Introduction: Patients with chronic obstructive pul-monary disease (COPD) have an increased cardiovas-cular risk, the main comorbidities being ischemic heart disease, rhythm and conduction disturbances, and heart failure, all leading to increased mortality among this population. Physical exercise training is a core element in pulmonary rehabilitation, heart rate and rhythm monitoring being very important in supervi-sing it.
Objective: To identify electrocardiographic changes of arrhythmic type and conduction disorders in patients with chronic obstructive pulmonary disease (COPD) prior to the initiation of the respiratory rehabilitation program, as part of the initial assessment of the chronic respiratory patients.
Methods: The study included patients diagnosed with COPD consecutively admitted in the Clinical Depart-ment of Respiratory Rehabilitation Iasi to undergo a pulmonary rehabilitation program, between January and December 2017. All patients had a 12-lead electro-cardiogram (ECG), and multiple pulmonary function tests (spirometry, 6-minute walking test, dyspnea sca-les) as part of their initial assessment. Electrocardiogra-phic data were analyzed in the context of demographic and anthropometric parameters, pulmonary function tests, and severity of the chronic pulmonary disease. Subsequently, patients with COPD and electrocardio-graphic changes were compared with those with nor-mal resting ECG. The descriptive and comparative sta-tistical analysis was done using Microsoft Excel 2010.
Results: The study included 124 patients, 69.35% men and 30.65% women, mean age 68.13±10.4 years and mean body mass index of 27.29±6.56 kg/m². Patients with COPD stage II represented the majority of cases (33.87%). The analysis of the usual ECG parameters demonstrated an average heart rate of 76±12 bpm, mean QRS complex duration of 95.95±17.96 msec, and mean QTc interval of 429.03±31.54 msec. Ar-rhythmias and conduction disorders were identified in 53.22% patients, the most common being right bundle branch block (15.32%), atrial fibrillation (9.67%), pre-mature ventricular beats (9.67%), left bundle branch block (4.83%), and first-degree atrioventricular block (4.03%). In male patients, atrial fibrillation, RBBB, and first-degree AV block were more frequent while pre-mature ventricular beats predominated in women. Pa-tients with COPD and arrhythmic changes are signifi-cantly older (74±10.9 vs. 67.4±10.1, p<0.05), with more severe bronchial obstruction (FEV1 46.4±17, 4% vs. 60.7±27.5%, p<0.05), and more pronounced dyspnea (p<0.01). There were no significant correlations betwe-en electrocardiographic changes and pulmonary func-tion tests.
Conclusions: The comprehensive approach of the pa-tients with chronic respiratory disease prior to inclusi-on in a pulmonary rehabilitation program involves the identification of clinically manifested cardiovascular comorbidities and careful analysis of the resting elec-trocardiogram that provides important information on rhythm and conduction disorders with implications in pharmacological treatment as well as supervision of the physical training heart rate and rhythm in this diseased population.