What is the classic arrhythmia associated with COPD?

• A. Atrial fibrillation
• B. Sinus tachycardia
• C. Multifocal atrial tachycardia
• D. Ventricular tachycardia

Answer: (C)

In COPD, the classic arrhythmia is multifocal atrial tachycardia. It presents with an irregular rhythm and a rate typically over 100, but what sets it apart are at least three different P-wave morphologies with varying PR intervals, reflecting multiple atrial foci firing simultaneously. This pattern arises because COPD can cause atrial enlargement, right atrial strain, hypoxemia, and increased atrial automaticity, especially during exacerbations, leading to several sites in the atria taking over pacing.

This differs from other common choices. Atrial fibrillation also occurs in COPD, but it karakteristically shows an irregularly irregular rhythm with no distinct, consistent P waves and chaotic baseline activity rather than the clear but changing P-wave shapes seen in multifocal atrial tachycardia. Sinus tachycardia is a regular rhythm with a single, upright P-wave morphology and a consistent PR interval, even when the rate is elevated. Ventricular tachycardia is a wide-complex tachycardia that arises from the ventricles and typically has no organized P waves at all.

Management centers on treating the underlying COPD and improving oxygenation, with careful rate control as needed and addressing any electrolyte disturbances.