Pro-arrhythmic and pro-ischaemic effects of inhaled anticholinergic medications

http://thorax.bmj.com/content/68/1/114.full?utm_content=HT_A6&utm_medium=Link6&utm_medium=email&utm_campaign=ATS&utm_campaign=Thorax_ATS&utm_source=landingpage&utm_source=marketing_email&keytype=ref&siteid=bmjjournals&utm_term=&ijkey=rx9mxHs129chk

Conclusions

The inhaled anticholinergic agents ipratropium and tiotropium have the potential to increase the risk of serious cardiovascular events, including mortality, when used in the treatment of COPD. 

The authors urge caution in prescribing inhaled anticholinergics for patients with pre-existing arrhythmias or cardiac disorders.