Background: Electrocardiography (ECG) is a cheap widely available examination and its contribution in predicting mortality in patients with chronic obstructive pulmonary disease (COPD) is not well established.

Aim: The aim of the study was to evaluate the significance of ECG parameters in prediction of mortality in patients with COPD.

Methods: ECG parameters were analysed in patients enrolled in the Czech COPD registry - a non-interventional multicentre observational prospective database focusing on the collection and analysis of data on real mortality and morbidity in an unselected population of COPD patients (ClinicalTrials.gov NCT01923051). We analysed ECG parameters of subjects who died during follow up and those who survived from randomization until 31.12.2019. Cox proportional-hazards model was used for investigating the association between the survival time of patients and one or more predictor variables (ECG parameters).

Results: 300 patients with COPD were enrolled and 143 patients died during follow up. Patients were divided into three groups. Patients in group A with severe pathology on ECG (heart rate >90/min, QRS?120ms, P pulmonale, P mitrale, right ventricle hypertrophy or combination of these) had 3,7 times (p<0,001) higher mortality risk in five years than those with normal ECG (group B). Patients with other ECG abnormalities than mentioned above (group C) had 1,8 times higher risk of death in five years which was not statistically significant.

Conclusion: Severe electrocardiographic pathologies were associated with higher risk of death which makes electrocardiography a valuable tool in predicting mortality in patients with COPD.