Extended Wearable ECG Monitoring Detects Unrecognised Arrhythmias After COPD Exacerbation: The PRECURSOR Pilot Study

BACKGROUND: The period after hospitalisation for an acute exacerbation of chronic obstructive pulmonary disease (COPD) is associated with cardiovascular vulnerability. Clinically important rhythm disturbances may be intermittent or asymptomatic and escape routine postdischarge assessment; however, the diagnostic yield of prolonged monitoring is intrinsically influenced by monitoring duration. METHODS: In this prospective, single-centre observational pilot, 18 adults recently hospitalised for COPD exacerbation underwent continuous remote monitoring for 21 days between September 2019 and February 2020. The three-lead ZENSOR wearable recorded electrocardiographic rhythm, heart rate and respiratory rate and transmitted full-disclosure data and predefined alerts for clinician review. The primary outcome was participant-level detection of previously unrecognised, cardiologist-confirmed arrhythmias warranting therapeutic evaluation or intervention. Outcomes were analysed descriptively with exact 95% binomial confidence intervals. RESULTS: Participants were predominantly male (15/18; 83.3%), with a mean age of 73 ± 6 years. Seven had GOLD grade 3-4 airflow limitation, seven received long-term oxygen therapy, five had coronary artery disease and four had chronic atrial fibrillation. During the planned 21-day monitoring period, previously unrecognized clinically actionable arrhythmias were detected in 9/18 participants (50.0%; 95% CI: 26.0-74.0). Nonmutually exclusive findings included trigeminy (2/18), third-degree atrioventricular block (2/18), bradycardia (5/18), newly detected atrial fibrillation (1/18), supraventricular tachycardia (2/18) and nocturnal atrial or ventricular ectopy (8/18). Sixteen participants (88.9%; 95% CI: 65.3-98.6) reported satisfaction with monitoring. CONCLUSIONS: Extended wearable electrocardiographic monitoring produced a high participant-level detection yield of previously unrecognised arrhythmias during early recovery from hospitalised COPD exacerbation. This finding supports targeted postdischarge rhythm surveillance but does not distinguish biological post-exacerbation vulnerability from the greater ascertainment achieved by prolonged monitoring. Confirmation requires larger controlled studies with comprehensive cardiopulmonary phenotyping, standardised monitoring-performance metrics and comparative clinical outcomes.