Nan Ding,1,2,* Weida Qiu,1,* Jinmin Chen,1 Kaihao Wang,1 Zeyue Chen,1 Ruli Cai,1 Ailan Chen1 

1Department of Cardiovascular Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China; 2Center of Cardiovascular Diseases, The Fifth Affiliated Hospital, Sun Yat-sen University, Zhuhai, Guangdong, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Ailan Chen, Department of Cardiovascular Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, People’s Republic of China, Email 1228327958@qq.com

Background: Cardiac arrhythmias are commonly seen in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD), but their prevalence, risk factors, and prognostic significance are still not fully understood.
Objective: To estimate the prevalence of arrhythmias in patients with AECOPD, identify related clinical factors, and assess their influence on in-hospital mortality.
Methods: A systematic search of PubMed, Embase, Web of Science, CENTRAL, and Cochrane Reviews was conducted to identify observational studies and randomized controlled trials. A random-effects meta-analysis using the DerSimonian–Laird method was performed. Subgroup and sensitivity analyses were conducted to explore heterogeneity, and publication bias was assessed using Egger’s and Begg’s tests.
Results: Twenty-eight studies were included. The pooled prevalence of arrhythmias in AECOPD patients was 15% (95% CI: 12– 18%), with considerable heterogeneity (I² = 99.93%). Prevalence was higher in studies from developed countries, particularly those with larger sample sizes and older populations. Advanced age (WMD = 2.79 years) and elevated C-reactive protein levels (WMD = 5.32) were associated with increased arrhythmia risk. Use of long-acting beta-agonists (LABAs) was associated with a reduced risk (OR = 0.42), although the causal mechanism remains uncertain. Arrhythmias were significantly associated with increased in-hospital mortality (RR = 3.33, 95% CI: 3.27– 3.38). In a predefined subgroup analysis, atrial fibrillation (AF) was also linked to a higher risk of death (RR = 3.70, 95% CI: 2.40– 5.70). Sensitivity analyses confirmed the robustness of these findings, and no significant publication bias was detected.
Conclusion: Arrhythmias are common during AECOPD and are associated with increased short-term mortality, especially in patients with AF. Aging and systemic inflammation appear to be key contributors. While LABA use may have a protective association, this finding requires cautious interpretation. Standardized ECG monitoring and individualized risk stratification are warranted to improve patient outcomes.
Plain Language Summary: About 15% of patients hospitalized for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) develop abnormal heart rhythms (arrhythmias).Older age and higher levels of C-reactive protein (CRP), a marker of inflammation, are linked to an increased risk of arrhythmias.Patients who develop arrhythmias during AECOPD have a significantly higher risk of dying during hospitalization. Specifically, those with atrial fibrillation (AF) face nearly four times greater risk of in-hospital death compared to those without AF.These findings highlight the need for early identification, continuous heart monitoring, and personalized treatment strategies to reduce complications and improve outcomes for patients with AECOPD.

Keywords: chronic obstructive pulmonary disease, cardiac arrhythmias, hospital mortality, systematic review