Holter-Detected Arrhythmias in Acute Exacerbations of COPD: NT-proBNP Correlates and Hypercapnia Associated with COPD-Related Readmission
TL;DR
NT-proBNP is consistently associated with multiple arrhythmia phenotypes and may aid arrhythmic risk stratification andHypercapnia, but not arrhythmia status, remained independently associated with COPD-related readmission despite the limited sample and observational design.
Abstract
Background Cardiac arrhythmias are increasingly recognized during acute exacerbations of chronic obstructive pulmonary disease (AECOPD), but their full spectrum and prognostic significance detected by continuous Holter monitoring remain insufficiently characterized. Methods We conducted a single-center retrospective cohort study of patients hospitalized for AECOPD between April 2022 and January 2025 who underwent continuous Holter monitoring. Arrhythmias were classified as atrial arrhythmias (AA), atrial fibrillation/flutter (AF/AFL), ventricular arrhythmias (VA), or coexistence of ≥2 arrhythmia types. Multivariable regression models were used to identify factors associated with arrhythmias and clinical outcomes. COPD-related readmission was assessed using Kaplan–Meier and Cox regression analyses. Results Among 548 patients, 60.4% experienced at least one arrhythmia during hospitalization. AA (37.6%) was the most frequent subtype, followed by VA (31.0%) and AF/AFL (12.2%), while 21.5% exhibited multiple arrhythmia types. Older age, male sex, higher heart rate, elevated NT-proBNP, and larger left atrial diameter were independently associated with in-hospital arrhythmias. NT-proBNP was consistently associated with all arrhythmia phenotypes and demonstrated moderate discrimination for arrhythmia identification (AUC=0.730; cutoff, 131.5 pg/mL). AF/AFL was independently associated with prolonged hospitalization (adjusted ratio=1.26, P=0.010). After accounting for the time-dependent effect of age, hypercapnia (PaCO2 ≥45 mmHg) remained associated with a higher risk of COPD-related readmission (adjusted HR=1.85, 95% CI 1.19–2.88; P=0.007). Conclusion In-hospital arrhythmias are highly prevalent among patients hospitalized for AECOPD. NT-proBNP is consistently associated with multiple arrhythmia phenotypes and may aid arrhythmic risk stratification. Hypercapnia, but not arrhythmia status, remained independently associated with COPD-related readmission despite the limited sample and observational design.