Coronary Arterial Disease and Arrhythmias in Chronic Obstructive Pulmonary Disease

Abstract

We would agree with Kachel that coronary arterial disease probably is an etiologic factor of arrhythmias in some patients with chronic obstructive pulmonary disease (COPD). Certainly, the coexistence of clear-cut coronary arterial disease with COPD would seem to heighten the likelihood of arrhythmias, since poor left ventricular function is present in such patients. 1 Steele P Ellis Jr., JH Van Dyke D et al. Left ventricular ejection fraction in severe chronic obstructive airways disease. Am J Med. 1975; 59: 21-28 Abstract Full Text PDF PubMed Scopus (63) Google Scholar Unfortunately, there are no data relating arrhythmias in patients with COPD to a careful evaluation of their coronary arteries. In our published experience, serious arrhythmias occurred commonly in patients with advanced COPD but without clinical evidence of coronary arterial disease. 2 Kleiger RE Senior RM Longterm electrocardiographic monitoring of ambulatory patients with chronic airway obstruction. Chest. 1974; 65: 483-487 Crossref PubMed Scopus (73) Google Scholar This is noteworthy, since in the majority of the patients with poor left ventricular function and coronary arterial disease at autopsy in the study of Steele et al, 1 Steele P Ellis Jr., JH Van Dyke D et al. Left ventricular ejection fraction in severe chronic obstructive airways disease. Am J Med. 1975; 59: 21-28 Abstract Full Text PDF PubMed Scopus (63) Google Scholar the diagnosis of coronary arterial disease was clinically evident. It would appear that in patients with COPD, the prevalence of arrhythmias exceeds the prevalence of advanced coronary arterial disease (the latter incidence being about 25 percent), 3 Murphy ML Adamson J Hutcheson F Left ventricular hypertrophy in patients with chronic bronchitis and emphysema. Ann Intern Med. 1974; 81: 307-313 Crossref PubMed Scopus (48) Google Scholar so that, as we suggested, factors other than coronary arterial disease probably have a more important role in most patients; however, clearly, this entire issue requires study, since, as Kachel points out, the results may have therapeutic importance.