Theophylline and salbutamol in combination in patients with obstructive pulmonary disease and concurrent heart disease: effect on cardiac arrhythmias.

We compared the frequency and severity of cardiac arrhythmias during combined oral theophylline and inhaled salbutamol vs. salbutamol therapy alone in 18 patients with moderate to severe chronic obstructive pulmonary disease who had concurrent cardiac disease. Seventeen patients showed at least one supraventricular premature complex (SVPC) on the 24-h ECG recording when receiving salbutamol alone: eight patients had isolated SVPCs, less than 10/h; five patients had greater than or equal to 10 SVPCs/h; eight patients showed runs of supraventricular tachycardia or paroxysmal atrial fibrillation. Seventeen patients also had at least one ventricular premature complex: seven patients had less than 10 isolated PVCs/h, five patients greater than or equal to 10 PVCs/h; eight patients had paired or multifocal PVCs and one patient a run of ventricular tachycardia. The addition of oral theophylline at an average dose of 600 mg in the evening (blood concentrations showed a mean maximum of 13.4 +/- 4.0 (SD) and minimum of 5.5 +/- 2.9 mg/l) had no influence on the frequency or severity of either ventricular or supraventricular arrhythmias. Thus, cardiac arrhythmias are very common in patients with chronic obstructive pulmonary disease and concomitant heart disease, but oral theophylline added to a regimen of salbutamol does not seem to affect the occurrence or severity of arrhythmias.