title: Deceleration and Acceleration Capacities in Risk Stratification for Arrhythmias in Patients With Chronic Obstructive Pulmonary Disease.
abstract: BACKGROUND
  Patients with chronic obstructive pulmonary disease (COPD) have an increased risk for both supraventricular and ventricular arrhythmias. Autonomic dysregulation may be responsible for the development of arrhythmias in these patients, and its analysis could be useful for identifying those at high risk for arrhythmias.
  
  
  OBJECTIVE
  Our purpose is to analyze the role of acceleration capacity (AC) and deceleration capacity (DC), novel markers of the autonomic balance, as potential arrhythmic risk predictors in patients with COPD.
  
  
  METHODS
  We prospectively included 47 patients diagnosed with COPD, and a control group of 64 age-matched subjects without COPD. AC and DC values were obtained using 24-hour Holter monitoring. The arrhythmias were isolated premature atrial complexes, supraventricular tachycardias, isolated premature ventricular beats (PVC), and combined ventricular arrhythmias consisting in ventricular tachycardias or more than 10 PVC per hour.
  
  
  RESULTS
  Supraventricular arrhythmias and isolated PVC were more frequent in the COPD group. The DC was significantly lower (3.10 vs. 5.60, P < 0.0001) and AC higher (-4.60 vs. -6.60, P = 0.002) in patients with COPD. DC was identified as a predictor of arrhythmic events with an area under the curve (AUC) for premature atrial complexes >70/d of 0.72 (0.56-0.87, P = 0.013), for supraventricular tachycardias 0.76 (0.62-0.90, P = 0.002), and for combined ventricular arrhythmias 0.69 (0.54-0.82, P = 0.025). AC was predictor only for combined ventricular arrhythmias with an AUC of 0.74 (0.58-0.85, P = 0.002).
  
  
  CONCLUSIONS
  Patients with COPD associate a significant autonomic imbalance and a higher incidence of arrhythmias. DC could be a strong predictor for supraventricular and ventricular arrhythmias in patients with COPD with no clinically apparent cardiac disease. AC could be useful alongside with DC regarding the risk for ventricular arrhythmias, but seems to have lesser value as a predictor for supraventricular arrhythmias.
authors.affiliation: 1University of Medicine and Pharmacy "Carol Davila," Internal Medicine Department, Bucharest, Romania; and 2Clinical Hospital Colentina, Bucharest, Romania.
authors.forename: Catalin A
authors.initials: CA
authors.lastname: Buzea
authors.forename: Gheorghe A
authors.initials: GA
authors.lastname: Dan
authors.forename: Anca R
authors.initials: AR
authors.lastname: Dan
authors.forename: Caterina
authors.initials: C
authors.lastname: Delcea
authors.forename: Marius I
authors.initials: MI
authors.lastname: Balea
authors.forename: Daniela
authors.initials: D
authors.lastname: Gologanu
authors.forename: Raluca A
authors.initials: RA
authors.lastname: Popescu
authors.forename: Mihaela
authors.initials: M
authors.lastname: Dobranici
mesh_terms: D000054:Acceleration; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000453:epidemiology* / Q000503:physiopathology; D018880:Atrial Premature Complexes / Q000453:epidemiology / Q000503:physiopathology; D001342:Autonomic Nervous System Diseases / Q000453:epidemiology* / Q000503:physiopathology; D016022:Case-Control Studies; D015897:Comorbidity; D003654:Deceleration; D015716:Electrocardiography, Ambulatory; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology* / Q000503:physiopathology; D018570:Risk Assessment; D013617:Tachycardia, Supraventricular / Q000453:epidemiology / Q000503:physiopathology; D017180:Tachycardia, Ventricular / Q000453:epidemiology / Q000503:physiopathology; D018879:Ventricular Premature Complexes / Q000453:epidemiology / Q000503:physiopathology; D014797:Vital Capacity