Arrhythmias in Patients With Pulmonary Hypertension; A Narrative Review of the Current Literature

Abstract

Background Pulmonary hypertension (PH) is defined as an increase in the mean pulmonary pressure (mPAP) >25 mm Hg at rest and capillary wedge pressure (PCWP) <15 mm Hg in precapillary (group 1, 3-5) or >15 mm Hg in postcapillary (group 2) forms. 1 Proliferation of pulmonary artery smooth muscle and endothelial cells, endothelial dysfunction, inflammation and excessive vasoconstriction lead to arteriolar obstruction, elevated pulmonary arterial pressure, and increased pulmonary vascular resistance (PVR). 2,3 Increased PVR causes elevated afterload of the right ventricle and cardiac remodelling. 4 Elevated rightsided filling pressure and cardiac remodelling could provide the substrate or trigger for arrhythmias. 5,6 Several studies have evaluated the incidence of supraventricular and ventricular arrhythmias and their prognostical relevance in patients with PH. 7-15 It is already known that supraventricular arrhythmias are associated with clinical deterioration, but the incidence of sudden cardiac death was not elevated in these patients. 8,10,12,14,15 The incidence and clinical/prognostical relevance of non-sustained ventricular tachycardia was analyzed in only three studies. 16-18 2. Objective The aim of this review is to give an actual and comprehensive overview of the current literature with respect to incidence and clinical and prognostical relevance of arrhythmias in patients with PH. 3. Methods This review summarized the current evidence from the literature. Studies indexed (until 20/11/2017) in Medline and published in English or German that investigated patients in all PH groups (1-5) were considered. Medline searches included the following keywords: