Background ST-segment elevation myocardial infarction (STEMI) and cardiac arrhythmias frequently occur in patients with chronic obstructive pulmonary disease (COPD). However, little is known about the association of COPD with the occurrence of atrial arrhythmias after STEMI. Methods This retrospective analysis consisted of 320 patients with first STEMI without a history of atrial arrhythmias, with available 24-hour holter-ECG at 3- and/or 6 months follow-up. In total, 80 COPD patients were compared with 240 non-COPD patients, matched by age and gender (mean age 67±10 years, 74% male). Atrial arrhythmias were defined as: atrial fibrillation/flutter, atrial tachycardia (≥3 consecutive premature atrial contractions (PAC’s)) and excessive supraventricular ectopy activity (ESVEA, ≥30 PAC’s/hour or runs of ≥20 PAC’s). Results Baseline characteristics were similar among COPD and non-COPD patients regarding infarct location, β-blocker use and cardiovascular risk profile except for smoking (69% vs. 49%, respectively, p=0.002). Additionally, atrial volumes, LVEF and TAPSE were comparable. During 1 year follow-up, a significantly higher prevalence of atrial tachycardia and ESVEA was observed in patients with COPD as compared to non-COPD patients (70% vs. 46%; p<0.001 and 21% vs. 11%; p=0.024, respectively). In multivariate analysis, COPD was independently associated with the occurrence of atrial arrhythmias (combined) during 1 year of follow-up (HR 3.59, 95% CI 1.78-7.22; p<0.001). Conclusion COPD patients after STEMI have a significantly higher prevalence of atrial tachycardia and ESVEA within 1 year follow-up as compared to age- and gender matched patients without COPD. Moreover, COPD is independently associated with an increased prevalence of atrial arrhythmias after STEMI.