RESULTS

ECG abnormalities were significantly more prevalent in patients with arrhythmias. P pulmonale was more frequent in the arrhythmia group (55% vs. 20%, p = 0.002), although analysis was restricted to patients in sinus rhythm. RAD (62.5% vs. 20%, p < 0.001), RVH (45% vs. 15%, p = 0.007), T-wave inversion (65% vs. 30%, p = 0.003), and RBBB (60% vs. 20%, p < 0.001) were significantly more common in patients with arrhythmias. Low QRS voltage did not differ significantly between groups (70% vs. 55%, p = 0.20). On multivariable analysis, P pulmonale (OR 3.2, 95% CI 1.3-7.8, p = 0.01) and RVH (OR 2.9, 95% CI 1.1-7.2, p = 0.03) were independent predictors of arrhythmias.

CONCLUSION

ECG markers of right heart strain, particularly P pulmonale and RVH, are independent predictors of arrhythmias in COPD patients. ECG may serve as a simple, non-invasive tool for early risk stratification and identification of patients who may benefit from closer rhythm monitoring. The relatively small sample size and single-centre design may limit the generalizability of the findings.